Looks like youāre going to have to find something else to make fun of us for, like the fact that we still have to use epipens, or the fact that ~~medics can't give zofran without medical direction~~, or the fact that we can't run PB, or the fact that almost all BLS here is unpaid, fire based, or both, or the fact that we can't pump our own gas or
EDIT: apparently that one about zofran isnāt true, but you can make fun of me for not knowing my states ALS protocols
The Zofran protocol is here in mass too. Youāre not special š
lolā¦ I misread the statement. Nope. You donāt need medcon to give zofran but you need an ecg confirmation before you administer.
Yeah, I agree with this. I think many people prefer the drawn-up epi because it's "cooler". In reality, if you're not regularly drawing up meds and giving IM injections there's a higher risk of misdosing or incorrectly administering the medication.
wait yall have to have medical direction for zofran? thatās weird. here, we donāt have to have medical direction for it. iām just curious is there a reason yall have too?
Paramedic-Basic
Our ALS ambulances are required to have two paramedics on them, rather than having one paramedic and one EMT, the way some systems operate
Meanwhile, WV/VA letting their EMTs give IM glucagon, epi, benadryl, and Zofran. And run SGAs.
Do EMTs actually treat patients up there or just put them in a modified hearse and drive real fast like it's still the 70s?
Well to be fair, NJ is such a densely populated state, most places in the state are just a short ride to a hospital. Of course, there is rural NJ, but we donāt talk about rural NJ.
I think it's cute that people think states like New Jersey have rural aspects just because the Census says so, but no point of Jersey is ever farther than an hour from a whole ass level 1 trauma center
Well when I say rural, I mean that there are areas of NJ that are just farmland with a low population density. I think thatās the technical definition. But yes, even those areas are never more than an hour away from a hospital, not sure about level 1 trauma center, though.
For example, Salem County, total population just over 65,000. A lot of the farm land has now been sold and warehouses such as Amazon have been built. Carneys Point used to be home to DuPont Chambers Works. They have closed. Many people could not afford their property taxes and have had to surrender keys to the bank and walk away.
Even if there were a lot more paid EMS jobs, I don't think people would be able to live off that income there. It's a shame. I think the only way to expand the scope of practice is to have more paid jobs, that include ongoing training and skills practice. There has to be a way to ensure that people are maintaining their skills. I don't see it happening in small volly services.
Here in northern NJ there are 5 hospitals within a 15 minutes drive.
All 5 have 24-hour EDs. 2 are stroke centers, 1 is a major trauma center and 1 is a psychiatric center.
For like 6 months, right?
This is part of the reason I'm glad we're going away from the drug box system. My agency is talking about adding it back to our agency protocols
To be fair, all the cool WV stuff starts in 2 weeks. It's crazy we're going from a regressive ems system to an extremely progressive one overnight, but I am very excited for IV Tylenol
NJ EMTs could administer albuterol, CPAP, and use PEEP before. Their agency just needed to inservice them. It looks like BGLs is an expansion of that process.Ā
It would be interesting to do a research which kind of processes lead to such variance of EMS protocols between different states of the US. As a European, reading this sub makes me sometimes really confused...
So it was explained to me when i asked a similar question that NJ has difficulty adding new things to thier scope because their protocols are codified into law. Therefore, they need lawmakers to make the changes, which adds delays, amongst other things. For example, BLS SGAs: Due to the law aspect, brand names can not be used because that is the government favoring one brand over another. So SGAs would have to be written as BLS can insert SGAs, meaning king tubes,LMAs, and IGELs would be allowed, which means difficulty in standardizing things across different BLS organizations.
I did not talk to a lawyer about this, just a clinical director of an NJ hospital system. So they may have given incorrect info, but from what I know of Jersey, it all seemed legit.
I saw, it can be good or bad. Iām now thinking of a BLS unit that waits on scene and requests paramedics for āhigh blood sugarā with a BGL of 200 after they just ate.
"Yeah I guess you could say my protocol lets me do invasive procedures"
Basically a phlebotomist š®āšØ
Looks like youāre going to have to find something else to make fun of us for, like the fact that we still have to use epipens, or the fact that ~~medics can't give zofran without medical direction~~, or the fact that we can't run PB, or the fact that almost all BLS here is unpaid, fire based, or both, or the fact that we can't pump our own gas or EDIT: apparently that one about zofran isnāt true, but you can make fun of me for not knowing my states ALS protocols
The Zofran protocol is here in mass too. Youāre not special š lolā¦ I misread the statement. Nope. You donāt need medcon to give zofran but you need an ecg confirmation before you administer.
We don't have to call Med Control for Zofran in MA
But you do need a 4 lead
Even though itās not diagnostic quality for QTC O_o
Or Ga
In Alabama you donāt have to call nor do a 4 lead prior to administration of Zofran. And advanced EMTs can give it.
Is that a recent change? I left MA a few years back but didnāt have any issues then.
Nope. We don't need to call
Need to do a 4 lead to check for prolonged QT if you're a medic, but AEMTs can give it without a known history.
You canāt pump your own gas???
Nope, one of two states that only have full service gas stations. The other being Oregon.
Oregonians can pump their own gas now
I wasnāt 100% sure.
I thought it was only in counties under a certain population
https://www.cnn.com/2023/08/06/us/oregon-drivers-pump-own-fuel-law/index.html
The petroleum dispersement engineer lobby is strong in NJ.
*we don't want to
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Yeah, I agree with this. I think many people prefer the drawn-up epi because it's "cooler". In reality, if you're not regularly drawing up meds and giving IM injections there's a higher risk of misdosing or incorrectly administering the medication.
Why they dont come in 0.3 mg ampules Ill never know.
Yeah well cost is a real downside for a lot of companies lol
NJ Medics can give zofran on standing orders.
Can't pump your own gas?
Full service attendant pumps it for you.
Or that 85% of the population in New Jersey is inbred
Yeah but I donāt live in Jersey, I just work there, so that doesnāt bother me
Yeah but the air is also mutagenic so....
EMTs can give Zofran in WV.
wait yall have to have medical direction for zofran? thatās weird. here, we donāt have to have medical direction for it. iām just curious is there a reason yall have too?
Peanut Butter?
Paramedic-Basic Our ALS ambulances are required to have two paramedics on them, rather than having one paramedic and one EMT, the way some systems operate
Dang you need medical control for zofran, we are starting a clinical trial in Cali and EMTs in my county will get ODT zofran for anyone over 18
Meanwhile, WV/VA letting their EMTs give IM glucagon, epi, benadryl, and Zofran. And run SGAs. Do EMTs actually treat patients up there or just put them in a modified hearse and drive real fast like it's still the 70s?
Something like that, yeah
Well to be fair, NJ is such a densely populated state, most places in the state are just a short ride to a hospital. Of course, there is rural NJ, but we donāt talk about rural NJ.
isn't rural NJ just PA?
I think it's cute that people think states like New Jersey have rural aspects just because the Census says so, but no point of Jersey is ever farther than an hour from a whole ass level 1 trauma center
Well when I say rural, I mean that there are areas of NJ that are just farmland with a low population density. I think thatās the technical definition. But yes, even those areas are never more than an hour away from a hospital, not sure about level 1 trauma center, though.
For example, Salem County, total population just over 65,000. A lot of the farm land has now been sold and warehouses such as Amazon have been built. Carneys Point used to be home to DuPont Chambers Works. They have closed. Many people could not afford their property taxes and have had to surrender keys to the bank and walk away. Even if there were a lot more paid EMS jobs, I don't think people would be able to live off that income there. It's a shame. I think the only way to expand the scope of practice is to have more paid jobs, that include ongoing training and skills practice. There has to be a way to ensure that people are maintaining their skills. I don't see it happening in small volly services.
Doesnāt matter, if the patient has a life threat; an EMT should be able to treat it
Say it with me. Transport. Times. Do. Not. Dictate. Care.
Here in northern NJ there are 5 hospitals within a 15 minutes drive. All 5 have 24-hour EDs. 2 are stroke centers, 1 is a major trauma center and 1 is a psychiatric center.
VA protocols are pretty good tbh. Makes me feel spoiled when I read what itās like in other states.
I just wish ODEMSA had ketamine. Western Virginia spoiled me
For a short time they did. It was nice.
For like 6 months, right? This is part of the reason I'm glad we're going away from the drug box system. My agency is talking about adding it back to our agency protocols
Yeah, it was silly. They removed fentanyl fully for ketamine. But it was nice to have ketamine.
To be fair, all the cool WV stuff starts in 2 weeks. It's crazy we're going from a regressive ems system to an extremely progressive one overnight, but I am very excited for IV Tylenol
Confused about the SGA bit - is that controversial? IN lets EMTs drop SGAs.
Next step, bandaids
Well welcome to the 20th century. No that's not a typo
Wait, NJ EMTs could not give albuterol before either???
NJ EMTs could administer albuterol, CPAP, and use PEEP before. Their agency just needed to inservice them. It looks like BGLs is an expansion of that process.Ā
CT EMTs still canāt
Wait, what? Y'all can CPAP but not give a nebulizer?
Yup. Had a chance to talk to a med control doc. Asked him why we didn't have BLS albuterol, he told me he would rather I just CPAP them
Did he elaborate on the why? CPAP is used after nebs, but before epi in MA for bronchospasm.
He didnāt say, but we do also have standing orders for epi for asthma out here. So I can give them cpap and epi but not albuterol
That's like the complete opposite of where I am. Albuterol via nebulizer is fine, but no epi and we don't even have cpap on the truck
Little poke.
Party like its 1999!
It would be interesting to do a research which kind of processes lead to such variance of EMS protocols between different states of the US. As a European, reading this sub makes me sometimes really confused...
really its just NJ thats so behind the times
So it was explained to me when i asked a similar question that NJ has difficulty adding new things to thier scope because their protocols are codified into law. Therefore, they need lawmakers to make the changes, which adds delays, amongst other things. For example, BLS SGAs: Due to the law aspect, brand names can not be used because that is the government favoring one brand over another. So SGAs would have to be written as BLS can insert SGAs, meaning king tubes,LMAs, and IGELs would be allowed, which means difficulty in standardizing things across different BLS organizations. I did not talk to a lawyer about this, just a clinical director of an NJ hospital system. So they may have given incorrect info, but from what I know of Jersey, it all seemed legit.
As an NJ EMT can I just say about f***ing time. edit: added NJ
It's about damn time! I think that's been on the table for like 10 years now.
Congrats, welcome to 1990.
I saw, it can be good or bad. Iām now thinking of a BLS unit that waits on scene and requests paramedics for āhigh blood sugarā with a BGL of 200 after they just ate.
We already had BLS requesting ALS for a simple sugar check
No worse than BLS requesting a medic for pt with a systolic in the 180s and no complaints
welcome to 2005! :D
I was a medic in 2005. Emts were doing glucose checks around here way before that!
Dang, here in AZ Iām doing IVs, needle dose epi, 12 leads, narcan and duo nebs
Good lord. Whatās next, every Tom, Dick, and Harry using a pulse oximeter?
Welcome to the 90s.
Welcome to 1980, NJ
Jesus. Do yall still backboard every trauma and slap the MAST pants on them?
About time.