[firemedic21]

I was recently fired from one EMS dept and was not told the reason why. When I asked for the reason, I was told that the city could not give it to me because,"they would have to be able to prove whaterver reason they gave". Two days prior to the termination I was told by the chief what a good job I had been doing and thanks for all I was giving to the dept as one of the primary responders on calls. The only thing that I can think of is that earlier on that day, I complained to the chief about a non certified person (still in first responder class) functioning as a lead tech on calls and adminstering asa and non pt perscribed nitro to a chest pn pt on a call. what legal reight do I have in this situation and what would anyone advise as being the best way to handle this situation. Since this time, i have not been able to get any emt positions in the county or next county over. I want to get on a career dept in another state in a year or so but have just been informed that I am permentaly unfit for iring at that dept as long as there is an involuntry termination on my emt empolyment record. any help would be appreicated.

 

[hirundo82]

Probably the best thing to do in this situation is get a lawyer and see what they can do.

Another question--is Kansas an at-will employment state? If so , I do not think they are required to give a reason for terminating you.

 

[Pa Glock guy]

I agree with the above poster, its lawyer time. I dont know your state laws but a good lawyer will. You might want to see how much this is going to cost you as the cost may not be worth it. However is this keeps you from getting hired somewhere else you may want to proceed. Good luck.

 

[Glkster19]

Originally posted by firemedic21
The only thing that I can think of is that earlier on that day, I complained to the chief about a non certified person (still in first responder class) functioning as a lead tech on calls and adminstering asa and non pt perscribed nitro to a chest pn pt on a call.

Whose NTG is he administering? I'd can his butt on the spot. You don't give someone else's meds to another individual. You want to give your meds to your spouse/family member that's your business, but to give a 3rd party meds from someone else, that's a major no-no.

 

[DaleGribble]

I don't know about Florida but here in SC as an Intermediate I can not administer ASA or non pt prescribed Nitro under any circumstances. I can administer pt prescribed Nitro with online med control orders.

 

[Glkster19]

Originally posted by DaleGribble
I don't know about Florida but here in SC as an Intermediate I can not administer ASA or non pt prescribed Nitro under any circumstances. I can administer pt prescribed Nitro with online med control orders.

Same here in MI............



















but the pt must have a good B/P also :clown:

 

[firemedic21]

It was ntg from the drug box

 

[DaleGribble]

Originally posted by firemedic21
It was ntg from the drug box

If you have any type of proof you need to take it to whatever state office is over EMS in your state!

 

[akulahawk]

Originally posted by DaleGribble
If you have any type of proof you need to take it to whatever state office is over EMS in your state!

I absolutely agree. A FR administering NTG/ASA from the drug box is a huge no-no. That is even with a properly certified person overseeing the administration. This way out of the scope of practice of any first responder and most EMT-B's.

About the only time a FR trainee MIGHT be able to work as a "Lead Tech" would be during training AND the preceptor was present at all times during delivery of patient care. Even then the care given may not exceed (in this case) FR level. Once the level of care required exceeds the FR level, then the FR may assist but the EMT (or higher) functions as lead. Otherwise, the FR is practicing w/o a license and the preceptor is responsible for any bad outcome that the FR trainee does.

When I was actively working as an EMT-P, I allowed my BLS partner to assist me in setting up for ALS procedures, but I refused to allow my partner to DO any ALS as it was out of their scope and if they goofed, would put me in legal jeopardy.

If you have ANY concrete proof of this happening, most definitely report it to the appropriate medical authority at the state or county level.

 

[DScottHewitt]

Originally posted by DaleGribble
I don't know about Florida but here in SC as an Intermediate I can not administer ASA or non pt prescribed Nitro under any circumstances. I can administer pt prescribed Nitro with online med control orders.

Tough state. We carry ASA and NTG. And can give it under standing orders as EMTBs, once we have the local protocol training.....



Scott

 

[DScottHewitt]

Originally posted by DaleGribble
I don't know about Florida but here in SC as an Intermediate I can not administer ASA or non pt prescribed Nitro under any circumstances. I can administer pt prescribed Nitro with online med control orders.

Tough state. We carry ASA and NTG. And can give it under standing orders as EMTBs, once we have the local protocol training.....



Scott

 

[akulahawk]

I used to work in Santa Clara County as an EMT. When I left that county, there was talk of adding to the EMT Local Optional Scope of Practice. Effectively you'd have 2 types of EMT-1's: the garden variety and those certified in specific ALS meds and procedures. Above them you'd have Paramedics.

I just rechecked that county's protocols. There is now a mechanism by which an EMT-1 can be certified by the county in certain ALS procedures. Effectively the county is raising the EMT-1 to something just short of an EMT-2 (intermediate). The added stuff for that county's EMT's now CAN include:
-Albuterol Nebulizer
-AED
-Laryngoscopy w/ use of forceps
-OTI Adult/Peds
-Combitube
-ASA/NTG for chest pain
-Glucometry & Glucagon use for Hypoglycemia/ALOC
-Epi for anaphylaxis
-Naloxone for suspected Opiate OD/ALOC

Note: Nothing is allowed to go via IV as these EMT's are NOT allowed to start IV's. ASA is given PO, NTG is given SL, and injectables are given deep IM.

Just before I left, I was trying to get my company to go ALS so I wouldn't have to deal with those restrictions... and just be able to DO full bore ALS. We had to give away many contract/private emergency calls, (we weren't a primary 911 provider) because we didn't have a county accredited EMT-P, due to scene/transport time protocol limitations that applied ONLY to BLS providers.:frown:

 

[Victory]

you have every right to complain about underqualified personell giving treatments outside their scope of practice. As the highest medical authority it's your ass.

No need to plug the benifits of unionizing EMS agencies again....

 

[paragod]

in my own opinion, emt-b's should NOT be giving nitro/asa.

what are you going to do when you bottom out their pressure,

medics shouldnt even be giving nitro w/o a line.

not to mention the other potential problems, what if its a triple A, congrats you just killed your pt.

the point is no line no meds.....trendelenburg is not a adequate replacement for a life line for hypotension.

 

[hirundo82]

Originally posted by paragod
in my own opinion, emt-b's should NOT be giving nitro/asa.

what are you going to do when you bottom out their pressure,

medics shouldnt even be giving nitro w/o a line.

not to mention the other potential problems, what if its a triple A, congrats you just killed your pt.

the point is no line no meds.....trendelenburg is not a adequate replacement for a life line for hypotension.

With nitro's half-life, I really don't think that it is a problem to give nitro without IV access. Nitro won't last much more than 5 minutes with the 0.4 mg SL dose.

Really, what are you going to do with a cardiac patient who drops their pressure with nitro? Bolus 500cc's of NS? Great, now they have flash pulmonary edema. I always just put them flat, maybe in the Trendelenburg position, and they were fine when the nitro wore off. No reason an EMT-B can't do that.

Doctors prescribe nitro for their patients to use at home all the time. If it goes away with 3 or fewer SL pills, fine. If not, call an ambulance. I think that most EMTs can be trusted to give nitro to the same population.

 

[Tvov]

Originally posted by firemedic21
I was recently fired from one EMS dept and was not told the reason why. When I asked for the reason, I was told that the city could not give it to me because,"they would have to be able to prove whaterver reason they gave".

It is hard to believe that you were not given a reason. Was the person you talked to in a position to know, or was it just something they "heard"?

 

[Glkster19]

Originally posted by paragod
in my own opinion, emt-b's should NOT be giving nitro/asa.

what are you going to do when you bottom out their pressure,

medics shouldnt even be giving nitro w/o a line.

not to mention the other potential problems, what if its a triple A, congrats you just killed your pt.

the point is no line no meds.....trendelenburg is not a adequate replacement for a life line for hypotension.

Your thought process is not correct. Trendelenberg will adequately replenish the volume lost due to NTG. After a few minutes they are fine. Had many a Dr say that. These days its no different than someone having the same effect from Viagra, they pass out and are fine after becoming supine and blood flow being restored to an adequate level.

I agree on your thought for the triple A, however, that could happen to anybody. Not all pts present with classical signs of a triple A. Had a guy once called for CP, no other complaints and throwing PVC's. EKG was questionable. Treat the pt with Lido and NTG and get to the hospital and they find out later he was a triple A.

 

[DScottHewitt]

Originally posted by paragod
in my own opinion, emt-b's should NOT be giving nitro/asa.

what are you going to do when you bottom out their pressure,

medics shouldnt even be giving nitro w/o a line.

not to mention the other potential problems, what if its a triple A, congrats you just killed your pt.

the point is no line no meds.....trendelenburg is not a adequate replacement for a life line for hypotension.

And the Gods speak to the peons. Meanwhile, patient care goes out the window, because a God was not available.....



Scott

 

[paragod]

Originally posted by DScottHewitt
And the Gods speak to the peons. Meanwhile, patient care goes out the window, because a God was not available.....



Scott

im sorry that i offended you, its not a personal attack. i thought this forum was for opinions.

but hey, at least thanks for reading my post!!!

 

[DScottHewitt]

Originally posted by paragod
im sorry that i offended you, its not a personal attack. i thought this forum was for opinions.

but hey, at least thanks for reading my post!!!

I guess it sounded offensive to me. Sorry. Don't know what it is like where yo uare, but around here we seldom get a medic when requested. That's why our council has approved things like:

Ntg/ASA for chest pain
Glucagon for diabetics who can't swallow



Scott

P.S. Sorry if my response may have sounded pissy. Since on re-reading it, it WAS.....