Id rather have a bystander too, but to think that an EMT-I or a AEMT can replace paramedics in a pre hospital setting is just a terrible idea
I agree.
Mostly because it perpetuates skills based providers instead of knowledge based ones.
In the modern world, skill based EMS is simply not effective and not worth paying for.
As far as the IV thing goes. Name one single other skill that you would rather have a Basic learn. Just one skill...
The ability to take a proper history andperform a physical exam that is more than an easily remembered acronym that is so basc it basically gives no info at all.
IV access would seem to be one of the most important things a pre-hospital team can do to provide relief for patients in life threatening situations.
I respectfully disagree.
Code drugs are basically BS.
Fluid therapy for massive hemorrhage has been reduced in favor of permissive hypotension.
In anaphylaxis, IM is the prefered epi route.
In hypoglycemia there is not only IM glucagon, which carries much less risk than extravasiation of d50, but also buccal and sublingual glucose.
In the US for respiratory emergencies requiring B agonists, nebulized is preferred over IV.
Midazolam and diazepam can be given IN and rectally respectively. (much easier than starting a line on a seizing patient.)
Furosimide is being steadily removed for CHF exacerbation around the world in the prehospital environment.
Did you have another life threatening emergency in mind that isn't better helped with a mechanical or electrical device?
It however is probably the single most important thing it can do to provide an easy continuum of care into the hospital setting to allow for the most rapid treatment of the patient once reaching a hospital.
What about in the growing number of institutions that are imediately DCing prehospital lines and starting their own fr fear of not being reimbursed for "treatment relating to preventable complications" in the US?
In a hospital (here at least) when you roll through the door if you don't have a BP in the last 10 minutes they might say why, but the fact is they will retake one before they do anything (therefore you have not delayed PT care). If you have evaluated the patient mentally they will be happy, but they will do it again before they do anything (therefore whether you do it you have not delayed pt care).
Because they are looking for change over time?
But if you have not placed a IV yet and pushed meds per protocol (and more importantly using a good educational background) then you have delayed patient care whether its a slower time to pain relief or a slower time to lowering a high BP.
Does that include IN fent or SL nitro or nitro paste?
Perhaps if you are using lebatalol you need the IV, but I can count on one hand the number of times I have used that in my career. At least one of those times it wasn't really needed, but verbal orders are verbal orders, and ever since discovering esmolol I would choose that over labetalol any day.
(wh is carrying that on the truck?)
I was wrong to say it was the single most important thing in a pre-hospital setting. I may be more right to say it is the most helpful single skill that could be added on to a basics training with ease.
I agree.