BLS and IV's

[Gbro]

In previous threads we have heard from some ALS members that BLS services have no business using IV's.
The service i am with doesn't, although we do have the option to become trained and use IV's for shock/Trauma.
There are 2 BLS services in our county that have IV's on board.

 

[KEVD18]

here we go again...

intravenous therapry is an invasive, advanced life support skill. when i was trained is this skill, we spent a full week of classes(m-f 9-330) covering the anatomy/physiology of the veinous system. the indications and contraindications of iv therapy. fluid/electrolyte balance. how much fluid to give and how fast. catheter types and thier uses. preperation, insertion, securement. how to examine for patency. what to do when it goes wrong. and the list goes on. its my opinion, given the dumbing down of ems curriculum nationwide, that the bls version of this course material would amount to maybe 10hrs of lecture, a few pokes at the rubber arm and a card to put in your wallet. while i strongly believe that 95% of the basic out there could handle this skill, the other 5% ruin it for you.

case in point: a rural system has just authorized bls iv therapy. bls truck get call for c/p. crew arrives on scene and decides to initiate an iv. they spend 40min onscene, blow every vein they could find and decide to t/p. their transport time to the H, 14min. while this may be the exception to the rule, it still happens. and yes, maybe it happens with -p's too but not as much.

not every pt needs a line just "because i can". there are physiological considerations that need to be factored in. now i under stand that there are plenty of services that use -iv or -i crews that start hundreds of lines every day. but you have to have a need, not just a toy you want to play with.

as we all said in the magill thread, if you want to be a medic, go to medic school. learn how to do this stuff well and you be a better tech for it.

 

[bstone]

While on a camping trip 2 summers ago I came across a very severely injured hiker. Had a seizure, fell, hit his head, bleeding, etc. Held c-spine for over an hour until EMS got there. They had one EMT-B an one FR. I am an NREMT-Intermediate, tho not licensed in that state. They asked me to come along to the hospital in order to assist BLS care in the back (the EMT-B was clearly very new and very uncertain as to the proper things...he messed up basic backboarding and c-collar).

En route he instructs the driver to stop while he "starts a line". Blows both lateral ACs. I am cringing at his poor skill sets. One of the first things they taught us in Intermediate school was "start distal, go proximal". A certain part of me wanted to take over starting the line or at least offer some instruction to him, but I kept my mouth shut as I didn't want to step on any toes or do anything with dubious legal issues.

In any case, it's clear to me that IV skills should only be taught in Intermediate or higher level class rooms. No offense to the Basics, but when I got out of Basic school I barely knew my BP cuff from my foley catheter.

 

[Summit]

EMT-B with a successful Colorado IV Approval may perform peripheral IV starts/dc/monitoring, administer saline and dextrose, perform blood draws, and check BGL. This is state regulated and may be implemented by individual services as their MDs see fit.

To receive the approval I had to complete the class (24 classroom hours where passing is a grade of 80% minimum (got an A+)) and clinical (15 successful clinical IV starts and preceptor signoff)

 

[bstone]

EMT-B with Colorado IV Approval class and clinicals may perform peripheral IV starts/dc/monitoring, admister saline and dextrose, perform blood draws, and check BGL. This is state regulated and may be implemented by individual services as their MDs see fit.

Interestingly, in my above posted situation, I was in CO. I am not so impressed with the competency of the EMT-Bs and this skill set.

 

[crash_cart]

In my state, classification is set up-EMT, EMT-I, and EMT-P(aramedic.) EMTs may monitor intravenous solutions, but that's it in regards to this topic. EMT-Intermediates are certified to carry out intravenous therapy, though paramedics are only approved to do intravenous drug administration and injections. To me, it sounds like an advanced skill, an interesting one at that.

 

[medicdan]

here we go again...

intravenous therapry is an invasive, advanced life support skill. when i was trained is this skill, we spent a full week of classes(m-f 9-330) covering the anatomy/physiology of the veinous system. the indications and contraindications of iv therapy. fluid/electrolyte balance. how much fluid to give and how fast. catheter types and thier uses. preperation, insertion, securement. how to examine for patency. what to do when it goes wrong. and the list goes on. its my opinion, given the dumbing down of ems curriculum nationwide, that the bls version of this course material would amount to maybe 10hrs of lecture, a few pokes at the rubber arm and a card to put in your wallet. while i strongly believe that 95% of the basic out there could handle this skill, the other 5% ruin it for you.

case in point: a rural system has just authorized bls iv therapy. bls truck get call for c/p. crew arrives on scene and decides to initiate an iv. they spend 40min onscene, blow every vein they could find and decide to t/p. their transport time to the H, 14min. while this may be the exception to the rule, it still happens. and yes, maybe it happens with -p's too but not as much.

not every pt needs a line just "because i can". there are physiological considerations that need to be factored in. now i under stand that there are plenty of services that use -iv or -i crews that start hundreds of lines every day. but you have to have a need, not just a toy you want to play with.

as we all said in the magill thread, if you want to be a medic, go to medic school. learn how to do this stuff well and you be a better tech for it.

I completely hear you-- I am not arguing that Bs should be able to put in IVs. I do know Basic services in MA that carry IV supplies and only Basics, but they are ALSO trained either as ER-Techs or Phlebotomists (sp?). Some of the hospitals in the area like to have blood drawn when the patient arrives and TRAINED basics are happy to do this.
Is your distrust of Basics with needles an issue with the amount of time that IVs are covered in class-- or not knowing A/P? I agree that for some Basics it is another toy and is often misused, but with proper training, would you support it?

 

[Ridryder911]

Okay.. We need to ask ourselves what reasons IV's are initiated in the first place.

There are only two reasons:
Fluid replacement
Route to administer medications

That's it.. now, with that in hand, can a basic really diagnose and treat those that need fluid replacement, as well as other have discussed of having the understanding of physiology behind them? If one is going to learn fluids & electrolytes, and IV therapy then one would no longer will be a basic, would they?

Pharmacology, as represented in other posts Basics have no reason to administer (not assist) medications per IV. Period.

R/r 911

 

[KEVD18]

aloow me to clarify. its not that i dont trust basics to start lines. i am a basic. i can start a line, monitor it, push meds through it, dc when necessary. my lack of faith is in the system. i dont believe -iv programs will cover enough of the anciliary information to make it a safe situation. the a/p, fluid/electrolyte balance, med administration, imho, wont be covered. it would(or is in some cases) taught as purely a mechanical skill with none of the medicine behind it.

24hrs in the classroom and 15 starts? we did over 40(maybe more i wasnt counting) and by the time i leave my clinical rotation i will have an average of 300+. thats the diff betweenreal training and just throwing a skill and hoping it sticks.

"I do know Basic services in MA that carry IV supplies and only Basics, but they are ALSO trained either as ER-Techs or Phlebotomists (sp?). Some of the hospitals in the area like to have blood drawn when the patient arrives and TRAINED basics are happy to do this."

it is entirely possible that this type of thing is happening in the western part of the state(illegaly i might add) but there is no way this is going on east of 495. this isnt even a grey area. this is blatantly outside ma bls protocols and is ground for immediate revocation of certification regardless of certification as a phlebotomist or ed tech. these certs do not carry over into mass ems in anyway.

 

[BossyCow]

My state does have a cert for EMT-B- IV. It is an additional class and requires prior permission of the MPD before you can take it. We are a BLS agency and our ALS is about 30 miles away. Once an IV is started, we must call for ALS support. The advantage is that when we do meet ALS, generally on the side of the road, the IV access has already been acquired and generally done before leaving the scene, in a more well lit, unbouncy environment.

Bad IV starts, blown veins, and repeated failures are signs of poor skills. Regardless of the level of certification, the level of skill is below par. There is no need to turn a Pt into a purple pin cushion.

Also, once the IV certification has been added to EMT-B, according to our protocols, the EMT then has to recert at the EMT-I level from then on. So the standard of education and testing is higher.

 

[Flight-LP]

This again falls into the "can vs. should" issue. As Rid stated there is limited TRUE REASONS to start a line and when it is TRULY needed, then it REQUIRES someone who can utilize the forethought and critical thought process to interprete and understand WHY they are doing it. Not a common occurance in the BLS environment......................

It can't be justified, no matter how hard you try.................

 

[emtmomof2]

As a volunteer EMT-b here in Jersey, we are not allowed to administer IV. Personally i wouldn't want to anyway...leave that to the medics.

 

[Gbro]

The intent of this thread is to show that there are BLS services that Have IV skills, and that it should be looked at as a good thing.
This site "could" be a place for those using skills like IV, And other base line procedures to find a comfortable place to discuss situations that have been encountered, or are likely to be encountered. A place to find support for their skills, and gain confidence in the use of these items carried on their rigs.
The Medic's (EMT-P's) could be very valuable in instilling confidence in these BLS providers.

Lets look at the positive side for now, Please?

 

[Flight-LP]

There isn't a positive side to it. It is not justified, that is a fact. Emt-B's are incapable of providing pseudo ALS care. Again, a proven fact (hence why after many years of existance, the DOT ciriculum has not included ALS skills for a BLS provider). Keep bringing it to the table, you will see that our beliefs and views will not waiver. Collectively, your beliefs are not recognized by industry experts, ER physicians, or the medical community as a whole. I fail to see any productive reason for you to continue on what WILL be a failed crusade. You just do not have the backing and our patient's care is too valuable to allow someone with under 200 hours of training taught at an 8th grade level to perform invasive procedures. SIMPLE AS THAT. There IS nothing more than can be said about it, period.

/rant...........Have a great evening!

 

[reaper]

In Florida basics can "start" IV's, in the presence of a medic. They cannot run fluids, cannot push meds, and cannot ride with the pt.

They do have to go through extensive IV therapy training and it is still up to the med dir. to allow this.

Our system does allow basics to start IV's, we are one of the few around. Yes, this does help out on scene, that they can do IV's. But, there is no way I would want to let them do this on their own, on a BLS unit.

As was said before. If you want to preform ALS skills, then go to medic school just like the rest of us had to. There is so much you do not understand about IV therapy to be allowed to preform this skill without supervision.

 

[bstone]

I think that learning the basics of IV therapy should be part of the Basic cirriculum- if only to be able to assist medics and demystify this fundamental part of ALS. Of course this would add additional time to the BLS course so it's probably been considered and dropped.

 

[focal06]

I just started my ride time on an ALS truck here in florida and we have an EMT-B on the truck who just finished "IV school" (2 day course) and she started two lines in front of me and gave fluids in presence of a medic. I dont think its a bad thing really, she did a good job..thats my .02.

 

[ffemt8978]

Can anyone name one instance where an IV saved a patient's life?











Didn't think so. I'm an EMT-ILS, which means that I can start IV's or IO's, and push Narcan or D50 via these routes, or administer Albuterol, NTG, Epi-pen, activated charcoal. Personally, I don't feel that the physiology or pharmacology was in depth enough for what we administer. In addition, we breezed over acid-base balance. I blame the dumbing down of curriculum for this. Too many people consider IV's to be a routine part of EMS, or a basic skill for an advanced provider. What they are forgetting is that it is not a basic skill for a basic provider.

That being said, I can see a use for people who can start IV's to assist an ALS provider in certain areas. I know that in the ideal world, every rig would be an ALS unit, but that isn't going to happen any time soon. Smaller, lesser funded department have to make due with what they have.

 

[Ridryder911]

I just started my ride time on an ALS truck here in florida and we have an EMT-B on the truck who just finished "IV school" (2 day course) and she started two lines in front of me and gave fluids in presence of a medic. I dont think its a bad thing really, she did a good job..thats my .02.

You should understand the process of an IV is a skill. A monkey could be taught the process (yes, they can use their thumbs) but; to understand and have the knowledge of why, when and the risks of what happens when we do establish one. One needs to understand the pathophysiology that every time we administer fluids, (no matter if they need it or not) we are changing homeostasis.

As in my state, Basics are required to have a "working knowledge" of IV's. This being on how to spike a bag (set up) as well they are tested on IV drips etc, since they are able to transport them (monitor them).

R/r 911

 

[focal06]

You should understand the process of an IV is a skill. A monkey could be taught the process (yes, they can use their thumbs) but; to understand and have the knowledge of why, when and the risks of what happens when we do establish one. One needs to understand the pathophysiology that every time we administer fluids, (no matter if they need it or not) we are changing homeostasis.

As in my state, Basics are required to have a "working knowledge" of IV's. This being on how to spike a bag (set up) as well they are tested on IV drips etc, since they are able to transport them (monitor them).

R/r 911

I realize this, However all Im saying is, If you know how to do it and the medic "ok's" it I dont see the problem in letting the bls provider do it. The only thing the EMT-B is allowed to do with this "certificate" is administer fluids anyways. They are not pushing drugs, that is out of thier scope of care, but if administering fluids can be "taught to a monkey" then whats the problem letting an EMT-B do it?