# EMT-Bs and IV therapy



## LucidResq

Out here in Colorado EMT-Bs can take a quick and dirty course (mine was about 24 hours lecture with an 8-16 hour clinical rotation, some are shorter) to get "IV approval" allowing them to start peripheral IVs and administer crystalloids such as normal saline and lactated ringer's as well as D50 and Narcan (curriculum teaches intranasal admin but medical directors may allow for IV narcan admin). 

Any opinions on this? I just completed the course but still need to do my clinical rotation. I've gotten 5 or so successful sticks on other students in class, but I'm pretty nervous to stick a patient.


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## KEVD18




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## JPINFV

IVs? Go directly to medic school (or other appropriate health profession school such as nursing or medical). Do not pass go. Do not collect $200.


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## Jon

OK... I think 24 hours to teach the "monkey skill" of IV initiation is a little light - depends on how many additional clinical hours are required, etc.

I don't have that much of a problem with it - I mean the US Army has EVERYONE now trained on IV initiation. I'm cool with Saline and Narcan... but I question D50. Why not just teach you how to do an IM and give you Glucagon (Heck a Google search shows studys showing that IN - by nose - glucagon works OK). D50, given through a non-patent IV, can cause all sorts of tissue damage... and I've seen medics have that problem... I'd be worried about EMT's with an additional 24 hours of education.

I guess the bigger question is "Why?". Why does the EMT-B need this skill set?

The only answer I can think of is if it was the EMT-B partner to a paramedic... that way, I can get an IV while my partner gets the tube. But we manage OK without that now.


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## Airwaygoddess

*"Fast forward"*

Only 24 hours of classroom time and 8 to maybe 16 hours of clinical?  I'm sorry, but is this type of "training" that gets  EMT-B's into trouble.  If something of that magnitude is going to be taught, then why in the world should it be taught with such haste and almost too little theory involved?  Not to mention the understanding of pharmacology.    It is one thing to be able to stick a healthy person in class.  It is a completely different story when it comes to someone that is very sick or critically injured.  Dehydration, disease processes, and shock are only a few problems listed here.  One of the first things that go out the window are the patient's veins, period.

     I am also an EMT-B (Here in California we are called EMT-1)  but I strongly believe that certain skills are meant to in the scope of an EMT-I and definitely for the scope of practice of EMT-Paramedic.  I think it is very important to keep up to date the latest theory and continuing education and training, but not by taking these "fast ward"  classes.   These  skills require many more hours of theory, the practice of techniques, and many observed patient contacts than just the days and hours as mentioned above. 

                       Respectfully submitted.........-_-


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## fma08

I'll  admit, going through medic school, before we were allowed to start IV's during clinicals, we probably had similar hours of lecture and lab. (Don't misunderstand, that is just on starting and maintaining IV's, NOT pharmacology). But then, we were practicing in our clinicals for the rest of the year. So I can see, the theory of JUST starting IV's in that amount of time... eh maybe. But, definitely as far as med administration and such, needs to be waaaaaaaaaaayyyyyyyyy longer and waaaaaaaaayyyyy more clinical hours. Pharmacists don't get their degree's over night and there should be no short cuts either in EMS for things like this that can easily make a patient get worse or dead. (Intubation and other ALS skills included). Like mentioned before, practicing on healthy partners in class is one thing, but the little old septic lady, or obese diabetic with lymph edema is another story. 

Glad to hear you are interested in advancing your knowledge and skill set though. 


Respectfully my 2 cents.


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## rmellish

Well, I'm currently finishing up EMT-Basic-Advanced over here in Indiana.It's a subsequent certification which replaces EMT-B, and adds IV access and basic 3-lead monitoring (7 rhythms and manual defibrillation). I dont have the actual didactic hours, but its as long as EMT-B was. 

Our IV access includes normal peripheral IVs and EJs, normal saline, D5w, and ringers. We cannot administer any more meds than an EMT-B, but we can check a blood glucose level. 

All in all its not a bad certification. It was offered free through one of the services I work for, so I took advantage of it to get more IV practice before I go off to paramedic. 

Its still no replacement for paramedic though.


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## zacdav89

*not that bad*

This class is more then this is your angiocath there’s the vain. I had to take this class at one point too. It went in to detail of the physiology of cardiovascular system, and the pharmacology around the different fluids available to the basic IV LR NS D 5W. 

It also went further in to detail with the sodium potassium pump and the cellular aspects of this skill. It also covers the pharmacology aspects of using D50 and narcan and ways to make sure that you didn’t blow the vain and how to tell.

This is also the reason why you have to do clinical hours and I know I had to personally have 20 live sticks under the eye of a skilled preceptor witch was either a medic or one of the nurses and once under the doc. This isn’t the army’s stick your fellow solider for his life class.

And don’t be nervous about your first sticks, look for all available options go for the easiest one that will give you the flow rate that you need. Start with the hands and work in, if your really not comfortable with it give it to your preceptor. And remember to remove your tourniquet. Also just review your IV class materials along with your book from time to time to keep your skills sharp and knowledge at hand for when you need it most. Good luck.


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## traumateam1

Here in BC BLS can use IV's. I cannot yet personally.. but I'm sure a PCP will discover this sooner or later and elaborate more on the issue. I do know that NS and D50, Narcan and all that, they can administer.


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## BrianJ

Jon said:


> I guess the bigger question is "Why?". Why does the EMT-B need this skill set?
> 
> The only answer I can think of is if it was the EMT-B partner to a paramedic... that way, I can get an IV while my partner gets the tube. But we manage OK without that now.



Many SAR teams use EMT-B as the baseline medical training.  When faced with a heat exhausted patient with a long transport time; IV's might have a place.  The problem seems to be that even on very active SAR teams an active volunteer might only stick a patient once or twice a year; probably not enough to keep the skill proficient.


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## mikie

I don't know the specifics of the IV 'elective' course, but what is actually taught?  Just how to start an IV or indications/contraindication, the physiology of the veins/curriculaiton system?


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## Buzz

A common thing around here is ED techs starting IVs on patients... It could have application in that setting as well.


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## mdkemt

This is slightly similar here.  But you have to get special approval as a PCP to take the course and the clinical is one day...maybe 8 hours max.

MDKEMT


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## mikeylikesit

It is OK. i am from Colorado as well, i think Colorado standard is 20 hours for an IV certification. No, you can't start centrals, or push meds, or go IO routes...but hey, most IV's in the field are just to pump NaCl anyways, might as well have someone who can do it with you. Don't worry about patients, try and do your sticks in the Dialysis center, i doubt they will complain or squirm on ya. heed this warning though, take all the tough patients while your learning in lou of the easy ones, when you get in the field in crunch time you don't want it to be your first time on a hard patient or stick.


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## LucidResq

BrianJ said:


> Many SAR teams use EMT-B as the baseline medical training.  When faced with a heat exhausted patient with a long transport time; IV's might have a place.  The problem seems to be that even on very active SAR teams an active volunteer might only stick a patient once or twice a year; probably not enough to keep the skill proficient.



FYI: my SAR team's medical director will not allow anyone regardless of level of cert to start IVs unless they are employed in some kind of capacity that has them sticking regularly. Having the IV approval will be worthless to me while working SAR until I get a job. 

And just for everyone's info... I *do* feel like the course was inadequate for what it was intended to be - a crash course in prehospital intravenous therapy. It's a lot like the EMT-B course: a lot of "what", a little "how", and very very little "why". 

The reason I took this course was to improve my chances of being hired in the hospital setting where techs often start IVs and leave the fluid-choosing, rate-selecting, and drug-pushing to the nurses and docs. And no, I'm not stopping at the EMT-B with IV level. I'm entering a BSN program in the next year or so. 

But out here, many of the ambulances staff a medic and a basic, and almost every basic has IV approval. How do you all feel about EMT-Bs starting IVs and administering some of these fluids and drugs under a paramedic's supervision?

PS thanks for the tips everyone. My clinical rotation will be completed in the ER, which is probably a good thing because it'll be more relevant and realistic, you know?


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## fcfiremedic

thats all fine and dandy until that same person starts a 20ga in the hand, checks a blood sugar, gets a reading of 'low', and tries to push D50 through it, causing severe necrosis. 

yes, i believe more time is needed, along with more ride time, and the consequences of screwing up.


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## Bosco578

fcfiremedic said:


> thats all fine and dandy until that same person starts a 20ga in the hand, checks a blood sugar, gets a reading of 'low', and tries to push D50 through it, causing severe necrosis.
> 
> yes, i believe more time is needed, along with more ride time, and the consequences of screwing up.



Actually you can admin D50W through a 20g. Yes it goes more slowly, but you can. I have done this many times, especially on Peds. Ideally 18g or bigger is best.


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## Ridryder911

Bosco578 said:


> Actually you can admin D50W through a 20g. Yes it goes more slowly, but you can. I have done this many times, especially on Peds. Ideally 18g or bigger is best.



Actually D50w is contraindicated in pediatrics as one should administer D25w or even D10w. It is too highly caustic and hypertonic and one can receive the same results with such. 

R/r 911


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## Bosco578

Ridryder911 said:


> Actually D50w is contraindicated in pediatrics as one should administer D25w or even D10w. It is too highly caustic and hypertonic and one can receive the same results with such.
> 
> R/r 911




Perhaps I should clarify Mr. Rid, children or adults (not neonates) with small veins,. My point was and is, you can admin D50W through a 20g.


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## bstone

I learned IV therapy when I went through Intermediate school. I went that the extra 140 hours was just what we needed to learn IV therapy, several IV meds, ETT and 3 lead EKG with a bunch of rhythms.


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## ILemt

So how much did this course cost to take?


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## daedalus

I would love the opportunity to take such a course. If not only to be able to start IV in the ER.


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## Blacke00

> Found a good source (I think it's current):
> 
> http://en.wikipedia.org/wiki/Emergen...-_Intermediate
> 
> 
> 
> Quote:
> Tennessee EMTs are licensed at either the EMT-IV (Intravenous Therapy) Level or the EMT-Paramedic Level. EMT-IVs are trained to the NREMT-B standard in accordance with DOT regulations, as well as receive additional training in advanced airway management, administration of Epinephrine 1:1000 in Anaphylaxis, administration of nebulized and aerosolized Beta-2 Agonists such as Xopenex and Albuterol, administration of D50W and D25W, IV Therapy and Access, and trauma life support including the use of MAST Trousers. EMT-IVs can also administer nitroglycerine and aspirin in the event of cardiac emergencies, and can give Glucagon. EMT-IVs can also administer the Mark 1 Autoinjector kit for Organophospate poisoning and suspected nerve gas exposure. The State of TN Board of EMS is currently evaluating allowing EMT-IVs to administer NARCAN and Nitrous Oxide, as well. The Board is also considering going to an Emergency Medical Responder, EMT-B, EMT-Advanced, and EMT-P format and eliminating the EMT-IV rank.
> 
> That's more than I would have expected for what would be an EMT-B anywhere else, right?



Posted this on the "scope of practice" thread...


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## Ridryder911

Bosco578 said:


> Perhaps I should clarify Mr. Rid, children or adults (not neonates) with small veins,. My point was and is, you can admin D50W through a 20g.



Gottcha...  Just wanna clarify for those that are learning. The same myth that RBC's cannot be administered through 24g IV's. Yes, it may damage if the blood volume is many and needs to administered fast, but how do you think they administer blood to neonates or than central or umbilical lines? 

R/r 911


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## emtlady76877

*EMT-B starting IVs*

I'm a EMT-B/paramedic student however I volunteer for a rurual ems that just started the protacol that EMT-Bs are going to be able to start IVs after being trained but can not push drugs or d50. However, I still have to be tested out from on our ems even though I learned it at college, which I have no problem with.


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## bstone

I believe that if EMT-Bs want to start IVs they should take a 140 hour course to become an EMT-Intermediate. That's what I did. It's another semester long and you learn the right way the hows and whys the IV therapy. Also you learn 3-lead EKG, some rhythms, what they mean, etc and (in some areas) endotracheal intubation. Other than that, I cannot see any way or reason how Basics can learn how to do IV therapy appropriately or properly.


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## Ridryder911

There are only two purposes for prehospital IV therapy. Administering fluids (hypovolemia)and IV medication. If you cannot perform either one of those, then there is *NO* reason.

If you have NOT received an in-depth course of fluids and electrolytes as well, there is NO reason for you to administer fluids. The IV meds is a gimmee... if you cannot interpret ECG's and have not had a in-depth pharmacology course, then there is no reason for an IV for medication. 

Remember, we should be able to justify any procedure we perform. Basics are not able to justify this. 

Skills are not "something" that one should be able to do. There is severe and even life threatening consequences and dangers of IV therapy that many are not aware of. 

*Again, if you want to do Paramedic procedures... then become a Paramedic.*


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## bstone

Ridryder911 said:


> *Again, if you want to do Paramedic procedures... then become a Paramedic.*



Or an Intermediate....to do Intermediate procedures.


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## apagea99

I'll be taking my course here in middle TN. I selected it on the advice of my county's EMS director who said he considers it the best in the state. It's 213 hours + labs and such and will include everything in Blacke00's post. Is 213 hours enough to learn the EMT-B skills as well as IV maintenance? For an EMT student in TN there really isn't another option for learning the skills required by the state. I know there are other programs, but eventually you have to learn IVs here in order to get your license.


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## BossyCow

We start an IV while enroute to meet up with ALS. The veins might not be there, or the pt too combative to sucessfully start one 15 - 30 minutes later when ALS is on scene.


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## IrishMedic

I have to agree with a lot of people on thread, good luck and respect for planning to further yourself in this field, but i have to say there is a reason EMT-I, Paramedic courses are long and thats because we have a responsibility to the people we vow to save..we have a responsibility to get the best training and understand exactly why we do what we do....it all come back to understanding and justifying everything we do with a patient. Unless your course extensively teaches you about pharm and Med Admin, IV Therapy etc, and you have a lot of experience sticking the tough patients, i'd search for a better course. you owe to yourself and patients, i mean on my course we had to get over 100 - 150 successful sticks before we were signed off on being proficient on doing them. we had verbally give our preceptors the indications, contra indications, side effects, routes, doses and other pertinent info before we were allowed to adminster the med...a lot of work but im happy i did it, i feel very confident now as a medic because of this training. good luck


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## mcdonl

bstone said:


> I believe that if EMT-Bs want to start IVs they should take a 140 hour course to become an EMT-Intermediate. That's what I did.



Me too... thats what I am doing.


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## EMT11KDL

LucidResq said:


> Out here in Colorado EMT-Bs can take a quick and dirty course (mine was about 24 hours lecture with an 8-16 hour clinical rotation, some are shorter) to get "IV approval" allowing them to start peripheral IVs and administer crystalloids such as normal saline and lactated ringer's as well as D50 and Narcan (curriculum teaches intranasal admin but medical directors may allow for IV narcan admin).
> 
> Any opinions on this? I just completed the course but still need to do my clinical rotation. I've gotten 5 or so successful sticks on other students in class, but I'm pretty nervous to stick a patient.



i believe also in the new rule 500, basics can also do front line cardiac and something else if an I or P is on board and tells them to push it.  Its been awhile since i worked in CO (about 2 years)


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## medicRob

Tennessee has EMT-IV as the minimum level, we spent 2 full college semesters in class + clinicals. Our EMT-IVs do a great job! I have absolutely no problem with it.


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## MrBrown

Until you can answer me the following, I am not allowing you to cannulate and infuse:

*Fluid Balance*
•  Define the boundaries of each of the three fluid compartments and state the proportional volumes typically found in each

•  Define the terms: electrolytes, ions, cations, anions. Give examples of each found in the body, and state their physiological functions. (half page)

•  Define the term non-electrolyte and give three examples 

•  Give a brief explanation of the following electrolyte disorders. Include signs and symptoms that may manifest as a result of these.
o Hyponatremia
o Hypernatremia
o Hypokalemia
o Hyperkalemia

•  Explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law.

•  Define the following terms and explain the role each process plays in human fluid dynamics.
o Diffusion
o Osmosis
o Active Transport
o Facilitated Diffusion

•  Define the following terms 
o Shock
o Perfusion
o Inotropic
o Chronotropic
o Pulse Pressure
o Mean arterial pressure (MAP)

•  Explain these complications of irreversible shock and how we may pre•  vent and help treat them.
o Renal Failure
o Acute Respiratory Distress Syndrome (ARDS)
o Disseminated Intravascular Coagulation (IDC)

•  Describe the pathophysiology, common presentation and briefly outline the management of distributive, cardiogenic and hypovolaemic shiock

•  Discuss the differences between how children and adults (particularly the aged) maintain and respond to blood pressure changes

•  Provide a definition of the peripheral resistance and stroke volume

•  What factors about a blood vessel determine its peripheral resistance?

•  During exercise stroke volume will increase. How is that achieved?

•  Explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock.

•  Blood transports a number of substances around the body. What are those substances and how are they transported in the blood

•  Pulse Oxymetry measures the oxygenation of the blood flowing through the capillary beds and peripheral tissues. Explain how this concept works and when the use of pulse oxymetry is not indicated and why?

•  Define isotonicity, hypertonicity and hypotonicitiy

List the constituent of various IV fluids and there respective tonicity.
o normal saline
o 0.45% NaCl
o 5% Dextrose
o Hartmanns

*Homeostasis Regulation*

•  Explain the Renin-angiotensin pathway and explain how homeostasis of blood pressure and volume is maintained.

•  Describe how the kidneys regulate the excretion of water in urine, and the role of the hormones ADH, and Aldosterone

*Acid / Base Balance*

•  What is the normal pH range of body fluids?

•  Define the term buffer system and list the 3 major buffer systems involved in acid / base balance

•  Briefly describe the renal and respiratory compensatory mechanisms of acid/base balance

•  A person presents with hyperventilation syndrome, classic signs of carpopedal spasm, peri-oral parasthesia. Explain the physiology that results in these signs and symptoms.

*Trauma*

•  Explain the difference between blunt trauma and penetrating trauma, the difference in the types of injuries commonly encountered and their MOI (mechanism of injury) and the difference in the management of shock occuring as a result of each.

•  Describe causes of shock, other than hypovolaemia, in trauma patients, and how to recognize and manage them.
o Tension pneumothorax
o Myocardial contusion
o Acute Myocardial Infarction
o Spinal injury

•  Explain the shock management of this patient (on your 20min ride to hospital) with this head injury?
o B.P - 80/30
o Pulse – 128
o Resps – 28
o GCS - 13

*IV Cannulation and Complications*

•  Indicate the anatomical location of common cannulation sites

•  Discuss and explain factors that influence choice of vein for cannulation

•  Intravenous cannulas are colour coded. List the colour, gauge and flow ware of various sized IV cannulas.

•  Define ‘aseptic technique’ and explain universal safety measures taken while cannulating.

•  Describe and discuss the concept of ‘informed and implied consent’.

•  When gaining informed consent. List the information that you would inform the patient. (6234 – P.C 3.4)

•  Prior to the administration of I.V fluids to a patient what checks should you perform? (6231 – P.C 4.4)

•  State the clinical procedure for administering IV fluids to the shocked patient.

•  List the signs and symptoms of the three IV complications below.
o Infiltration
o Phlebitis
o Extravasation

•  For the following complications of IV cannulation describe the signs and symptoms and management of each.
o Fluid Overload
o Air Embolism
o Catheter Shear


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## mgr22

MrBrown, if a score of 100% is required, I think you just ruled out most of the medics in the U.S.


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## MrBrown

mgr22 said:


> MrBrown, if a score of 100% is required, I think you just ruled out most of the medics in the U.S.



Those are a sampling of questions from the Ambulance Paramedic intravenous therapy theory assignments.

Yes, you have to be classed as "competent" on each one in order to move on to the practical part of the module, and no it's not that bloody hard! 

After all, Brown stumbled his way through it 

Seriously, it is something I would expect a first year Student Paramedic would be able to answer.


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## mgr22

MrBrown said:


> Those are a sampling of questions from the Ambulance Paramedic intravenous therapy theory assignments.
> 
> Yes, you have to be classed as "competent" on each one in order to move on to the practical part of the module, and no it's not that bloody hard!
> 
> After all, Brown stumbled his way through it
> 
> Seriously, it is something I would expect a first year Student Paramedic would be able to answer.



I'm not disagreeing about the way things should be. I'm talking about reality in the U.S.

There's probably a better chance that a paramedic student could answer some of your questions than a seasoned medic, unless the medic just completed a refresher (even then it's questionable).


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## Shishkabob

Shoot, I knew all that theory stuff back in school, now it's just "poke and push"


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## Jinkx

BossyCow said:


> We start an IV while enroute to meet up with ALS. The veins might not be there, or the pt too combative to sucessfully start one 15 - 30 minutes later when ALS is on scene.





IrishMedic said:


> I have to agree with a lot of people on thread, good luck and respect for planning to further yourself in this field, but i have to say there is a reason EMT-I, Paramedic courses are long and thats because we have a responsibility to the people we vow to save..we have a responsibility to get the best training and understand exactly why we do what we do....it all come back to understanding and justifying everything we do with a patient. Unless your course extensively teaches you about pharm and Med Admin, IV Therapy etc, and you have a lot of experience sticking the tough patients, i'd search for a better course. you owe to yourself and patients, i mean on my course we had to get over 100 - 150 successful sticks before we were signed off on being proficient on doing them. we had verbally give our preceptors the indications, contra indications, side effects, routes, doses and other pertinent info before we were allowed to adminster the med...a lot of work but im happy i did it, i feel very confident now as a medic because of this training. good luck



I couldnt agree more. However, your medical director can sign you off on this skill. As with any skill practice makes it easier. As always, take advantage of any opportunity to advance your clinical and or educational experience. I dont know about other states but practicing a skill outside of your certification or a Med direc sign off even in the presence of a higher cert is not just frowned on but can and will most likely result in immediate decertification. If in doubt call the state. 

Good luck.


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## zmedic

I think people are forgetting that often these EMTs are working with a medic. I used to work in CO and had my IV cert. It wasn't a matter of me running around doing fluid therapy on my own. But rather I was legally allowed to start a line while my paramedic partner was pulling up drugs, doing assessment etc. It worked great because it meant that we could run a code just with a medic and and EMT and someone (FF) to do compressions. It's a lot cheaper for the system to have a medic and and EMT who can start a line and put on a 12 lead then to run double medic trucks. 

The medical director can decide that they don't want their EMTs doing fluids even if they have the cert, but it's nice to have for those systems where you can use it. And it's a lot easier to put all your EMTs through a 24 hour EMT class then demand that they call got their EMT I. (IV cert was a requirement of the company I worked for.)


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## ExpatMedic0

Linuss said:


> Shoot, I knew all that theory stuff back in school, now it's just "poke and push"


haha +1


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## JPINFV

Linuss said:


> Shoot, I knew all that theory stuff back in school, now it's just "poke and push"


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## MrBrown

I knew all that stuff in school and *gasp, I still know it!


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## EMTSTUDENT25

Here in TN(nashville) we are trained in IV therapy within the first month of class, and were required to get at least 5 sticks on our clinical rides and ER shifts.  We are also able to administer glucagon IM and D5W IV.  With that being said however, its up to the county or service whether or not they even allow their EMT's to start IVs. I know for sure that some dont.  There are only so many techniques and tricks to learn about getting a successfull line in place.  Ive seen RN's and Medics struggle.  Im no expert considering i havent done many myself, but their not always easy from what ive witnessed.


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## bstone

EMTSTUDENT25 said:


> EMT's to start IVs.



Why is EMT with an apostrophe and IV isn't? Sorry, just confused.


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## medicRob

EMTSTUDENT25 said:


> Here in TN(nashville) we are trained in IV therapy within the first month of class, and were required to get at least 5 sticks on our clinical rides and ER shifts.  We are also able to administer glucagon IM and D5W IV.  With that being said however, its up to the county or service whether or not they even allow their EMT's to start IVs. I know for sure that some dont.  There are only so many techniques and tricks to learn about getting a successfull line in place.  Ive seen RN's and Medics struggle.  Im no expert considering i havent done many myself, but their not always easy from what ive witnessed.



EMT-IV (i/85) has worked out quite well for Tennessee. In Fall 2011, EMTSTUDENT25 you will be given the option to take a bridge course to 
emt-Advanced or revert to EMT-B, you will gain the ability to administer nitrous, EZ IO, administer narcan, and a few other things. The state is still finishing up on the gap analysis.


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## medicRob

bstone said:


> Why is EMT with an apostrophe and IV isn't? Sorry, just confused.



EMT shouldn't have had an apostrophe nor should IV. IVs and EMTs, that would be the proper way to pluralize those terms, although neither is a word, they are abbreviations. However, you would not say, "Intravenous's", so the argument falls apart all together.. damn abbreviations.


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## JPINFV

Abbreviations are always funny. Technically just leaving "IV" at "IV" is stupid. Hey guys, I just started an intravenous!" Really? Intravenous what? However starting an "IV line" or "IV lines" makes perfect sense.


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## medicRob

JPINFV said:


> Abbreviations are always funny. Technically just leaving "IV" at "IV" is stupid. Hey guys, I just started an intravenous!" Really? Intravenous what? However starting an "IV line" or "IV lines" makes perfect sense.



I ran 2 large bore Intravenous's normal salines TKOs over a period of 2 hours. 

.. yeah, that sounds about right.


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## JPINFV

medicrob said:


> i ran 2 large bore intravenous's normal salines *to keep open*s over a period of 2 hours.
> 
> .. Yeah, that sounds about right.



ftfy.


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## EMTSTUDENT25

My apologies with my horrible grammer. Ha!  MedicRob-my instructors spoke of this "advanced" option, will this consist of a couple classes teaching the new drugs and then a test at the end?  Just wondering because they wernt too specific on how the process was going to work.


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## 8jimi8

LucidResq said:


> Out here in Colorado EMT-Bs can take a quick and dirty course (mine was about 24 hours lecture with an 8-16 hour clinical rotation, some are shorter) to get "IV approval" allowing them to start peripheral IVs and administer crystalloids such as normal saline and lactated ringer's as well as D50 and Narcan (curriculum teaches intranasal admin but medical directors may allow for IV narcan admin).
> 
> Any opinions on this? I just completed the course but still need to do my clinical rotation. I've gotten 5 or so successful sticks on other students in class, but I'm pretty nervous to stick a patient.



I haven't read any of the responses, this is my gut reaction to reading the OP.

you should be nervous to kill, or infect a patient.  Do you really think you understand fluid dynamics, hemodynamics and all of the complications that can arise from intravenous therapy?  Do you know what cerebral perfusion pressure is?  Do you know what IICP is?  Do you know the difference between the sound of pneumonia and fluid overload?  

these are not questions to intimidate or be mean to you. i just dont think that basics should be administering IV fluids. 

With the caveat being:  Allow the basic to instill no more than 30 cc of 0.9%N.S.  that gives you 10 cc for the iv insertion, and 10 before and after you draw some labs off the new line.

And really, i might actually only be th inking i'd be ok with You doing that, Lucid,  even though I don't know you IRL, i trust that you are truly at heart a patient advocate and not just a skill monkey chasing interventions.  I haven't met very many other basics that I'd trust with IV therapy.


----------



## medicRob

EMTSTUDENT25 said:


> My apologies with my horrible grammer. Ha!  MedicRob-my instructors spoke of this "advanced" option, will this consist of a couple classes teaching the new drugs and then a test at the end?  Just wondering because they wernt too specific on how the process was going to work.



They didn't really specify that at the directors conference when they announced it. They just said that they are still in the process of getting things ready. They are looking to give EMT-IV up to 2 renewal periods to take the course, before being forced to become an EMT-B again. I am thinking it will be like our current EMT-B to IV Bridge course, consisting of 4 credit hours. The NREMT won't be hosting a test for EMT-Advanced until 2014 according to the newsletter, so I assume all current EMT-IV will become Advanced that take the test and we wont see any initial advanced classes until sometime around Fall 13.


----------



## CAOX3

If your system allows this in a PB system I dont see a problem with it.

In general I dont see the point of a double basic truck needing IV access.  Never been on scene and thought to myself "Hmmm I wish I could put an IV in this person."


----------



## 8jimi8

MrBrown said:


> Until you can answer me the following, I am not allowing you to cannulate and infuse:
> 
> *Fluid Balance*
> •  Define the boundaries of each of the three fluid compartments and state the proportional volumes typically found in each
> 
> •  Define the terms: electrolytes, ions, cations, anions. Give examples of each found in the body, and state their physiological functions. (half page)
> 
> •  Define the term non-electrolyte and give three examples
> 
> •  Give a brief explanation of the following electrolyte disorders. Include signs and symptoms that may manifest as a result of these.
> o Hyponatremia
> o Hypernatremia
> o Hypokalemia
> o Hyperkalemia
> 
> •  Explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law.
> 
> •  Define the following terms and explain the role each process plays in human fluid dynamics.
> o Diffusion
> o Osmosis
> o Active Transport
> o Facilitated Diffusion
> 
> •  Define the following terms
> o Shock
> o Perfusion
> o Inotropic
> o Chronotropic
> o Pulse Pressure
> o Mean arterial pressure (MAP)
> 
> •  Explain these complications of irreversible shock and how we may pre•  vent and help treat them.
> o Renal Failure
> o Acute Respiratory Distress Syndrome (ARDS)
> o Disseminated Intravascular Coagulation (IDC)
> 
> •  Describe the pathophysiology, common presentation and briefly outline the management of distributive, cardiogenic and hypovolaemic shiock
> 
> •  Discuss the differences between how children and adults (particularly the aged) maintain and respond to blood pressure changes
> 
> •  Provide a definition of the peripheral resistance and stroke volume
> 
> •  What factors about a blood vessel determine its peripheral resistance?
> 
> •  During exercise stroke volume will increase. How is that achieved?
> 
> •  Explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock.
> 
> •  Blood transports a number of substances around the body. What are those substances and how are they transported in the blood
> 
> •  Pulse Oxymetry measures the oxygenation of the blood flowing through the capillary beds and peripheral tissues. Explain how this concept works and when the use of pulse oxymetry is not indicated and why?
> 
> •  Define isotonicity, hypertonicity and hypotonicitiy
> 
> List the constituent of various IV fluids and there respective tonicity.
> o normal saline
> o 0.45% NaCl
> o 5% Dextrose
> o Hartmanns
> 
> *Homeostasis Regulation*
> 
> •  Explain the Renin-angiotensin pathway and explain how homeostasis of blood pressure and volume is maintained.
> 
> •  Describe how the kidneys regulate the excretion of water in urine, and the role of the hormones ADH, and Aldosterone
> 
> *Acid / Base Balance*
> 
> •  What is the normal pH range of body fluids?
> 
> •  Define the term buffer system and list the 3 major buffer systems involved in acid / base balance
> 
> •  Briefly describe the renal and respiratory compensatory mechanisms of acid/base balance
> 
> •  A person presents with hyperventilation syndrome, classic signs of carpopedal spasm, peri-oral parasthesia. Explain the physiology that results in these signs and symptoms.
> 
> *Trauma*
> 
> •  Explain the difference between blunt trauma and penetrating trauma, the difference in the types of injuries commonly encountered and their MOI (mechanism of injury) and the difference in the management of shock occuring as a result of each.
> 
> •  Describe causes of shock, other than hypovolaemia, in trauma patients, and how to recognize and manage them.
> o Tension pneumothorax
> o Myocardial contusion
> o Acute Myocardial Infarction
> o Spinal injury
> 
> •  Explain the shock management of this patient (on your 20min ride to hospital) with this head injury?
> o B.P - 80/30
> o Pulse – 128
> o Resps – 28
> o GCS - 13
> 
> *IV Cannulation and Complications*
> 
> •  Indicate the anatomical location of common cannulation sites
> 
> •  Discuss and explain factors that influence choice of vein for cannulation
> 
> •  Intravenous cannulas are colour coded. List the colour, gauge and flow ware of various sized IV cannulas.
> 
> •  Define ‘aseptic technique’ and explain universal safety measures taken while cannulating.
> 
> •  Describe and discuss the concept of ‘informed and implied consent’.
> 
> •  When gaining informed consent. List the information that you would inform the patient. (6234 – P.C 3.4)
> 
> •  Prior to the administration of I.V fluids to a patient what checks should you perform? (6231 – P.C 4.4)
> 
> •  State the clinical procedure for administering IV fluids to the shocked patient.
> 
> •  List the signs and symptoms of the three IV complications below.
> o Infiltration
> o Phlebitis
> o Extravasation
> 
> •  For the following complications of IV cannulation describe the signs and symptoms and management of each.
> o Fluid Overload
> o Air Embolism
> o Catheter Shear



yes.. +1 and add delete my original response.


----------



## EMTSTUDENT25

thanks for the positive response medicrob! i was starting to think that we were all on this forum for the wrong reasons! Im just a lil emt trying to learn a few things and dont claim to have all the answers...some of these members lil power hungry...

so not sure if this is the right area for this but: starting out, are emts just the ?go get this person?" are they "retrained" for the real world once they get with a certain service? just curious how its gonna be...


----------



## medicRob

EMTSTUDENT25 said:


> thanks for the positive response medicrob! i was starting to think that we were all on this forum for the wrong reasons! Im just a lil emt trying to learn a few things and dont claim to have all the answers...some of these members lil power hungry...
> 
> so not sure if this is the right area for this but: starting out, are emts just the ?go get this person?" are they "retrained" for the real world once they get with a certain service? just curious how its gonna be...



Here in Tennessee, on your EMT-IV clinicals you will ride as the third person on the ambulance during clinicals and have the ability to perform any skill you are checked off on. Once you take your NR exam and your state EMT-IV license is processed, you will then go through the hiring process. The hiring process usually consists of an agility test, driving record, criminal background check, physical, and drug test and typically a few pre-employment ride alongs. 

Once the decision to hire you has been made, you will usually ride with a senior EMT-P or a Field Training Officer until they feel comfortable enough to sign off on you and let you out on your own. The length of time this will take is all on you. Once you are with a service, you will be expected to attend a certain amount of mandatory in services such as NRP, King LT training, BTLS, PHTLS, etc as the service and your medical director sees fit. Moreover, you will be expected to complete a minimum amount of continuing education hours every 2 years by the state before they will allow you to renew your licensure. Most of us get our CEU's through EMS in services OR attending EMS Night Out with our local HEMS services.


----------



## LucidResq

8jimi8 said:


> I haven't read any of the responses, this is my gut reaction to reading the OP.
> 
> you should be nervous to kill, or infect a patient.  Do you really think you understand fluid dynamics, hemodynamics and all of the complications that can arise from intravenous therapy?  Do you know what cerebral perfusion pressure is?  Do you know what IICP is?  Do you know the difference between the sound of pneumonia and fluid overload?
> 
> these are not questions to intimidate or be mean to you. i just dont think that basics should be administering IV fluids.
> 
> With the caveat being:  Allow the basic to instill no more than 30 cc of 0.9%N.S.  that gives you 10 cc for the iv insertion, and 10 before and after you draw some labs off the new line.
> 
> And really, i might actually only be th inking i'd be ok with You doing that, Lucid,  even though I don't know you IRL, i trust that you are truly at heart a patient advocate and not just a skill monkey chasing interventions.  I haven't met very many other basics that I'd trust with IV therapy.



First of all I'd just like to point out I made the initial post over 2 years ago. I never even completed my IV approval. But it is standard in CO and it is almost impossible to get an EMT job without it. If they hire you without it, they will put you through it. That's just the way it is around here. 

Me... yes I do know what cerebral perfusion pressure is, ICP, and a bit about hemodynamics and such. Unlike most EMTs out here, I've actually taken anatomy, physiology and several other relevant classes. You'll note though that I said "unlike most EMTs out here" which I find terrifying, honestly. That even without a background in A&P or any other real education/training, an EMT can be administering fluids and such drugs after a 24 hour crash course that focuses on the act of inserting an IV cath more than anything else.


----------



## 8jimi8

LucidResq said:


> First of all I'd just like to point out I made the initial post over 2 years ago. I never even completed my IV approval. But it is standard in CO and it is almost impossible to get an EMT job without it. If they hire you without it, they will put you through it. That's just the way it is around here.
> 
> Me... yes I do know what cerebral perfusion pressure is, ICP, and a bit about hemodynamics and such. Unlike most EMTs out here, I've actually taken anatomy, physiology and several other relevant classes. You'll note though that I said "unlike most EMTs out here" which I find terrifying, honestly. That even without a background in A&P or any other real education/training, an EMT can be administering fluids and such drugs after a 24 hour crash course that focuses on the act of inserting an IV cath more than anything else.



LOL like i said i didn't read any of the posts in my original reply.  i also apparantly didnt read the date of the original posting.  i wouldnt have noticed unless you pointed it out either! haha


----------



## mcdonl

MrBrown said:


> Until you can answer me the following, I am not allowing you to cannulate and infuse:
> 
> *Fluid Balance*
> ......
> 
> *Homeostasis Regulation*
> 
> *Acid / Base Balance*
> .......
> 
> *Trauma*
> .....
> 
> *IV Cannulation and Complications*
> .....



Mr. Brown, you just summed up most of the Intermediate program -cardiology... And, in Maine 12 leads and IV's are about the only thing that separates a basic from an intermediate.


----------



## MrBrown

mcdonl said:


> Mr. Brown, you just summed up most of the Intermediate program -cardiology... And, in Maine 12 leads and IV's are about the only thing that separates a basic from an intermediate.



Fantastic, doesn't pH, renin angiotensin aldosterone and K/Na+ just make you get all excited?


----------



## mcdonl

MrBrown said:


> Fantastic, doesn't pH, renin angiotensin aldosterone and K/Na+ just make you get all excited?



It does indeed! I want a bumper sticker that says "My other car uses a k/Na+ pump!"


----------



## Cohn

Are you guys kidding me? I work for a rural department in southern Arizona and our base hospital UMC in Tucson allows EMT-Bs to take IV classes held by the hospital (clinic hours and what not also) and then (OMG!) they actually allow us to use our new skills OMG!!!!  Because out here we get UDAs and they need fluids before a medic can get to us (usually 30 minutes to hours sometimes!)

I don't understand why you people are so against EMT-Bs giving IVs especially my rural vol. department does not have any medics.


----------



## EMT11KDL

Cohn said:


> I don't understand why you people are so against EMT-Bs giving IVs especially my rural vol. department does not have any medics.



its not that they are against it, its the fact the class is only 21 hours long.  I am a basic and i had IV access when I was in Colorado, but starting out, i knew after my class and after my clinical sticks that i was still not ready to start iv's in the back of the bus.  it more goes to liability issue.  Personally, I dont see any problems with Basics having IV access, the problem i have is the class.  I think they need to make the class longer... and go into more detail on the medications they are being authorized to use, and have an understanding why they are giving it to the patient


----------



## Cohn

Well we are only allowed Saline and Lactated Ringers and our class we need 15 (successful) sticks in the ER department.


----------



## EMTSTUDENT25

Cohn! i was starting think i was crazy. I wasnt trying to start a war, but wow...I definatly agree with you on this issue.  If it wasnt safe for us to start lines as basics, then i would have to come to the conclusion that they would take it out of our curriculum.  Do i think that we should have spent more time on IV Therapy, yes i do.  Its a vital part of ems and can be done wrong. Considering some of the meds we are allowed to administer I would have liked to go into more detail about isotonic and crystaliod solutions, etc...More knowledge usually equals more confidence.

EMT11KDL - by liability are you refering to pushing wrong med/dosage?


----------



## EMT11KDL

Yes i am, i do not think that a 21 hour class is enough time to know which med and dosage should be pushed and also the rate it should be given at.  That is why I think the class should be longer than 21 hours. 

Also, in volly departments when there basics might see a handful of calls a month, how many of those calls truly need IV access and medication given to them via iv.


----------



## Shishkabob

Why do people equate putting a piece of plastic in to a vein and pushing 10cc of NS with allowing EMTs the ability to push meds?


Two separate things, so quit bunching them together.


----------



## EMT11KDL

Linuss said:


> Why do people equate putting a piece of plastic in to a vein and pushing 10cc of NS with allowing EMTs the ability to push meds?
> 
> 
> Two separate things, so quit bunching them together.



Linuss if you read what I wrote, 



> I think they need to make the class longer... and go into more detail on the medications they are being authorized to use, and have an understanding why they are giving it to the patient



So I am not sure where you are seeing where it got bunched together


----------



## medicRob

Linuss said:


> Why do people equate putting a piece of plastic in to a vein and pushing 10cc of NS with allowing EMTs the ability to push meds?
> 
> EMT-IV in Tennessee can hang a non medicated drip, that's it. They can give a bolus of saline, administer D50, D5, etc but other than that this is it. The only real med push the EMT-IV is authorized to do is Subq and IM Epi in anaphylaxis.
> 
> (Weight / 2.2) * 0.01
> 
> cc x drop factor
> ---------------
> time in min
> 
> 
> not rocket science.
> 
> EMT-IV has 9 months of training and ample clinical time for this. Now, were the state of TN to lose their minds and allow them to push Versed, Morphine, or hang dopamine... there would be a fight, as the EMT-IV does not have the proper training behind them necessary to realize when it is appropriate to deviate from what a standing order says based on the patient's condition. There are alot of variables to consider and every patient is different. The EMT-B, EMT-IV are trained to follow protocols.. The Paramedic is trained to follow protocols and to understand the underlying mechanisms of a patient's condition as it relates to the intervention he/she is taking and to deviate from that protocol if the patient's
> condition requires (within scope of practice of course)
> 
> 
> In summation:
> 
> Having been an EMT-IV myself, I felt quite comfortable in starting IV's, maintaining them, and administering the few meds I was authorized to administer.
> 
> I do not feel however that the EMT-IV has the appropriate level of training to
> push anything more than maybe narcan (which is being implemented in the state of TN with the beginning of the EMT-IV to Advanced bridge course in Fall 2011).
> 
> This is the EMT-IV skills manual for the state of TN. There have been several things added to the EMT-IV skill set since this document was published and the state director of EMS told me, personally that they are in the process of rewriting the entire thing to comply with the new national scope once they finish doing their gap analysis, etc for the new bridge courses.
> 
> http://health.state.tn.us/Downloads/EMS_Skills.pdf


----------



## Cohn

EMT11KDL said:


> Yes i am, i do not think that a 21 hour class is enough time to know which med and dosage should be pushed and also the rate it should be given at.  That is why I think the class should be longer than 21 hours.
> 
> Also, in volly departments when there basics might see a handful of calls a month, how many of those calls truly need IV access and medication given to them via iv.



We get a lot more then a handful a month, and since we are about 30 minutes from the boarder a large majority of UDAs need fluids ASAP especially during the summer months here. Also we don't push meds... We rehydrate them per our Hyperthermia standing order.

Edit: Oh and forgot to mention majority of the calls out here ARE ALS calls (where meds do need to be pushed.) You guys must be used to riding a EMT-B - Medic teams because when its down to EMT-B - EMT-B (or even EMT-B - First Responder) teams that we have out here there is not much we can do for most people, mostly package them up and try to help as much as we can.


----------



## EMTSTUDENT25

yeah, i mean, im am confident that i can start a line on most patients...In TN we, as far as i know, dont run dual emt rigs, so we are always paired with a medic and emt.  We are trained to think that the medic runs almost every call and are soley responisble for everything that plays out. If we get a BLS call and they(medic) wants to let us run it, then so be it.


----------



## EMTSTUDENT25

medicrob to the rescue, didnt see your post until after i posted my last, well said.
Do other states have that different teaching criteria?


----------



## Cohn

EMTSTUDENT25 said:


> yeah, i mean, im am confident that i can start a line on most patients...In TN we, as far as i know, dont run dual emt rigs, so we are always paired with a medic and emt.  We are trained to think that the medic runs almost every call and are soley responisble for everything that plays out. If we get a BLS call and they(medic) wants to let us run it, then so be it.



And that is why I love the experience that I am getting from being on a EMT-B - EMT-B department I can be lead EMT on the worst of the worst and learn how to solve problems. I would hate it if I started out with a Medic - EMT-B department and ended up being a "ambulance driver" or a mule for the medic. Personally I think the stuff I am learning from my department will build me to be the best EMT I am capable of being.


----------



## medicRob

EMTSTUDENT25 said:


> medicrob to the rescue, didnt see your post until after i posted my last, well said.
> Do other states have that different teaching criteria?



This is one of the issues that EMS faces. In one state the EMT-B level is the EMT-IV while in another it is emt-B with IV, and another it is EMT-cc (I think), etc. The national model addressed this by presenting one set of levels for all emergency medical technicians in the US. States are asked to follow suit, however the time frame for the NREMT exams at these levels is around 2014. TN will be one of the states that goes into the initiative early, having announced that we will start licensing individuals at the EMT-Advanced level as early as Fall 2011 for EMT-IV and will begin the EMT-Advanced initial courses after that. 

The national model calls for:

Emergency Medical Responder <--- Our now First Responder
EMT <--- Our current EMT-B
EMT-Advanced <--- Our current I/85
Paramedic <--- Our current Paramedic and i/99s who bridge.

South Carolina was allowing EMT-B to intubate at one point. The scope of practice is set by your individual state in adherance with national guidelines
and your individual medical director chooses which skills he wishes to authorize you to use in your service and which ones he is not comfortable with. 

EMT-B varies across so many states. At last count, there were 47 different EMT titles. 

I think the EMT-Advanced is going to come in handy in rural areas and in areas where services can't justify having paramedics on staff. 

As far as TN goes, most of our trucks run: Medic/Medic, Medic/EMT-IV, however a lot of services still have BLS trucks that run EMT-IV/EMT-IV but remember, EMT-IV is technically not a B because this level is trained under the i/85 curriculum. This is why you see differences between lecture hours, clinicals, and scope with EMT-IV and EMT-B. Our current first responders here in TN have the scope of EMT-B, ever since Combitube and PTL were added. We can all argue over scope, etc. As a matter of fact, we do it in nursing all the time. After all, a BSN spends 4 years in school, and 2 years in clinicals in Trauma Centers, Nursing Homes, ICU, CCU, NICU, OB/GYN, ER, Med/Surg, etc, have to take Anatomy & Physiology I and I (full class, not survey), Pathophysiology, Pharmacology, English Composition, Chemistry, Fundamentals of Prof Speaking, etc. We could hold the argument that a paramedic shouldn't be allowed to perform any of their medical skills before having all these courses and all this time in clinicals, but we don't. Every one has their place in the continuation of care. I think a lot of the Paramedics here would change their mind about EMT-B and IV's if they had the chance to ride along with a TN EMT-IV. Once again, please note I am not saying that an EMT-B should be pushing meds like valium, versed, etc. IV Therapy & Med Admin are two different ballgames.


----------



## Hal9000

*EMT-B and IO Therapy*

Thoughts on EMT-B's performing IOs?  I know it happens unsupervised in some areas. (Meaning sans ALS presence.)


----------



## lightsandsirens5

EMT11KDL said:


> Linuss if you read what I wrote,
> 
> 
> 
> So I am not sure where you are seeing where it got bunched together



I think what is getting bunched together is that people think the just because a basic has an IV attachment to their cert, they can now do Intermediate drugs. In WA state at least, after a class (30 hrs I think) I basic can become an IV tech. Than means the can start lines ans flow NS under Med. Cont'l (at least in my county). No fluid w/o med cont'l, no drugs whatsoever other than already approved basic drugs, no IO. 

That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.


----------



## Shishkabob

lightsandsirens5 said:


> That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.



Ta-da.


I'm totally for EMTs sticking someone and pushing 10ccs of Saline to flush it.    There isn't much you can screw up there....


----------



## Lifeguards For Life

lightsandsirens5 said:


> That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.



I don't think paramedics receive as much training on IV or drug admin as people like to think.


----------



## Level1pedstech

lightsandsirens5 said:


> I think what is getting bunched together is that people think the just because a basic has an IV attachment to their cert, they can now do Intermediate drugs. In WA state at least, after a class (30 hrs I think) I basic can become an IV tech. Than means the can start lines ans flow NS under Med. Cont'l (at least in my county). No fluid w/o med cont'l, no drugs whatsoever other than already approved basic drugs, no IO.
> 
> That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.



  Your pretty much spot on with the IV tech program here in WA. The course our ALS transport company provides was an additional 56 hours of class time and some clinical time on top of the 150+ hour basic class and included IO. You needed to have a year as a basic or able to obtain a waiver from your agency if less than a years experience. Both the basic and IV tech classes were longer than what the state requires. Most of the agencies in our area have extended transport times so there is extra emphasis placed on extrication and trauma.

 We practiced sticking each other and then showed competency by getting 10 successful IV starts before we were allowed to sit for the state exam. IO competency was shown on the old stand by,chicken legs.


----------



## Level1pedstech

Lifeguards For Life said:


> I don't think paramedics receive as much training on IV or drug admin as people like to think.



 Many RN's I know received zero training on starting lines before they hit their clinicals. I see RN grads that are still struggling even after their clinicals and some time in the ER.


----------



## medicRob

Level1pedstech said:


> Your pretty much spot on with the IV tech program here in WA. The course our ALS transport company provides was an additional 56 hours of class time and some clinical time on top of the 150+ hour basic class and included IO. You needed to have a year as a basic or able to obtain a waiver from your agency if less than a years experience. Both the basic and IV tech classes were longer than what the state requires. Most of the agencies in our area have extended transport times so there is extra emphasis placed on extrication and trauma.
> 
> We practiced sticking each other and then showed competency by getting 10 successful IV starts before we were allowed to sit for the state exam. IO competency was shown on the old stand by,chicken legs.



How did you guys do your EMT program? Did they train you to i/85 standards like they did us in TN or was it just EMT-B + an IV Endorsement? 

In TN, IV Therapy is a section of our EMT-IV course, topics covered included indications for intravenous therapy, drip calculation, parkland formula, conversion factors, special considerations such as fluid overload in the elderly and pediatric fluid replacement. 

We also had a quiz every class after we covered IV Therapy on drip calculations and weight conversions. There was no middle ground on these quizzes, you either made a 100% or a 0% because if you missed one that represented one patient you compromised and that is not acceptable. This is why I feel our EMT-IVs are more than proficient at starting and maintaining lines as well as hanging non-medicated fluids. It amazes me how little time it takes to become an EMT-B in other places. EMT-IV takes 9 months and you do clinicals throughout. You are required a certain amount of patient contacts, IV starts, etc before finishing the course. Are there any i/85s here that can tell me how IV therapy was addressed in your course? As I've said before, TN is kind of an oddity, since the lowest level of EMT here is trained to i/85 but tests nationally as an NREMT-B. They actually tell you before taking your national registry to not think as an EMT-IV, because it is an EMT-B test and the scope is different.


----------



## Leonidas1

In this area (Chicago) BLS units that are not "one on one" (an ambulance staffed with an EMT-B and EMT-P), can only transport patients who have saline/heparin locks. Personally, I feel they (BLS units) should be able to transport patients with .9NS @ TKO rates at least.


----------



## 8jimi8

Leonidas1 said:


> In this area (Chicago) BLS units that are not "one on one" (an ambulance staffed with an EMT-B and EMT-P), can only transport patients who have saline/heparin locks. Personally, I feel they (BLS units) should be able to transport patients with .9NS @ TKO rates at least.


what happens if they don't notice that fluids are extravastating? or if they don't notice the patient is becoming fluid overloaded?

People get fluids for a reason.  If you didn't need to know anything to run fluids, they would send people home with fluids running from the hospital all the time.


----------



## lightsandsirens5

medicRob said:


> How did you guys do your EMT program? Did they train you to i/85 standards like they did us in TN or was it just EMT-B + an IV Endorsement?



In WA we are trained to the I-85 standard. We are actually trained to somewhere between 85 and 99, but my county holds us back to the 85 level. Even though we used the 1999 textbook. :-S


----------



## lightsandsirens5

8jimi8 said:


> what happens if they don't notice that fluids are extravastating? or if they don't notice the patient is becoming fluid overloaded?



What happens when you or I don't notice? How about a medic? An RN? Same problems no matter what level you are trained to. A medic has to pay attention to that stuff too. Just because you are a baisc with IV endorsement dosent mean you can't see an infiltrated IV. 

Or am I wrong?


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## Shishkabob

Psh, I don't have to pay attention.  I warn the fluids before we leave the hospital that if it does one thing I don't like, off to the trash it goes.


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## 8jimi8

lightsandsirens5 said:


> What happens when you or I don't notice? How about a medic? An RN? Same problems no matter what level you are trained to. A medic has to pay attention to that stuff too. Just because you are a baisc with IV endorsement dosent mean you can't see an infiltrated IV.
> 
> Or am I wrong?



Eactly.  The level you are trained to.  That is the point of this thread.  Someone who has only 120 hours of experience plus a 30 hour class, might not know the difference.  I also disagree philosophically to the word "trained."  Would you rather training or an education?


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## lightsandsirens5

8jimi8;247187I also disagree philosophically to the word "trained."  Would you rather training or an education?[/QUOTE said:
			
		

> Good point. I suppose a monkey can be "trained." Although I guess that EMS is (should be?) mostly education followed by some training.


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## Jon

What's a UDA?

And really? Taking over an hour for ALS? Sounds like your EMS system sucks.


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## Akulahawk

Jon said:


> What's a UDA?
> 
> And really? Taking over an hour for ALS? Sounds like your EMS system sucks.


I'm going to guess that UDA is "UnDocumented Alien" Aka Illegal Alien. An hour for ALS to arrive at some locations does sound a LOT like rural Nevada or Arizona.


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## Cohn

Akulahawk said:


> I'm going to guess that UDA is "UnDocumented Alien" Aka Illegal Alien. An hour for ALS to arrive at some locations does sound a LOT like rural Nevada or Arizona.



You got that right, and sometimes some of the roads at my station the normal ALS ambulances can't get to, luckily we have a 4 wheel drive and a higher then normal rescue.


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