# What is your protocols for admin of IV NS



## rhan101277 (Jan 26, 2009)

I wanted to get some feedback on this.  I have never been on a ALS call where normal saline wasn't administered.  It must be a pre-cautionary measure for any call.  I guess giving it can't hurt since if its not needed the kidneys will filter it out.  Just wanted to see what others though.

We simply just don't give high flow 02 for those that don't need it, so why is this an exception?


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## medic417 (Jan 26, 2009)

rhan101277 said:


> I wanted to get some feedback on this.  I have never been on a ALS call where normal saline wasn't administered.  It must be a pre-cautionary measure for any call.  I guess giving it can't hurt since if its not needed the kidneys will filter it out.  Just wanted to see what others though.
> 
> We simply just don't give high flow 02 for those that don't need it, so why is this an exception?




Are they just starting IV's to start them?  If so that is bad practice.  Also NS can be harmful you can throw the how system out of whack, you know screw up the electrolytes and such.  Some systems do the IV's to try and bump payment rates to ALS level but it is fraud.


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## divinewind_007 (Jan 26, 2009)

at my service we usually start a saline lock and draw blood most everyone that will allow it...except for certain situations such as 4am tooth pain...but we dont hang a bag unles we need it


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## tazman7 (Jan 26, 2009)

our system wants an iv on everybody unless they are already flooded with fluid, then you just need to be careful in how much you give. Kidneys dont always filter out excess fluids. It is possible for the fluid to get backed up into the lungs.

Alot of times the ed nurses complain if you dont bring them in with an iv..

Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint. If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help? They could drive themselves for cheaper.. If you get in my ambulance you better have a good reason for me to not stick you with an iv...its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurts or you can go get you arm botched by some careless nurse in our ed..


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## rhan101277 (Jan 26, 2009)

Yeah I forgot about the electrolytes if they are well hydrated.  But 1 IV bag is how many ounces?


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## tazman7 (Jan 26, 2009)

1000ml in a bag.
There is more to worry about then electrolytes.


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## triemal04 (Jan 26, 2009)

tazman7 said:


> Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint. If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help? They could drive themselves for cheaper.. If you get in my ambulance you better have a good reason for me to not stick you with an iv...its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurts or you can go get you arm botched by some careless nurse in our ed..


So...what's a good reason to not get an IV?


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## reaper (Jan 26, 2009)

Sorry, I do not start IV's unless I am giving meds or they really need fluids. To start an IV because you can or because you are afraid the ER nurse will yell at you, is not professional or ethical.

If they need it, then do it. If they don't, leave them be!


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## tazman7 (Jan 26, 2009)

tazman7 said:


> Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint.



Reaper,  maybe i worded that wrong.
I never said dont follow protocol...


If I just stuck people even if they didnt need it do you think I would be able to keep my license...

And alot of times giving a little fluid bolus of ns and some o2 to someone will make them feel alot better anyways..  You think 80 year old grandma couldnt use a little hydration...


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## Epi-do (Jan 26, 2009)

tazman7 said:


> Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint. If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help? They could drive themselves for cheaper.. If you get in my ambulance you better have a good reason for me to not stick you with an iv...its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurts or you can go get you arm botched by some careless nurse in our ed..



Oh, where to start.  First of all, not every complaint needs an IV.  Alot of the time, an asthmatic does need a neb treatment, but nothing else.  Why would you start an IV on them?  Or what about the peds patient who's mom called because he/she stuck a bead up their nose or might have swallowed a coin?  There are plenty of patient's out there that there is no good reason for starting an IV on them.  They simply do not need it.  Part of the job of a paramedic is knowing when NOT to do something.

As for why some people call for help...Maybe they just want the reassurance that they are doing the right thing.  New parents are easily spooked, especially if they haven't spent much time around babies/kids.  We've all been on the little old lady (or man) that is just lonely and wants some company, even if it is only for 15-20 minutes.  We will never know why some people choose to call EMS, but they do.  Just because they pick up the phone, it does not mean that they all need XYZ procedure/treatment.


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## tazman7 (Jan 26, 2009)

Ok let me rewrite my post...

 Im not saying to jump out of the ambulance with a tournaqit in one hand and a 18ga in the other am I? I never said dont follow protocol. Yeah your right an asthmatic might just need a neb treatment... or a pediatric might not need an iv...honestly if I can avoid giving a kid an iv i will..just for the simple fact that i dont want to miss and its alot easier with more hands holding the child down to do it. But if the child needs it or needs some kind of med your damn right i will stick them.

But how is every kind of med in the ambulance besides 2 (on our ambulance at least) given...by iv.

So are you saying that on a call for abdominal pain your not going to start an iv because you prob wont end up giving any kind of pain meds anyways.....

But what I am saying, is yes if I think an iv is needed im not afraid to start one.

Reaper, my thinking on what is unprofessional or unethical is the paramedic that doesnt want to use all the tools in the back of the ambulance on the pt. If they just wanted a ride to the hospital then they would have called a taxi not an ambulance.


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## Sasha (Jan 26, 2009)

> If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help?


Because to them it's an emergency and sometimes people just don't know what else to do. That doesn't mean they warrant an IV, especially if they decline the IV. 



> If you get in my ambulance you better have a good reason for me to not stick you with an iv


They need no other reason besides the fact that it's their body and they said no.



> its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurt


Purely anecdotal, but the last person who told me that they're always told their IVs don't hurt, stuck my tendon the first time, and the second time started it over a knuckle. Both times they hurt like a witch.


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## medic417 (Jan 26, 2009)

Sasha said:


> Because to them it's an emergency and sometimes people just don't know what else to do. That doesn't mean they warrant an IV, especially if they decline the IV.
> 
> 
> They need no other reason besides the fact that it's their body and they said no.
> ...



Good answer.  Tell her whats shes won Chuck.

A patient has the right to refuse any procedure.  Its just like backboarding.  Some say if they are trauma they will be backboarded or they can not go in the ambulance.  Bull.  Patient says no, have them sign refusal of that treatment then take care of any other problems they have.  

IV's just because is just sadistic.  Plus it even puts the provider at additional unnecessary risk of exposure.  No matter how good you are something could go wrong.


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## tazman7 (Jan 26, 2009)

Never said to give an iv just because. Thats why I rewrote my post, is because thats kinda how i made it sound..

What I am saying is you have to follow protocol and if a pt shows the need for an iv, I am going to start one. im not just going to stick anybody and everybody, but if I think there is potential for them crashing or if they are in need of fluids, I will stick them. I would rather have an iv in and not really need it then to have to stick them while they are crashing.

Your right though, they can refuse all they want to. But sometimes people need a little "push" to get them to do the right thing.


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## Sasha (Jan 26, 2009)

tazman7 said:


> Never said to give an iv just because. Thats why I rewrote my post, is because thats kinda how i made it sound..
> 
> What I am saying is you have to follow protocol and if a pt shows the need for an iv, I am going to start one. im not just going to stick anybody and everybody, but if I think there is potential for them crashing or if they are in need of fluids, I will stick them. I would rather have an iv in and not really need it then to have to stick them while they are crashing.
> 
> Your right though, they can refuse all they want to. But sometimes people need a little "push" to get them to do the right thing.



A little push as in commiting battery?


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## rmellish (Jan 26, 2009)

Epi-do said:


> Oh, where to start.  First of all, not every complaint needs an IV.  Alot of the time, an asthmatic does need a neb treatment, but nothing else.



I would probably make sure I had access. If the nebs don't take well there's always IV steroids, either in the truck or the ER depending on protocols.

Disclaimer: nebs are out of my scope, so I'm just armchair quarterbacking this one.


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## csykes (Jan 26, 2009)

Treat the patient and no the protocol is basically what ours says, save for hypovolemia-maintain systolic at or above 90 with LR and NS. burns-parkland formula with LR and NS.  ped sepsis- 5 boluses based on weight before pressors come into the game.  If a medic deems it necessary to give 2 liters that is fine.  Just when bolusing big, monitor lung sounds.


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## tazman7 (Jan 26, 2009)

Sasha said:


> A little push as in commiting battery?



 Yeah, what you have to do is get in their face and scream profanity at them and tell them they have no other choice.... then pick out a 14 ga needle or an io and show it to them and then start stabbing around so you can commit assault and battery at the same time...

Are you kidding me? Battery?  What I mean by "push" is sometimes a pt will say well I dont think I need to go to the hospital, I have chest pain like this all the time. Or the call for the pt who fainted but says she feels fine now and doesnt want to go to the hospital...im sure you will be learning this sometime in medic school that SOME pts need to be talked into going to the hospital. not everybody is willing or thinks they need to go to the hospital...

And some people dont think that they need an iv, because they know nothing about medical stuff, and they dont realize that the reason you want to give them an iv because you see a firemans hat on the monitor and you dont really want to come out and say "look mrs. johnson, the monitor is showing a firemans hat, that could mean that you at having a heart attack!"


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## Ridryder911 (Jan 26, 2009)

Technically only two reasons: Giving fluids and or route for medications. 

Now that said, approximately 90% of our patients get an a IV. The reason is simple, our medical director wants them to have one. He feels that it is a lifeline for multiple reasons and weighing the risks vs. the benefits; he much rather of with having a saline lock. 

Our ED is busy (alike all others), and alike others it usual standard of care to obtain immediate labs, and route for analgesics, antibiotics, etc...

R/r 911


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## tazman7 (Jan 27, 2009)

Ridryder911 said:


> Our ED is busy (alike all others), and alike others it usual standard of care to obtain immediate labs, and route for analgesics, antibiotics, etc...
> 
> R/r 911




Hence the reason why I said the nurses get mad at you....I have been asked quite a few times why is there no iv? What did you do to help this pt?  And that was by a dr...


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## jochi1543 (Jan 27, 2009)

I think we've only had 1 IV started on the last 50 calls and the physician/nurse never complained about us not starting one. However, many of our calls have a minimal transport time, so there simply isn't an opportunity. The only drug we give IV is D50W, so our IVs are mostly for fluid resuscitation and as a precaution (as with nitro administration). For that matter, we don't really start an IV on a medical pt very often.


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## rmellish (Jan 27, 2009)

tazman7 said:


> Yeah, what you have to do is get in their face and scream profanity at them and tell them they have no other choice.... then pick out a 14 ga needle or an io and show it to them and then start stabbing around so you can commit assault and battery at the same time...
> 
> Are you kidding me? Battery?  What I mean by "push" is sometimes a pt will say well I dont think I need to go to the hospital, I have chest pain like this all the time. Or the call for the pt who fainted but says she feels fine now and doesnt want to go to the hospital...im sure you will be learning this sometime in medic school that SOME pts need to be talked into going to the hospital. not everybody is willing or thinks they need to go to the hospital...



Agreed. 

I usually explain that I'm simply trying to do my job (if the IV is indicated of course), you can't force them, but with a little explanation most everyone agrees to it. In fact, I don't think I've ever had a patient refuse an IV, in fact most expect to get one when there's an ambulance called. I can remember a number of instances where I had to explain why a patient wasn't getting one when I was a basic.


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## Juxel (Jan 27, 2009)

We have extremely conservative fluid administration protocols because our QA department was finding that people were giving boluses because "grandma is old, she can use fluid" only to find out that grandma is in renal failure.  That's just one example.

That's a terrible reason to give fluid.  If grandma's pressure is low or she is obviously dehydrated (hx of n/v, diarrhea, unable to keep fluids down), then sure, give her a bolus.  If you are doing it because "she's old, it won't hurt", you won't have a job here for long.

In adults, we only administer boluses if the SBP is <90 and then the first bolus is 500ml (250ml if over 65 or hx of CHF).  We don't even carry liter bags.  We carry 250cc and 500cc bags so someone can't open a bag up and forget about it.

When I'm working in the ED I'm similarly conservative with my stable patients.


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## DarkHuntressMedic (Jan 27, 2009)

Maybe I'm just simple but start and IV if its needed, or foreseen to be needed. A key part of your job is being able to recongize and act or not act.

Use fluids when you need them. If you don't know when NSS is needed, you have more issues then we can help.

There is always a saline lock option also. 10cc flushes work well to move the meds through the cath into the vein... if you need more then that- attach a bag. 

Stay safe out there


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## BLSBoy (Jan 28, 2009)

Every pt gets a lock. 
Pts needing fluid get...... FLUID! 

Of course, I only see ALS calls, so of course, the toe pains don't get IVs.


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## medic417 (Jan 28, 2009)

BLSBoy said:


> Every pt gets a lock.
> Pts needing fluid get...... FLUID!
> 
> Of course, I only see ALS calls, so of course, the toe pains don't get IVs.



Wow is your dispatch so good that you actually only see patients in need of ALS?


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## BLSBoy (Jan 28, 2009)

medic417 said:


> Wow is your dispatch so good that you actually only see patients in need of ALS?



In Jersey, MICUs are dispatched to ALS calls only. ^_^


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## marineman (Jan 28, 2009)

We actually rarely hang a bag. Cardiac problems, dehydration and trauma are the majority of the times that we'll hang a bag and even then I've only been on 1 call so far that they ran anything more than TKO rate. 

On the other side usually the senior medics are better at this but they have a pretty good feeling if the hospital will want an IV when they get there or not. If they think the hospital will want an IV but it doesn't fall into a category above we will start a lock, otherwise we let them be. Also if the veins are questionable or the patient is apprehensive we will skip on the lock and let the hospital deal with it, don't want to stick and miss.


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## medic417 (Jan 28, 2009)

That sucks as dispatch could be wrong.  ALS should be the standard for all responses.  No offense to basics but the "training" is not sufficient to actually determine true status of a patient.  Plus if they need advanced care sending basics delays proper care.


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## BLSBoy (Jan 28, 2009)

medic417 said:


> That sucks as dispatch could be wrong.  ALS should be the standard for all responses.  No offense to basics but the "training" is not sufficient to actually determine true status of a patient.  Plus if they need advanced care sending basics delays proper care.



EMD is usually pretty good at screening callers. 

Since there are only 4 MICUs and 2 MICU/CCT trucks for the entire county, skill retention is quite high. 

Not every pt is ALS.


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## medic417 (Jan 28, 2009)

BLSBoy said:


> EMD is usually pretty good at screening callers.
> 
> Since there are only 4 MICUs and 2 MICU/CCT trucks for the entire county, skill retention is quite high.
> 
> Not every pt is ALS.



But it should be confirmed with ALS then downgraded to BLS.  Less likely mistakes would be made that way.


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## BLSBoy (Jan 28, 2009)

medic417 said:


> But it should be confirmed with ALS then downgraded to BLS.  Less likely mistakes would be made that way.



Caller calls for a ride to the hospital, or toe pain, or arm pain, there is absolutely no need for ALS. 

The run through the is the pt conscious, breathing, etc.


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## medic417 (Jan 28, 2009)

BLSBoy said:


> Caller calls for a ride to the hospital, or toe pain, or arm pain, there is absolutely no need for ALS.
> 
> The run through the is the pt conscious, breathing, etc.




Until a hands on exam by someone with some education there is no accurate way to determine if a call is BLS or ALS.  All those flash cards with questions mean nothing.  A person calls ALS should respond.  If found to be BLS, send for BLS.  If the patient really does not need an ambulance the ALS provider should inform the person they do not need an ambulance and they will need to find another means of transport.


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## rmellish (Jan 28, 2009)

BLSBoy said:


> Caller calls for a ride to the hospital, or toe pain, or arm pain, there is absolutely no need for ALS.
> 
> The run through the is the pt conscious, breathing, etc.



Yeah, EMD algorithms are great if you're running with a limited number of ALS units.


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## medic417 (Jan 28, 2009)

rmellish said:


> Yeah, EMD algorithms are great if you're running with a limited number of ALS units.



Actually they have been proven to be a failure point of many a syatem that has tried them.  It sounds as if your system needs an upgrade.


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## BLSBoy (Jan 28, 2009)

You have no clue about NJ EMS do ya?
Not trying to come off like an ***, but we are.......different.


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## rmellish (Jan 28, 2009)

Truthfully we have a fair number of errors, but I think we're slightly better off than we would be otherwise. Are there anything statistical floating around which points out these shortcomings?


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## medic417 (Jan 28, 2009)

BLSBoy said:


> You have no clue about NJ EMS do ya?
> Not trying to come off like an ***, but we are.......different.



Actually that is what is wrong with EMS in the USA, everyone thinks they should not come up to proper standards.  Based on the many reports about the poor state of EMS in Jersey different is an understatement.


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## marineman (Jan 28, 2009)

The biggest downfall of EMD is that you're essentially making a diagnosis based on a laypersons perception of the incident. Due to poor information given to dispatchers we have been dispatched non emergency to a PNB and we more often get dispatched emergency to someone that cut their finger while making supper. One trigger I know of that will kick out an emergency response is spurting blood, to a lay person that has never seen a real severed artery spurting blood is exactly what they see. Not a perfect system but it usually works pretty well.

ALS vs BLS debate I could go either way and it would depend on the entire setup of your system as to which would work most efficiently but generalizing saying that ALS should always be dispatched first I cannot agree with.


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## BLSBoy (Jan 28, 2009)

Would I like to see more ALS? Sure. 
I would also like to see EMTs educated better. 

Most of the calls up here are flagrant abuse of the 911 system. No need for anything more then a taxi, let alone ALS.


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## medic417 (Jan 28, 2009)

marineman said:


> The biggest downfall of EMD is that you're essentially making a diagnosis based on a laypersons perception of the incident. Due to poor information given to dispatchers we have been dispatched non emergency to a PNB and we more often get dispatched emergency to someone that cut their finger while making supper. One trigger I know of that will kick out an emergency response is spurting blood, to a lay person that has never seen a real severed artery spurting blood is exactly what they see. Not a perfect system but it usually works pretty well.
> 
> ALS vs BLS debate I could go either way and it would depend on the entire setup of your system as to which would work most efficiently but generalizing saying that ALS should always be dispatched first I cannot agree with.



You even state dispatch gets it wrong.  So why not err on side of caution and start with an ALS exam.  Honestly with the limited "training" basics have they are not qualified to decide whether to allow it to stay basic or needs upgraded.  

I have been dispatched many times for welfare check to find someone on deaths door.  Had our service used a basic crew patients would have died.


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## marineman (Jan 28, 2009)

Some areas have many BLS crews that can manage a 5 minute response time with fewer ALS crews with an average response time of closer to 15-20 minutes. The way I see it getting any level of care there soon is better than a higher level later. 

I will agree with you that in the perfect little world that exists in my head all ambulances would be ALS and we would all have an education that rivals the best R.N. programs in the world but that simply isn't possible in all areas at the current time.


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## medic417 (Jan 28, 2009)

marineman said:


> Some areas have many BLS crews that can manage a 5 minute response time with fewer ALS crews with an average response time of closer to 15-20 minutes. The way I see it getting any level of care there soon is better than a higher level later.
> 
> I will agree with you that in the perfect little world that exists in my head all ambulances would be ALS and we would all have an education that rivals the best R.N. programs in the world but that simply isn't possible in all areas at the current time.




So you are agreeing then that ALS should be first response.  I hope that soon it becomes the standard everywhere.  I would hate to be some where and my family have a real emergency and only get a BLS response.


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## marineman (Jan 28, 2009)

Yes I agree that ALS should be the only response end of story, however I understand that it's just not possible in all areas right now so I give every system the benefit of the doubt that they're doing the best they can with the hand they've been dealt.


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## BLSBoy (Jan 28, 2009)

Ask Florida and Cali how the all ALS thing went........


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## marineman (Jan 28, 2009)

It's still a flawed system in general in those two states. That's why I do still agree with BLS in the system as it stands but would like to see changes in general that would solidify the system to support an entirely ALS response.


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## BLSBoy (Jan 28, 2009)

The only thing I would like to see is a few more ALS units, and better training for EMTs. 

Rare is it that BLS gets on scene, and needs to call for ALS.


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## medic417 (Jan 28, 2009)

BLSBoy said:


> The only thing I would like to see is a few more ALS units, and better training for EMTs.
> 
> Rare is it that BLS gets on scene, and needs to call for ALS.



I would bet it is more often than you realize.  BLS providers are not educated enough to determine who needs ALS.  If all EMTs upgraded to Paramedic we would not even have a discussion like this.


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## marineman (Jan 28, 2009)

BLSBoy said:


> The only thing I would like to see is a few more ALS units, and better training for EMTs.
> 
> Rare is it that BLS gets on scene, and needs to call for ALS.



That may be your system but not at all the case across the country. On a BLS unit in Milwaukee if we administer any drug other than O2 we have to call for ALS to transport.


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## BLSBoy (Jan 28, 2009)

medic417 said:


> I would bet it is more often than you realize.  BLS providers are not educated enough to determine who needs ALS.  If all EMTs upgraded to Paramedic we would not even have a discussion like this.



Like I said, go to Florida, or Cali, and see how well that went.


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## BLSBoy (Jan 28, 2009)

marineman said:


> That may be your system but not at all the case across the country. On a BLS unit in Milwaukee if we administer any drug other than O2 we have to call for ALS to transport.



Then they needed ALS to begin with. 

What works in NYC won't work in rural Kansas, won't work in suburban Jersey. 

What we have works for us. 

Granted, EMTs need a better education, and we could use another ALS unit per county, but other then that, we have pretty damn good EMDs who screen each call well.


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## medic417 (Jan 28, 2009)

LOL.


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## ffemt8978 (Jan 28, 2009)

Get back on topic....


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## tazman7 (Jan 29, 2009)

The way we do it in our district is, if there is a medical call in a little town near us we will tone out their volunteer firefighters for the call. We will then leave at that same time to go to the call..sometimes they beat us other times they dont. ( I honestly think its a waste of taxpayers dollars to send these clowns out there but thats another topic.) But the problem with this is that there are only a couple emts (if thats what you call them) on their depts and they are guys that went through emt school 40 years ago and think they know everything. So then by the time we get there we basically just push them out of the way and tell them to hold doors open on our way out..

Last call I went on was for a stroke pt. We show up, the whole crew they sent is sitting at the kitchen table having coffee with the mans wife!!!! We look in the bedroom and the man is laying on his bed, barely breathing we sit him up, he cant even remember his name, sob, facial drooping, one sided weakness, you name it he had it...well the guy about died from this stroke he was having... and here you are sending a bls crew that doesnt know adam from eve and they think its a coffee shop...

Thats why i think als needs to be sent, and basics need alot more education.


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## emtidon (Jan 30, 2009)

Epi-do said:


> Oh, where to start.  First of all, not every complaint needs an IV.  Alot of the time, an asthmatic does need a neb treatment, but nothing else.  Why would you start an IV on them?  Or what about the peds patient who's mom called because he/she stuck a bead up their nose or might have swallowed a coin?  There are plenty of patient's out there that there is no good reason for starting an IV on them.  They simply do not need it.  Part of the job of a paramedic is knowing when NOT to do something.
> 
> As for why some people call for help...Maybe they just want the reassurance that they are doing the right thing.  New parents are easily spooked, especially if they haven't spent much time around babies/kids.  We've all been on the little old lady (or man) that is just lonely and wants some company, even if it is only for 15-20 minutes.  We will never know why some people choose to call EMS, but they do.  Just because they pick up the phone, it does not mean that they all need XYZ procedure/treatment.


Well stated and like the quotes


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## emtidon (Jan 30, 2009)

marineman said:


> Some areas have many BLS crews that can manage a 5 minute response time with fewer ALS crews with an average response time of closer to 15-20 minutes. The way I see it getting any level of care there soon is better than a higher level later.
> 
> I will agree with you that in the perfect little world that exists in my head all ambulances would be ALS and we would all have an education that rivals the best R.N. programs in the world but that simply isn't possible in all areas at the current time.



I live in one of those areas in ND.We are lucky in the fact that most of our crew in my area are I-85 and Paramedic.We also have a Paramedic Quick response unit that gets dispatch on all our calls.I think in most cases the higher the level of response the better the outcome for the patient,as long as they are competent.I would rather see a good emt-b on a call than a not so good I or Paramedic.Because when you get right down to it we all are supposed to go for A B C first and after that its all gravy.


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## Ridryder911 (Jan 30, 2009)

Epi-do said:


> Oh, where to start.  First of all, not every complaint needs an IV.  Alot of the time, an asthmatic does need a neb treatment, but nothing else.  Why would you start an IV on them?  Or what about the peds patient who's mom called because he/she stuck a bead up their nose or might have swallowed a coin?  There are plenty of patient's out there that there is no good reason for starting an IV on them.  They simply do not need it.  Part of the job of a paramedic is knowing when NOT to do something.
> 
> As for why some people call for help...Maybe they just want the reassurance that they are doing the right thing.  New parents are easily spooked, especially if they haven't spent much time around babies/kids.  We've all been on the little old lady (or man) that is just lonely and wants some company, even if it is only for 15-20 minutes.  We will never know why some people choose to call EMS, but they do.  Just because they pick up the phone, it does not mean that they all need XYZ procedure/treatment.



Although I agree not every one warrants an IV, I highly suggest an Asthmatic gets one. Ever seen turn bad quickly? Try to get one then. Same, if they have a reaction to the updraft. Sorry, if they get a med, they get at least a lock and a monitor. 

If the people call for whatever; then you should do a better assessment. If it is loneliness, then a social worker or adult protection should be notified. 

I do agree: *Treat you patient, not a protocol and do not make your patient fit a protocol, protocols should fit your patients needs. *




BLSBoy said:


> Like I said, go to Florida, or Cali, and see how well that went.



Well, see who the primary provider(s) are in those states, and now we can see why it went that way.


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