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Paramedic Skills And Medications: Practice Options Utilized By Local Advanced Life Support Medical Directors

Published online by Cambridge University Press:  28 June 2012

Herbert G. Garrison ,
Nicholas H. Benson ,
Theodore W. Whitley  and
Bob W. Bailey
Herbert G. Garrison*
Affiliation:
Department of Emergency Medicine, East Carolina University, Greenville, N.C., USA
Nicholas H. Benson
Affiliation:
Department of Emergency Medicine, East Carolina University, Greenville, N.C., USA
Theodore W. Whitley
Affiliation:
Department of Emergency Medicine, East Carolina University, Greenville, N.C., USA
Bob W. Bailey
Affiliation:
Chief, North Carolina Office of Emergency Medical Services; president-elect National Association of State EMS Directors
*
Presented at the 6th Annual Scientific Assembly of the National Association of EMS Physicians, Houston, Tex., USA June 1990
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Abstract

Local advanced life support (ALS) medical directors in North Carolina choose the skills and medications they want utilized in their jurisdiction from a list of options authorized by the State Board of Medical Examiners. We surveyed all 35 medical directors of paramedic providers in the state to determine which optional skills and medications local medical directors allow to be used and, therefore, how they tailor their prehospital practices. Information concerning the urban or rural status of the paramedic service area, annual call volume, and the specialty classification of the medical director also were obtained.

All of the medical directors surveyed responded. Twenty-one (60%) of the paramedic service areas were rural and 14 (40%) urban. Twenty-three physicians (66%) listed emergency medicine as their primary specialty. Annual call volumes ranged from 580 to 33,500. Skills allowed by >80% of the medical directors include: drawing blood, insertion of esophageal and endotracheal airways, defibrillation, cardioversion, and initiation of intravenous fluids prior to hospital contact. The majority permit the administration of bretylium, dopamine, NaCl injection, sodium bicarbonate, furosemide, sublingual nitroglycerin, diazepam, diphenhydramine, and morphine. The majority do not allow the use of positive-pressure ventilators and do not allow administration of dobutamine, nifedipine, procainamide, propranolol, local procaine, isoetharine, metaproterenol, nitroglycerin paste, 10% dextrose solution, methylprednisolone, mannitol, phenytoin, meperidine, or nitrous oxide. Nitroglycerin paste and dexamethasone were significantly (p<.05) more likely to be allowed in rural than in urban areas. No differences in utilization by medical director specialty classification or call volume were detected. The results suggest that, when given a choice, local ALS medical directors select a limited prehospital practice. Further study is warranted to determine why available skill and medication options are not utilized.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 6 , Issue 1 , March 1991 , pp. 29 - 33
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

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