BLS and IV's

[Gbro]

That's part of my problem with Basic's and IV's. A straight IV does no good whatsoever. The times when giving saline or ringers will really make a difference (and I do mean really) are pretty rare, and more than likely will be seen in a rural, low volume setting where rapid transport to a ER is not an option.

Something like this maybe?

http://www.duluthnewstribune.com/articles/index.cfm?id=50780&section=None

A neighboring BLS service had this run a week ago or so,

 

[Flight-LP]

So you have a conscious, alert patient in pain with a pelvis fracture. How does this remotely prove your point? The IV would have been of no immediate necessity other than for pain management, which again, can not be provided by an EMT-B. Since the BLS service was able to transfer him, apparently pain wasn't too much of an issue..............

Bstone - Thats great that you do not give the blind "coma cocktail", but even if you do confirm an opiate OD, what is your criteria for administering the Narcan. For instance if you have someone who is slurring their speech, has sluggish pupils, BP 100/60, P 58, R 14, and an SPO2 of 95%, would you Narcan them? Why or Why not?

 

[bstone]

Bstone - Thats great that you do not give the blind "coma cocktail", but even if you do confirm an opiate OD, what is your criteria for administering the Narcan. For instance if you have someone who is slurring their speech, has sluggish pupils, BP 100/60, P 58, R 14, and an SPO2 of 95%, would you Narcan them? Why or Why not?

After checking with the current protocols, it states:


Intermediate standing orders
IV access, obtain blood sample and administer fluids to maintain systolic blood pressure >90 mmhg.
Suggested narcotic antidotes: naloxone 0.4–2 mg IV push, im, SQ, in or ETT. If no response,
may repeat initial dose every 5 minutes to a total of 10 mg.
Consider paramedic intercept.

http://www.nh.gov/safety/divisions/...cuments/2007_nh_patient_care_protocols_v2.pdf

 

[Flight-LP]

Sorry my friend, but this is precisely my point. I'm not interested in what your standing orders have to say, I am seeking your reason and rationale as to why you would or would not provide a treatment. Protocols are only guidlines, not the King James Bible. Narcan should only be administered in a known narcotic OD with RESPIRATORY DEPRESSION. If an airway is patent, there is no reason to give an antagonist that is going to do nothing more that agitate your patient and thus placing them at risk for an increase myocardial workload. Honestly,even with respiratory depression, I rarely ever give it. I'll just intubate them. That way their airway is definately controlled and I don't have an agitated patient pissed off at me for taking away their high.

This is the thought process that us ALS provders are referring to. If you cannot identify all of the pro's and con's to a treatment, then it shouldn't be given. It is slightly more understood and accepted at the Intermediate level, but this just adds one more justification as to why none of the Intermediate skills should be allowed in an EMT-B's hands............................

 

[bstone]

You asked me what my protocals were, I answered and now you're angry?

Huh?

 

[BossyCow]

Bossy,

What saved that patient was a combination of things.

Absolutely and part of that combination was the initial IV

 

[triemal04]

I do hope you are more attentive in your examination of a Pt. in front of you.

Humm?
I am posting this "because(as you can see from the poll) there "ARE" BLS services with IV Protocol's"
Not the service i am with as we elect not to.

I did take the EMT-I years ago. The system wouldn't allow just me(EMT-I or my Wife EMT/RN) because the whole crew wasn't equally trained.
There are some situations today that would make that hurdle lower.
The IV stick count was is a problem where I couldn't keep up my EMT-I. I would have had to work with another service and then who knows?
When I did my clinicals for the I, after 40 hours in the ER, Not one stick.
We did stick each other way too many times...

I think I've met you before. Or at least far to many people like you. If your service won't allow different levels to work there, maybe you should focus on fixing that problem. Then you could get some I's working there, (who knows, maybe an off-duty medic) which would be beneficial for the reasons I've listed. Having Basic who can start IV's (in your service, something you've allready said is an option) is not a good idea for the reasons allready listed. And if you went 40 hours in the local ER without starting an IV you're proving my point about keeping your skills up.

This bears repeating:
Couple suggestions. Think about why you need the skill. Really think about it, and then ask yourself what is best for your community. The able to maybe put a piece of teflon in someones vein, or the ability to perform a little better pt assessment and maybe give a few meds. If you really think that starting an IV is so great, go back and get your EMT-I. You'll learn a few tricks that could help out more than a piece of teflon.
Of course that means that you woud have to work to change your system, somethin you've allready voted against. Why was that? Because you knew you'd be putting advanced skills in peoples hand when they wouldn't get the neccasary practise using them?

Also:
You just want to be able to start IV's because...why? That's the part that is really funny. You've started this thread but haven't given one reason why simply starting an IV is a good idea for an EMT-Basic.
And your little example does not qualify. Basic's in an urban environment won't have this problem, it's services like yours that will. And shouldn't because...well...that's been done to death, and it even seems like you know that.

 

[Flight-LP]

You asked me what my protocals were, I answered and now you're angry?

Huh?

I'm not angry at all..................I asked what your criteria is for determination to administer Narcan. The perception I was going for is when do you deem it appropriate to administer? Its easy to stay within the "protocol box", but what is generally deemed to be a level of proficiency is when the ability to think out of the box comes into play. Sorry to use you as the scapegoat, no hard feelings implied.

 

[bstone]

I'm not angry at all..................I asked what your criteria is for determination to administer Narcan. The perception I was going for is when do you deem it appropriate to administer? Its easy to stay within the "protocol box", but what is generally deemed to be a level of proficiency is when the ability to think out of the box comes into play. Sorry to use you as the scapegoat, no hard feelings implied.

You asked me how I would use Narcan. If you want to know the exact indications then ask that. <_<

 

[disassociative]

Lord have mercy, we had to go so far as to cover the epidermal strata(stratum corneum, stratum granulosum, stratum basale) the various histology and structures such as pacinian corpuscles, meissner's corpuscles, fluid compartments, electrolytes, basic biology of cell processes, slight bit of chemistry(mainly in regards Acid/Base balance); then we focused on the emergency care.

THIS WAS FOR TN EMT-IV; not paramedic.
TN EMT-IV has NREMT-B with Additional training to hold licensure
in TN. I feel they are adequately prepared. However, I must infer
that medication administration of ALS drugs should not be allowed
for BLS providers as they are not trained in ACLS or Advanced interventions.

I have put some thought in it, and I am in the process of suggesting that one of the local community colleges go from certificate paramedic to associate; in which the student would have to take pre-nursing courses such as: A & P I, II, Microbiology, Gen Bio, Gen Chem, General Education Courses, Psychology, and dosage calculation.

This way, with the ever-increasing number of Paramedic-RN transition programs, our paramedics would have the appropriate training to enter into RN studies. I am not implying, by any means, that Paramedic should be given any nursing credits with regard to their training--however, I feel their should be a fast-track RN course designed for paramedics, which caters to their medical knowledge.

 

[reaper]

How bout we just get our pay raised to match that education, then most medics won't want to get their RN! Most RN programs are AAS degrees. If we have AAS degrees then why won't our pay match the education? People keep comparing us against RN's, that is apples to oranges. Two different specialties.

 

[disassociative]

Well, yes, it makes sense to think: well if I have an associates of this I should get paid like someone with an associates of that. The actual course work you do in paramedic school is only a small part of the degree process. The main part of any degree, as far as undergraduate is concerned, is comprised of general education curriculum(English, Communications, Math, Natural Science, Physical Science, Organic Chem, Non-Organic Chem, etc). These requirements vary based on major. If we were to begin offering A.A.S. to paramedics; sure their would be extra coursework, but that would equal more informed patient care and would equal more respect to the profession as a whole--not to mention the facilitation of an easy transfer from said degree to RN, A.A.S.--or B.S.N. for that matter. Next time you are out on the street(amongst civilians, not ems or fire personnel) ask them 2 questions. What does a paramedic do?, Job Roles?; then, ask What does a nurse do? Job Roles? Formal credentialing can have a variety of benefits.

Ever get sick of the fact that here you spent 3 long semesters + God knows how many hours in clinicals so that a college can tell you--Oh; we can't use that time toward anything...It was special student for credit or non-credit.

Or how about; sorry--this is a non-degree program, we do not offer financial aid nor government aid(even though most of you are government personnel)

Nurses once had to fight for proper credentialing, and now; it is our time.

 

[Gbro]

Triemal..
Also:
You just want to be able to start IV's because...why? That's the part that is really funny. You've started this thread but haven't given one reason why simply starting an IV is a good idea for an EMT-Basic.
And your little example does not qualify. Basic's in an urban environment won't have this problem, it's services like yours that will. And shouldn't because...well...that's been done to death, and it even seems like you know that.

I started this Poll/Thread because there "ARE" BLS services that are IV trained.
They are a necessary part of Rural EMS! As there is no ALS available to them.
We have beat that one to death and you have your opinion on that and "WE" who live and work in the Rural areas know that "YOU" don't know!

There need to be a place for those who do IV's in the BLS setting to be supported, Not told how useless they are and that there is no good that can become of it.
AMEN!

 

[Flight-LP]

If we were to begin offering A.A.S. to paramedics...........

Uhhhh, there are quite a few A.A.S. programs and even some B.S. Paramedic programs.................

 

[Flight-LP]

They are a necessary part of Rural EMS! As there is no ALS available to them.
We have beat that one to death and you have your opinion on that and "WE" who live and work in the Rural areas know that "YOU" don't know!

Been there, done that, got the t-shirt.......................

Worked in several rural environments throughout Texas, both on an ambulance and helicopter, and guess what.................Every ambulance had a Paramedic! Guess its not as necessary as you perceive.................. Regardless, I'm through wth this arguement. To each their own.............

 

[triemal04]

I started this Poll/Thread because there "ARE" BLS services that are IV trained.
They are a necessary part of Rural EMS! As there is no ALS available to them.
We have beat that one to death and you have your opinion on that and "WE" who live and work in the Rural areas know that "YOU" don't know!

There need to be a place for those who do IV's in the BLS setting to be supported, Not told how useless they are and that there is no good that can become of it.
AMEN!

No, you started this thread with a poll. At best you could say you wanted to know who had IV's in a BLS service. At worst you could say you started it with the intent of having this arguement since saying "In previous threads we have heard from some ALS members that BLS services have no business using IV's." is bound to get people's backs up. Other than seeing who did it, I can't see any reason for this thread, except for you wanting to show how wrong people are when they say that basic's shouldn't use IV's. So far, you've failed in that regard.

Now first, I'm going to repeat myself in the hope that you can actually answer the questions this time. Why do you want the ability to start IV's in a BLS service? You STILL have not given a reason why it's neccasary. Second, don't you think that getting a overall higher level of training would benefit your community more than just getting the "flash" skills? When have you had an IV REALLY AND TRULY save a life?

IV's are a part of EMS, rural or not. If you want them, go out and get the neccasary training and knowledge to use them. Though if they are so neccasary, why did you yourself vote to not have them in your service? You neglected to address that. Just like normal.

I've worked in the rural setting. And guess what, the people who wanted to really do right by the area went back to school, got their EMT-I and were able to better care for their pt's. They didn't try and take a shortcut to a skill that they wouldn't be qualified for. Again, if you think it is such an important skill, why would you not want your own service to have it?

Now, I've said about all I can. All my reasons why BLS services should not use IV's have been listed. There is no point in even responding to you since you pass over most to come back with something that is flat out ridiculous.

You good sir, are a great example of why EMS is not progressing at the rate it should and getting the respect it deserves. I hope you are happy with that.

 

[ffemt8978]

I think we've beat this horse to death...





Thread closed