Hey guys just started my EMT-I Class and we have to write a research paper on anything that has to do with EMS.  It could be an argument paper, research of a drug/equipment, or something about protocols.  I live in Maryland so dealing with MD EMS.  I was maybe thinking about arguing the fact of CPAP for BLS providers.  What are your opinions or any other ideas?

 

Regards,

Richard Cropper

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Arguing for or against CPAP for BLS providers?
It would be arguing for CPAP for BLS providers.

I live in Maryland as well.  I take it you're taking EMT-I at a local college?  One of the points in being assigned a research paper is to expand your awareness of the profession in addition to the technical training you will get with each module.  In that "vein,"  since MD EMS is so narrow, my suggestion is to research how modern EMS (from 1900 on) got established and why.  What was it's purpose and mission then?  What was its scope of practice, and why do you think it was what it was?  What were the conditions that affected the use of EMS and its scope of practice?  Trace the progression of EMS in the nation to where it is now.  Compare and contrast what it was then and what it was now, and try to find out all the different things (purposes) EMS is being used for now and discuss the conditions that lead to the changes in those uses between then and now.  Finally, where is EMS headed now?  Then, take a look at EMS in Maryland and think about how you would explain why it is the way it is here (scope of practice, etc).  It's great food for thought....

I agree with Mr.Azevedo's take on how you should approach your research paper.He could'nt of said it any better.It's nice you want to challenge and argue things that perhaps play a significant part of your life ,but it's also helpful to understand first what your arguing for and about...Therefore do what mr Azevedo suggested and do your research on C-Pap ...Believe me C-PAP is a wonderful tool to be used in the field only if used properly in accordance to the type of respiratory emergency the patient presents with,which goes along with a differential diagnoses....

You need to consider a few things.

Firstly your word count. The smaller it is the more difficult it is. Between 2000 and 5000 words is normal at your level.

If this is the case you must keep it very specific and keep it tight. 

The suggestions given above is ideal but you will need to focus right down on one part of it. Your introduction is usually 500 words and the conclusion is 250-500 word. Which only leaved you 1000 to 4000 words and trust me that's not a lot.

So if I were to take Chris' ideas I would focus in on one aspect of his suggestions. I think Joels idea of differential diagnosis of pulmonary oedema which indicates CPAP is perfect as there is lots of controversy about EMTs/Paramedics and doctors alike unable to perform this to a standard which is acceptable. But at the end of the day it has to be something which grabs your attention. 

 

If you try and tackle this subject as an overview you wont punch your message across.

We are here to help in anyway we can. Let us know what your idea is and the word count.

cheers

Mike

If you are going to look at BLS CPAP, they have been doing it for years just across the state line in Delaware. Bob Sullivan might be able to provide you with some good data, or put you in contact with some people who can provide you with some good data.

How about fentanyl vs. morphine in chest pain management?  Or whether morphine should be used at all for chest pain management given that its benefit to patients is inconclusive/controversial.

 

Here in my corner of Wisconsin, EMT-B's can use CPAP provided its approved in their operational plan by the medical director, and they received additional training specifically on the use of CPAP.

If BLS CPAP was the first idea to pop into your head and you're really interested in that topic then I'd go with it. Especially if you're in a state that doesn't allow it and bordered by a state that does. Could make for a very interesting persuasive paper. Now if you really wanted to have some fun you could switch it. Its harder to argue against something that you're actually in favor of. I think this can create fantastic learning, so you may want to consider arguing why Maryland is right and states that allow it are wrong.
I have used CPAP in the field as a Paramedic for years. I don't see the advantages to it's use. BiPAP on the other hand is very useful. CPAP for the most part has been a bridge device to use while you are preparing to intubate. That is the next step if the CPAP doesn't work. I have found that CPAP increases the patients anxiety and they find it harder to breath against the positive airway pressure. BiPAP assists in both directions so the patient doesn't have to breath against all that pressure. In my opinion EMT's probably shouldn't use CPAP because you need to be able to sedate and intubate a patient if the CPAP fails.

Sounds like your experience with CPAP has been atypical. (Though, yes, BiPAP would be preferred, but those devices tend to be bulky and much much more expensive than CPAP.)

 

Also any suggestion for BLS use of CPAP is likely in areas where ALS isn't available at all or where ALS response may be prolonged.  I don't think any medical director in her right mind would allow EMTs to recall ALS and transport with CPAP unless transport time to hospital is less than ALS response time (obviously).

Robert Melrose said:

I have used CPAP in the field as a Paramedic for years. I don't see the advantages to it's use. BiPAP on the other hand is very useful. CPAP for the most part has been a bridge device to use while you are preparing to intubate. That is the next step if the CPAP doesn't work. I have found that CPAP increases the patients anxiety and they find it harder to breath against the positive airway pressure. BiPAP assists in both directions so the patient doesn't have to breath against all that pressure. In my opinion EMT's probably shouldn't use CPAP because you need to be able to sedate and intubate a patient if the CPAP fails.
Scott, That very well may be true. Some of my colleagues swear by the use of CPAP and have had success with it. Perhaps the patients I used it with waited too long to call for EMS and were past the point in which CPAP could help. Or it could be the device we used. The CPAP we had was an oxygen powered unit that was completely disposable. A crude device that was little more than a mask attached to a PEEP valve set at 10 cm/h2o with a constant flow of oxygen.

Scott RB said:

Sounds like your experience with CPAP has been atypical. (Though, yes, BiPAP would be preferred, but those devices tend to be bulky and much much more expensive than CPAP.)

 

Also any suggestion for BLS use of CPAP is likely in areas where ALS isn't available at all or where ALS response may be prolonged.  I don't think any medical director in her right mind would allow EMTs to recall ALS and transport with CPAP unless transport time to hospital is less than ALS response time (obviously).

Robert Melrose said:

I have used CPAP in the field as a Paramedic for years. I don't see the advantages to it's use. BiPAP on the other hand is very useful. CPAP for the most part has been a bridge device to use while you are preparing to intubate. That is the next step if the CPAP doesn't work. I have found that CPAP increases the patients anxiety and they find it harder to breath against the positive airway pressure. BiPAP assists in both directions so the patient doesn't have to breath against all that pressure. In my opinion EMT's probably shouldn't use CPAP because you need to be able to sedate and intubate a patient if the CPAP fails.
Robert Melrose said:
In my opinion EMT's probably shouldn't use CPAP because you need to be able to sedate and intubate a patient if the CPAP fails.

Just a thought on your rationale: those same folks will be just as bad off if there's no CPAP available in the first place. If someone fails CPAP/BiPAP, by definition they would have failed a NRM at 15lpm also. Solution for the non-intubating set: BVM.

 

I do agree that BiPAP is more comfortable for pts than CPAP but there isn't solid data out there to show BiPAP clinically superior.

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