# IV certification??



## kp14 (Jan 21, 2009)

I did not receive my IV training with my EMT training did anyone else? How do I get it because it seems like everywhere I apply they want it.

Troubles in Denver


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## vquintessence (Jan 21, 2009)

Are you a basic or I?  Are you applying for position as a basic or I?


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## medic417 (Jan 21, 2009)

An IV is an advanced skill and honestly should not be given to basics.  There is much more involved than sticking the sharp object into the patient and letting fluids go in.  Without proper education you can do serious harm.  This is another problem with EMS many want the skills but not the education.  Wow I am starting to sound like Vent.


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## Shishkabob (Jan 21, 2009)

medic417 said:


> An IV is an advanced skill and honestly should not be given to basics.  There is much more involved than sticking the sharp object into the patient and letting fluids go in.  Without proper education you can do serious harm.  This is another problem with EMS many want the skills but not the education.  Wow I am starting to sound like Vent.



So, why would it not be included with the proper education?  Do you honestly think most schools would be like "Stick the sharp end into a vein" and send people on their way?


I say IV's SHOULD be basic skills, taught to basics, and added on to the current curriculum.   Not saying drugs should be run from basics, but with the proper training, only good can come of allowing basics to do it.

Let the EMT do the IV while medic does the ET, then the medic can run drugs from the IV. 

Like I said, with proper training.


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## medic417 (Jan 21, 2009)

Linuss said:


> So, why would it not be included with the proper education?  Do you honestly think most schools would be like "Stick the sharp end into a vein" and send people on their way?
> 
> 
> I say IV's SHOULD be basic skills, taught to basics, and added on to the current curriculum.   Not saying drugs should be run from basics, but with the proper training, only good can come of allowing basics to do it.
> ...




So how many months are we going to extend the basic course to provide the proper education to do this skill correctly and safely?  

You can train a monkey to start an IV but not educate them as to the when, whys, what ifs, etc.  We need to increase the focus on education, then skills can come.


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## Sasha (Jan 21, 2009)

Some areas do have Basics, yes, just Basics, not EMT-Is starting lines and being able to run NS. The insertion of an IV and how to tell if it's patent or not, and what to do when it's not patent, and when to do it is not as long and drawn out as you make it seem. An IV is not some intricate skill that requires intensive training and education.


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## Shishkabob (Jan 21, 2009)

The majority of IV training tends to go for the drugs used with the IV's, correct?  The actual IV sticking part is relatively short.

So in saying that, it shouldn't take long to teach a few basic areas to do IV's, and then teach about saline.  That's it.  

No D50, no other IV drugs, just the IV and the saline.


EMT-B techs in ER do it all the time, so obviously it works.


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## Sasha (Jan 21, 2009)

Linuss said:


> The majority of IV training tends to go for the drugs used with the IV's, correct?  The actual IV sticking part is relatively short.
> 
> So in saying that, it shouldn't take long to teach a few basic areas to do IV's, and then teach about saline.  That's it.
> 
> ...



Actually, I think NS and D50 would be great drugs to expand to the basic level, with proper education.


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## Shishkabob (Jan 21, 2009)

Sasha said:


> Actually, I think NS and D50 would be great drugs to expand to the basic level, with proper education.



Maybe even Narcan as well seeing as it has less contraindications then Albuterol!

(Same with Xopenex)


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## Sasha (Jan 21, 2009)

Linuss said:


> Maybe even Narcan as well seeing as it has less contraindications then Albuterol!
> 
> (Same with Xopenex)



I've heard some areas are allowing for the administration of Narcan intranasally by basics.


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## Veneficus (Jan 21, 2009)

Sasha said:


> Some areas do have Basics, yes, just Basics, not EMT-Is starting lines and being able to run NS. The insertion of an IV and how to tell if it's patent or not, and what to do when it's not patent, and when to do it is not as long and drawn out as you make it seem. An IV is not some intricate skill that requires intensive training and education.



Have to disagree on this.

While the skill of sticking a needle in somebody’s skin doesn’t require much as IV drug addicts can do it quite proficiently, there is considerable knowledge that goes with using crystalloid solutions. 

I know that popularly it is considered benign because of the low instance of complications, but because of the seriousness when those complications occur,(too vast for me to type out here) in addition the treatments for such, the administration of NACL requires background in pharmacology, physiology, and pathophysiology at least. 

EMS leaders and advocates cannot get these topics properly covered in the minimum paramedic education, how could you possibly do it for basics? 

As a simple cases what do you think the outcome of a saline bolus to a dehydrated marathon runner would be? Could others who are not athletes find themselves in a similar physiological state? What about overloading cardiac function?

If your instructors haven’t impressed upon you these and many more factors, I would demand some money back from the school.


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## EMTWintz (Jan 21, 2009)

Sasha said:


> I've heard some areas are allowing for the administration of Narcan intranasally by basics.



HEHE had to read that again, thought it said intra-anally
I need glasses


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## medic417 (Jan 21, 2009)

Veneficus said:


> Have to disagree on this.
> 
> While the skill of sticking a needle in somebody’s skin doesn’t require much as IV drug addicts can do it quite proficiently, there is considerable knowledge that goes with using crystalloid solutions.
> 
> ...



But wheres the fun in that.   

But your answer is correct.  Why does EMS focus so much on skills rather than education?


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## Veneficus (Jan 21, 2009)

medic417 said:


> But wheres the fun in that.
> 
> But your answer is correct.  Why does EMS focus so much on skills rather than education?



If I answer that question honestly they will lock the thread


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## rmellish (Jan 21, 2009)

I'll add my perspective to this. I'm a basic-advanced, which in Indiana is considered the lowest level of ALS care. I can intitate peripheral IV access with NS, LR, and D5W, I can check BGLs, and use a 4 lead monitor, manually defibrillating VT and VF. I cannot give any further medications, and I can only recognize 5 basic rhythms per my scope.

I'm not a paramedic replacement. In fact, I'm far closer to a BLS provider.

I consider it BLS, and it really should be BLS. Combine the two courses, and I don't see why we can't have a slightly more advanced basic curriculum. The advanced course is 3 sections, cardiology, trauma, and IV access. 

When I work on a medic truck, my skills allow me to expedite the care process by sharing some of the procedural workload. 


Now to answer the original question, in my area there are few advanced EMTs, but if its standard for your area, its probably not a bad thing to get if you want to be marketable.


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## medicdan (Jan 21, 2009)

I am of the personal opinion that IV training is useless and harmful in the hands of most EMT-Bs-- i just cant see many cases where a patient should receive a line KVO or a bag of saline and not receive full ALS services. With that said, long-transport (rural) services might be a place where it makes sense, as well as possibly the capacity to draw laws. ERs see field lines as potentially contaminated, and I have seen them pull many, and insert their own. 

With all of that said, I am in support of what Israel trains and allows their equivalent to the EMT-B to do. Every EMT in the country is trained on veinapucture, and gets a lot of expierence with it before leaving training. Every ambulance (BLS) in the country carries 2 complete, sealed IV kits, only to be used in specific cases, by order of a paramedic or MD.

Magen David Adom has learned, through experience, that fluid resuscitation is extremely important to patients in a terror attack (blunt force trauma by shrapnel, etc.). A blanket order is given (by a paramedic or MD) for every patient on the scene to get a line of NS, wide open, and rapid transport. IV insertion happens at the triage stage of MCI management, so despite the injuries, fluid replacement can begin ASAP. Every patient, before being transported off-scene is then evaluated by a paramedic or MD, and the IV may be D/Ced, meds may be added, etc. 

One last note: EMTs trained in phlebotomy for use in the ER are closely monitored (indirectly supervised) by RNs, LPNs, MDs, etc. If they have any trouble with a line, help is never more than a few feet away, and complications of IV access can be managed immediately. This is not true in the field. The ER-Techs dont need to know why they are giving patient X NS as opposed to patient Y, who is receiving LR, they just need the technical skill.


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## Ridryder911 (Jan 21, 2009)

Sasha said:


> Some areas do have Basics, yes, just Basics, not EMT-Is starting lines and being able to run NS. The insertion of an IV and how to tell if it's patent or not, and what to do when it's not patent, and when to do it is not as long and drawn out as you make it seem. An IV is not some intricate skill that requires intensive training and education.


Let's answer this with a proper point and even a NREMT test question. 

IV are iniated for only two reasons: 

1) Fluid replacement 
2) Drug administration

If you do not have in-depth education of fluids & electrolytes, cellular understanding and in-depth pharmacology (ECG interpertation) since all patients given med.'s should be on a monitor, then you should not do it. If you have all of that you are no longer a basic! Hence why it should be an advanced skill. 

As well *IV's are dangerous*, they have a high rate of potential death. Catheter and air embolism, phlebitis, sepsis and infection.  

Any time one introduces even NSS you screw up the homeostasis, even if you are attempting to correct a condition. 

Remember medicine is NOT about the skills, but rather the knowledge to incorporate those skills. Alike what was said_.."A monkey can start an IV"..._ It takes a thinking and knowledgeable medic to understand why and what that IV is going to do and what to do if there is a problem. 

R/r 911


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## BossyCow (Jan 21, 2009)

I hate to get back to the question of the OP since we seem to have sequed into a debate over what is a BLS skill AGAIN.

I am an EMT-B. IV is not taught as a BLS skill and is not incorporated in any EMT-B class that I know of. Some systems have an additional cert available to their EMT-Bs for IV. My state has an IV Tech cert which is available not only to EMS providers but also Lab Techs and MA. My IV cert runs independently of my EMT-B cert. I was trained for it separately and recert in it separately.

There are specific instances in my regional protocols where an IV is called for. Every single one of those instances are also considered ALS calls. Before I start an IV I have to make sure that a paramedic will be available at some point in the transport. If ALS is not available, I am not to start an IV.

Some examples of where this is appropriate and where I have seen it do good are as follows:


Multi system trauma with extreme blood loss. The insertion of an IV at the start of patient care makes sure that by the time I rendezvous with ALS the pt hasn't crumped to the point where the veins are no longer accessible to ALS
Chest pain. Since we are able to give nitro, in a cardiac event, the nitro may make it difficult for ALS to start an IV. My ability to start the IV gives ALS a medication port, while still enabling the pt to get the pain relief from nitro.


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## futuremedic (Jan 21, 2009)

I did receive IV Certification as an EMT-B. My class was not an easy class, we were taught Paramedic level shock....along with lung sounds. 
 The reason that I took the class was so that I could feel confident in my IV skills before I went to Paramedic school.  I am glad that I did since the class that I took as a B was way more in depth than the class that I have gotten as a Paramedic student. 
 I do work for an ALS transfer company that also does intercepts. There have been several times where my IV skills have come in handy...such as when the medic is preparing to RSI.


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## mikeN (Jan 21, 2009)

Sasha said:


> I've heard some areas are allowing for the administration of Narcan intranasally by basics.


This is an optional protocol in mass.  My company is against basics administering nasal narcan. I know some other services in mass carry it at the basic level. Albuteral via neb and blood sugars are other optional protocols here. My company is only considering albuteral treatments at this time.


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## medic417 (Jan 21, 2009)

Once when the hospital was in serious crisis I was asked to assist in surgery.  Since I knew how to spread a chest I did to save time for the surgeon.  Thinking about it I think we should start doing it in the ambulance to save time for the surgeon.  I mean all we're gonna do is seperate the ribs,not actually touch the heart or anything like that.  I mean its so simple a monkey can be trained to do it so why shouldn't we add this skill?


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## Shishkabob (Jan 21, 2009)

medic417 said:


> Once when the hospital was in serious crisis I was asked to assist in surgery.  Since I knew how to spread a chest I did to save time for the surgeon.  Thinking about it I think we should start doing it in the ambulance to save time for the surgeon.  I mean all we're gonna do is seperate the ribs,not actually touch the heart or anything like that.  I mean its so simple a monkey can be trained to do it so why shouldn't we add this skill?





Besides the fact you're being a smartface;

In the state of Texas, if your MC teaches you a skill and puts it in your protocols, you can use it.  If your MC teaches you how to do IV's as a basic, you're allowed to do IV's as a basic.



So, if your doctor teaches you how to do that skill, and allowed you to do it and puts it in your protocols, then sure, as it's his prerogative and his license.


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## vquintessence (Jan 21, 2009)

> Chest pain. Since we are able to give nitro, in a cardiac event, the nitro may make it difficult for ALS to start an IV. My ability to start the IV gives ALS a medication port, while still enabling the pt to get the pain relief from nitro.



That seems a strange policy?  Never personally seen this, but ya can apply nitro ointment to a site to facilitate IV access.

Nitro is a vasodilator, there is no vasoconstriction on a significant level to be aware of.  That's why low BP is a contraindication.  Do they want you guys getting the IV prior in case the pressure should drastically dump?  Is that the difficulty they forsee?  Seems like a liability giving the green light to administer someone a dose NTG who isn't on the Rx and BP is borderline.  I'm probably looking straight through the pink elephant searching for the answer.  What am I missing here guys?


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## Ridryder911 (Jan 21, 2009)

Again, people have lost the sensibility affect. If one is depending upon fluids for trauma their wrong. Fluid resuscitation is not avenue for trauma care. An access? Sure. However; the excuse of having to allow a basic to perform such is not warranted.

IV's do not save lives. 

It is what assessed, properly diagnosed and then what is administered through such that causes the change. 

R/r911


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## backcountrymedic (Jan 21, 2009)

Retracted.


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## JPINFV (Jan 22, 2009)

kp14 said:


> I did not receive my IV training with my EMT training did anyone else? How do I get it because it seems like everywhere I apply they want it.
> 
> Troubles in Denver



IVs are not in the NHTSA National Standard Curriculum and are not normally found in the scope of practice for EMT-Basics.


Let's not get into the entire "Should EMT-Bs start IVs" debate. Here's how that thread will end. 

One side says, "We need them, they're helpful, blah blah blah."
Other side says, "You don't have the education to do it nor the education to actually make it useful."
Pro: Yes we do, after out course.
Con: No, you won't. It'll just get watered down and you still can't administer drugs.
Pro: You're just a poopyhead paragod!
Mods: lock.


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## rmellish (Jan 22, 2009)

JPINFV said:


> IVs are not in the NHTSA National Standard Curriculum and are not normally found in the scope of practice for EMT-Basics.
> 
> 
> Let's not get into the entire "Should EMT-Bs start IVs" debate. Here's how that thread will end.
> ...




With some states offering an IV supplement, its perfectly reasonable that an area could be hiring EMT-Bs with the IV supplement. Not saying its right or wrong, but without personal knowledge of the area, the OP's issue makes sense. 

Especially if he was nationally registered and took his course in a different state.


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## JPINFV (Jan 22, 2009)

I'm not saying that his question doesn't make sense, but he also asked if anyone else didn't receive it. The way he phrased his post makes it look like he is under the impression that IV training is a part of the normal training for EMT-Bs.


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## Bmelanson (Jan 22, 2009)

Here in denver a emt can start iv's, we can give narcan, d50 and saline. base contact for narcan and d50 needed. I think half the iv's started are a waste of time because they weren't needed. I feel that most  basics get in trouble with this for not knowing the contradictions for fluid.


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## ptemt (Jan 22, 2009)

kp14 said:


> I did not receive my IV training with my EMT training did anyone else? How do I get it because it seems like everywhere I apply they want it.
> 
> Troubles in Denver




Here is a link to HealthONE, class starts tomorrow.


http://healthoneems.com/course_pdf/2009/2009_IV_Approval.pdf


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## medic417 (Jan 22, 2009)

Linuss said:


> Besides the fact you're being a smartface;
> 
> In the state of Texas, if your MC teaches you a skill and puts it in your protocols, you can use it.  If your MC teaches you how to do IV's as a basic, you're allowed to do IV's as a basic.
> 
> ...



You are right I am smart.  And your prize youngster is  a :wacko:  

Thank you for playing.

But seriously good medical directors do properly educate their people and with that proper education expand scope of practice.  You are telling me nothing knew as I work with some of the most aggressive protocols, but those were earned by education.  Not all in our service are given the extra protocols, sadly often as they just want the skill but are not willing to workfor it.


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## BossyCow (Jan 22, 2009)

vquintessence said:


> That seems a strange policy?  Never personally seen this, but ya can apply nitro ointment to a site to facilitate IV access.
> 
> Nitro is a vasodilator, there is no vasoconstriction on a significant level to be aware of.  That's why low BP is a contraindication.  Do they want you guys getting the IV prior in case the pressure should drastically dump?  Is that the difficulty they forsee?  Seems like a liability giving the green light to administer someone a dose NTG who isn't on the Rx and BP is borderline.  I'm probably looking straight through the pink elephant searching for the answer.  What am I missing here guys?



You are missing that we don't issue the NTG unless they are on the Rx and the BP warrants it. The only exception for us is under the direct orders of our MPD who has on a few occasions directed us to issue NTG to a pt who didn't have a script for it. All of those cases are ALS pts and we are enroute to meet with ALS. But in my neighborhood that can be up to a half hour away. 

I have seen veins just disappear after NTG administration especially in those big round fat arms of extremely white women. We are always told to start the IV prior to the administration of NTG regardless of whether or not its their prescription or ours at the orders of Med Control.


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## Veneficus (Jan 22, 2009)

BossyCow said:


> You are missing that we don't issue the NTG unless they are on the Rx and the BP warrants it. The only exception for us is under the direct orders of our MPD who has on a few occasions directed us to issue NTG to a pt who didn't have a script for it. All of those cases are ALS pts and we are enroute to meet with ALS. But in my neighborhood that can be up to a half hour away.
> 
> I have seen veins just disappear after NTG administration especially in those big round fat arms of extremely white women. We are always told to start the IV prior to the administration of NTG regardless of whether or not its their prescription or ours at the orders of Med Control.



I have noticed that in larger patients cannulating the cephalic or basilic vein is usually the best bet. Even if you cannot see them they are quite easy to approximate. 

use such info as you will.


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## mikeylikesit (Jan 22, 2009)

it would be great for you to start the IV but then what? put on a lock and wait till the hospital. like most said what is the point of starting one if you don't know where to go from there?


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## BossyCow (Jan 22, 2009)

mikeylikesit said:


> it would be great for you to start the IV but then what? put on a lock and wait till the hospital. like most said what is the point of starting one if you don't know where to go from there?



The point for us is with the extreme transport times, the patient may not have IV access by the time we meet up with ALS. We quarantee a med port and a patent IV for a pt that will need one. It's not that I don't know where to go from there, its that my cert is only for a specific level and it requires the monitoring of the IV by ALS.


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## Shishkabob (Jan 22, 2009)

What people seem to be missing is something that was stated early on;

No, B's wont be starting IV's and just sitting there twittling their thumbs, and no, B's won't be administering a crap load of drugs.

What the reason would be for a M/B combo, where the medic can intubate and the basic can IV.  or the medic can do any number of things and the basic can IV.  Or any number of different scenarios.


Do I need to phrase this differently?  Apparently many people aren't grasping the concept of "starting" and not administering.


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## JPINFV (Jan 22, 2009)

Just to make sure I'm reading your posts correctly, you think that basics should start IVs only under direct observation from a paramedic? Of course the proper follow up question is why not just have 2 paramedics?


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## TomT (Jan 22, 2009)

*IV Certification*

I believe that the ability to start IV.. draw labs, and intubation should be taught...if it is only under the orders or observation of and I or CC.


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## JPINFV (Jan 22, 2009)

Why should basics be intubating if a paramedic is on scene?


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## BossyCow (Jan 22, 2009)

JPINFV said:


> Just to make sure I'm reading your posts correctly, you think that basics should start IVs only under direct observation from a paramedic? Of course the proper follow up question is why not just have 2 paramedics?



Because our under 200 calls a year and many of them BLS doesn't justify changing our agency classification to ALS which requires 24/7 response. That means at least 3 full time medics and their toys. We are too geographically isolated to get that coverage from adjoining areas and have lost 2 of our go-to agencies for ALS support in the past year.


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## medic417 (Jan 22, 2009)

BossyCow said:


> Because our under 200 calls a year and many of them BLS doesn't justify changing our agency classification to ALS which requires 24/7 response. That means at least 3 full time medics and their toys. We are too geographically isolated to get that coverage from adjoining areas and have lost 2 of our go-to agencies for ALS support in the past year.




One of the services I work for is ALS 24/7 and has fewer than 200 calls.  Just means prioritys need changing.  Do whats best for the patients.


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## BossyCow (Jan 22, 2009)

medic417 said:


> One of the services I work for is ALS 24/7 and has fewer than 200 calls.  Just means prioritys need changing.  Do whats best for the patients.



Okay for those who haven't read my 2000 posts on the subject..... a recap. I live in an extremely rural, impoverished area where the literacy levels are low, the average education is 'some high school' and the major industries used to be logging and fishing, both of which have tanked. We have continually tried to get ALS to this area but can't pass a levy, don't have the property values to sustain it through tax and most of our real estate is state timberlands, or national parks. 

Not only have we been unable to upgrade our system to ALS but two adjoining agencies have dropped their ALS response to BLS. We do what is best for the patients. We do what we can. But telling the WalMart worker how a Caddy is a better ride than his Geo isn't going to make the money appear.


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## medic417 (Jan 22, 2009)

BossyCow said:


> Okay for those who haven't read my 2000 posts on the subject..... a recap. I live in an extremely rural, impoverished area where the literacy levels are low, the average education is 'some high school' and the major industries used to be logging and fishing, both of which have tanked. We have continually tried to get ALS to this area but can't pass a levy, don't have the property values to sustain it through tax and most of our real estate is state timberlands, or national parks.
> 
> Not only have we been unable to upgrade our system to ALS but two adjoining agencies have dropped their ALS response to BLS. We do what is best for the patients. We do what we can. But telling the WalMart worker how a Caddy is a better ride than his Geo isn't going to make the money appear.




Sad to hear that.  We are in same if not worse so again I would argue it can be done.   But regardless I disagree with basics doing ALS level procedures.  If you want ALS skills get your Paramedic.


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## BossyCow (Jan 22, 2009)

medic417 said:


> Sad to hear that.  We are in same if not worse so again I would argue it can be done.   But regardless I disagree with basics doing ALS level procedures.  If you want ALS skills get your Paramedic.



But in my state, its not ALS. I do what is legal within my cert. 

And as to 'getting my paramedic' I got one.. married him eons ago!


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## Sasha (Jan 22, 2009)

> Do whats best for the patients.



They ARE doing what's best for the patient, they're training what service they have to preform more advanced skills and procedures than the national norm. 

You can repost the same message, reworded over and over again but the fact of the matter is if there is no money to support it, there is no money to support it. If there is not a high demand, and 200 calls is not a high demand, for something, it's not going to happen.



> And as to 'getting my paramedic' I got one.. married him eons ago!



You're so cute!


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## medic417 (Jan 22, 2009)

Sasha said:


> They ARE doing what's best for the patient, they're training what service they have to preform more advanced skills and procedures than the national norm.
> 
> You can repost the same message, reworded over and over again but the fact of the matter is if there is no money to support it, there is no money to support it. If there is not a high demand, and 200 calls is not a high demand, for something, it's not going to happen.



Best for the patient care would be all advanced providers so no they are not doing whats best for the patients.  They are doing what the city/county/etc claims is best for the budget.  Two very seperate things.  

In time it will in time it will, yes in time all will be ALS.


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## Sasha (Jan 22, 2009)

medic417 said:


> Best for the patient care would be all advanced providers so no they are not doing whats best for the patients.  They are doing what the city/county/etc claims is best for the budget.  Two very seperate things.
> 
> In time it will in time it will, yes in time all will be ALS.



They cannot afford to staff ALS trucks. What part of that don't you comprehend? This is not the land of fairy tales where everything works out just because it's for the greater good. Money doesn't just pop up from nowhere. Running an ALS truck costs MONEY. More money than a BLS truck. ALS responders expect better pay then BLS responders. Money makes the world go round, and no money means no ALS. And they don't have a leg to stand on to request a grant or something. 200 calls? When places that run thousands of calls are still using LP10s, don't have ETC02, and there are trucks without a pulse ox? Where would the money do the greater good?


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## emtbill (Jan 23, 2009)

rmellish said:


> I'll add my perspective to this. I'm a basic-advanced, which in Indiana is considered the lowest level of ALS care. I can intitate peripheral IV access with NS, LR, and D5W, I can check BGLs, and use a 4 lead monitor, manually defibrillating VT and VF. I cannot give any further medications, and I can only recognize 5 basic rhythms per my scope.
> 
> I'm not a paramedic replacement. In fact, I'm far closer to a BLS provider.
> 
> ...



That's amazing. What if you're not on a medic truck? You can put a patient on a monitor and start an IV? What if they are symptomatic? "Yes mam I see you're in sinus brady with a rate of 35 and BP of 80 systolic, but I really can't do anything for you". That seems almost negligent. Does your state issue certifications or do you recripocate from the NREMT? I know the registry wouldn't certify you competent to read rhythms without being able to correct them.



JPINFV said:


> Why should basics be intubating if a paramedic is on scene?



Provided they have the proper education they should because if the most experienced provider always preforms the procedures no one advances their skills and knowledge.

In regards to the OP's question: It varies from state to state. If you went through an official state-approved EMT class and didn't get training in IV therapy chances are it's not in your scope of practice and you'll need additional training. For example, in Tennessee the lowest level of EMS provider is an IV technician which has little more training than an EMT-B in any other state. On the other hand, in Virginia, the next level of training to start IV's and have expanded pharmaceutical interventions takes an additional 120 hours of training (the same amount as the EMT-B curriculum).

To everyone else: I'm not surprised to see a lot of cynics saying that IV therapy shouldn't be given to BLS providers. It is an ALS skill, but the knowledge required to safely preform it is being exaggerated. The training I was given on the precautions of IV therapy can be summed as follows: 1)Watch for fluid overload by monitoring lung sounds and BP while giving a fluid bolus. If either become abnormal discontinue treatment. 2) Use an aseptic technique and cover the IV site. 3) Monitor IV site for infiltration. 4) Clear the infusion set of air and don't ever advance the catheter past the stylet as to avoid emboli.

Do those precautions really take months of instruction to properly train providers? No. Providers can be taught how to safely start IV's in a weekend, but it will take longer for them to become efficient at it. Providers do not realistically need to be educated in the finer points of osmosis to administer saline. Get real. Do you expect people to be worrying about hypernatremia while bolusing their crashing hypotensive patient? Hyperkalemia? There's not enough potassium in an entire bag of LR to cause any significant cardiac arrhythmias.

Practically every intervention in medicine has risks. For example, oxygen is toxic at elevated partial pressures. Should EMT-B's have to take university level chemistry and physiology to understand gaseous partial pressures and how it affects their patients? No, but one has to consider the risks and benefits of any intervention. In EMS, most of our interventions are clearly beneficial to the patient when they are indicated, and as a result marginal education in the procedures has become accepted. This is evidenced by EMT-B's being allowed a more liberal scope of practice such as the addition of IV therapy and supraglottic airway devices, and standing orders for the administration of nitroglycerin, epinephrine, albuterol, atrovent and glucagon. Is this acceptable? It's debatable, but consider the alternative situation in which a patient is denied an intervention that is clearly indicated such as glucagon in hypoglycemia, the denial of which could cause increased morbidity in lengthy transports. Should the provider be educated in the chemistry of the polypeptide and how it causes conformational changes in protein receptors, thereby activating adenylate cyclase along with several other steps in the pathway, ultimately resulting in an increase in blood sugar levels?

We have to draw the line somewhere, and if patient care becomes compromised when they can't get the care they need than there is a problem. One's education is _never_ complete, however the level to which a provider takes their education is a personal decision. As long as their interventions are safe and appropriate there shouldn't be a problem. Remember, we are technicians, not clinicians, and as such we follow orders from a physician in treating our patients. I would like to see EMS become more respected and autonomous which would require more education. This seems a blatant contradiction to my arguments above, and frankly I'm not sure how to address that. On one hand I _do_ think that the education level of EMS providers as a whole is lacking, but on the other hand I have see too often patients denied the care they need because of unrealistic expectations placed on the provider. The person whom balances this dichotomy will have accomplished a great feat.


----------



## vquintessence (Jan 23, 2009)

emtbill said:


> ((((snip its))))
> To everyone else: I'm not surprised to see a lot of cynics saying that IV therapy shouldn't be given to BLS providers. It is an ALS skill, but the *knowledge required to safely preform it is being exaggerated.*
> Do those precautions really take months of instruction to properly train providers? No.  *Providers can be taught how to safely start IV's in a weekend*
> *Providers do not realistically need to be educated in the finer points of osmosis to administer saline.*
> ...



Well put and agree with what wasn't cut out.  You mentioned how we need to be realistic and essentially just know how to do the skills, but on the other hand you want expanded education?  Which is it?  I wouldn't trivialize which fluid when it comes to the physiology of the body and its response to types of bolus either.

*0.9% NS, 0.45% NS, D10w, D5w and LR, oh my!*
Would LR be more beneficial to the trauma pt who is likely at least slightly acidotic?
Why do electrolytes matter?
Will giving a hypotensive trauma pt be cured with 3L of saline?  Oxygenation?
Do you give a 250cc fluid bolus to a dehydrated child?  How much fluid does a Neonate get?  Why do they get less?
Why do neonates get D10w instead of D50?  How much do they get?
Why do we give isotonic solutions instead of hypo/hypertonic?  Does it even matter?

Bill, I am willing to bet that you personally can answer most if not all of the questions above, along with a lot of the EMTs in the forum.  The questions weren't a personal attack.  The questions are for the average EMT who doesn't pick up a book after (hell during) school/training?  The ones gung ho on doing the stuff medics do, cause it looks easy and a monkey CAN do it better.

Disclaimer:  Medics aren't exonerated either for being uneducated, but the difference there is that they are expected to know those above, and if they don't, well they don't care along with the system that certifys them.  They deserve to get hung when the unfortunate happens and someone gets hurt or dies.


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## JPINFV (Jan 23, 2009)

emtbill said:


> Provided they have the proper education they should because if the most experienced provider always preforms the procedures no one advances their skills and knowledge.



False dichotomy. It isn't a "well, if they don't preform skills then they'll never advance" because there isn't a requirement of X amount of intubations before starting an EMT-Paramedic course. Furthermore, we don't see RNs or ER techs clamoring to intubate or start chest tubes to "advance." That's because advancing to a higher level is more than learning a handful of skills and throwing them out there. Furthermore, there's the problem of paramedic oversaturation and skill degredation (here's one article on it, I'm trying to find the original study). It doesn't matter if the paramedic is onscene if the paramedic still isn't preforming enough times to maintain competency. 


> To everyone else: I'm not surprised to see a lot of cynics saying that IV therapy shouldn't be given to BLS providers. It is an ALS skill, but the knowledge required to safely preform it is being exaggerated. The training I was given on the precautions of IV therapy can be summed as follows: 1)Watch for fluid overload by monitoring lung sounds and BP while giving a fluid bolus. If either become abnormal discontinue treatment. 2) Use an aseptic technique and cover the IV site. 3) Monitor IV site for infiltration. 4) Clear the infusion set of air and don't ever advance the catheter past the stylet as to avoid emboli.


What other skills should be lowered to the EMT-B level? How about 12 lead EKGs since there are area that don't require their paramedics to actually interpret the EKG? How about epi and atropine during a cardiac arrest? At what point do we draw the line and either say "We don't need any more of dem dare paramedics?" Alternatively, at what point do we sit here and say a 110 hour advanced first aid course (otherwise known as the 1994 DOT EMT-B curriculum) does not provide enough of a background to preform these interventions?



> [3 paragraphs of justifying low education standards including the following quote]
> Remember, we are technicians, not clinicians, and as such we follow orders from a physician in treating our patients.


...and that's why EMS will never be a profession and will continue to have things like required base hospital contact in a lot of areas and crap pay.


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## Shishkabob (Jan 23, 2009)

vquintessence said:


> *0.9% NS, 0.45% NS, D10w, D5w and LR, oh my!*
> Would LR be more beneficial to the trauma pt who is likely at least slightly acidotic?
> Why do electrolytes matter?
> Will giving a hypotensive trauma pt be cured with 3L of saline?  Oxygenation?
> ...




Do I have to say it for the umpteenth time?

We're not asking for all ALS interventions here.  We're not asking for all drugs here.

Add on the extra weeks it takes to educate people on how to poke a needle, and about NS.  Honestly, if you think it's so hard to teach in the proper time, then why should medics have it too?

I'm not saying give a 4 hour lecture and let them have at it.  *I'm saying do it in the appropriate amount of time.*


----------



## vquintessence (Jan 23, 2009)

Linuss said:


> Do I have to say it for the umpteenth time?
> 
> We're not asking for all ALS interventions here.  We're not asking for all drugs here.
> 
> ...



It was a question for the guy debating about there being only trivial rammifications behind fluid administration.  You work PB.  So for few and far between instances where it's absolutely crucial for a simultaneous IV and ETT, can be about the only argument for its use by a basic.

Until the 110 hour cirriculum changes, it doesn't seem wise to have EMT-B units initiating IV alone, when their only option after access is to give nor not give saline, and perhaps understand why.  Bossycow cited the only time she can do it is WITH authorization AND when ALS intercept is en route, and even that situation is with long transport times and minimal resources.  That could be about the only acceptable situation.

The other part about required education, is, an EMT-I.  If basics want IV, then they can get their Int or medic, and hell, after that they can intubate too!  Do they want the education involved to get that ability, or do they just want to skill?


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## VentMedic (Jan 23, 2009)

vquintessence said:


> .
> 
> The other part about required education, is, an EMT-I. If basics want IV, then they can get their Int or medic, and hell, after that they can intubate too! Do they want the education involved to get that ability, or do they just want to skill?


 
Why do EMT-Bs put so much time and effort into getting so many "certs" for individual "skills"? It is this type of piece mill stuff that has gotten EMS to the point of 50+ different levels. 

It seems that some just want to say they can do the skills of a Paramedic but without the extra responsility the comes with knowing why.


----------



## medic417 (Jan 23, 2009)

VentMedic said:


> Why do EMT-Bs put so much time and effort into getting so many "certs" for individual "skills"? It is this type of piece mill stuff that has gotten EMS to the point of 50+ different levels.
> 
> It seems that some just want to say they can do the skills of a Paramedic but without the extra responsility the comes with knowing why.



How true!!!!!!!!!!!!!!!!!!  In this day and age of technology there are so many options there is no other legit reasons a person would not go get their Paramedic if they want ALS.


----------



## Shishkabob (Jan 23, 2009)

I'm all for replacing Bs with Is but nationally it's not trending that way, just the opposite is true. 

It seems to me you're against people doing it with the proper education simply because they have a B instead of an I or P. 

Again, not looking for another 10 hours added on to the course. Proper education could be an extra 50 hours or 100. But for some reason you have it in your mind that it can't be done.


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## emtbill (Jan 23, 2009)

JPINFV said:


> False dichotomy. It isn't a "well, if they don't preform skills then they'll never advance" because there isn't a requirement of X amount of intubations before starting an EMT-Paramedic course. Furthermore, we don't see RNs or ER techs clamoring to intubate or start chest tubes to "advance." That's because advancing to a higher level is more than learning a handful of skills and throwing them out there.



You misunderstood my statement. It had nothing to do with entrance requirements to a paramedic program. Also, the hospital scenario is moot. There is always a physician in the hospital to do these procedures, however my point was to increase competency of EMS providers. If a patient needs to be intubated, and there's a veteran paramedic and a new paramedic (or even a student) there, no one learns anything if the veteran preforms the skill. Everyone knows he/she is competent, but if the rookie provider doesn't get the experience preforming the skill with the veteran helping him, it could reflect negatively during the rookie's next patient contact without the veteran.

I wholeheartedly agree with you over advancement being more than learning a handful of skills and throwing them out there. A good provider will always be more educated than that. As I was discussing in my OP, however, many procedures have such clear benefit that it might be more beneficial to the patient to give the provider access to the skills liberally.



JPINFV said:


> What other skills should be lowered to the EMT-B level? How about 12 lead EKGs since there are area that don't require their paramedics to actually interpret the EKG?



EMT-B's already obtain 12 leads in my area. See page 13: http://odemsa.vaems.org/index.php?option=com_docman&task=doc_download&gid=8



JPINFV said:


> How about epi and atropine during a cardiac arrest?



BLS providers already do so. See page 50: http://www.western.vaems.org/index.php?option=com_docman&task=doc_download&gid=169

Virginia Enhanced providers are able to start peripheral IV's, place supraglottic airways, etc and can give ASA, NTG, Albuterol, Narcan, Benadryl, Thiamine, Epinephrine, Valium, Morphine, D50, etc. They have no training in reading EKG's and no ACLS training. For this reason they are generally not considered ALS providers as their cardiac assessments are non-diagnostic. Still, in many regions they are allowed to preform paramedic level interventions because the patient will benefit form them.



vquintessence said:


> Do they want the education involved to get that ability, or do they just want to skill?



I think there's a lot of truth to that. There are a lot of whackers out there with the "Hey look what I can do to this patient!" kind of attitude.


----------



## Veneficus (Jan 23, 2009)

medic417 said:


> Best for the patient care would be all advanced providers so no they are not doing whats best for the patients.  They are doing what the city/county/etc claims is best for the budget.  Two very seperate things.
> 
> In time it will in time it will, yes in time all will be ALS.



Just my thoughts, but in Bossy's case, I think that providing the care they do is better than no care at all. I do not think basics around the country should be starting IVs. But it sounds to me that her area needs an exception to the rule. (which are more like guidlines anyway  ) I do not think simpy having "als" improves care. These same ALS providers would have to be constantly practicing their skills somewhere like a nearby hospital, because they would be using them so infrequently. It is the same situation as having a paramedic on every street corner.


----------



## BossyCow (Jan 23, 2009)

VentMedic said:


> Why do EMT-Bs put so much time and effort into getting so many "certs" for individual "skills"? It is this type of piece mill stuff that has gotten EMS to the point of 50+ different levels.
> 
> It seems that *some *just want to say they can do the skills of a Paramedic but without the extra responsility the comes with knowing why.



I'm sure there are SOME that are motivated by that, but I'm tired of being tarred with that brush!


----------



## Veneficus (Jan 23, 2009)

Where to begin....



emtbill said:


> To everyone else: I'm not surprised to see a lot of cynics saying that IV therapy shouldn't be given to BLS providers. It is an ALS skill, but the knowledge required to safely preform it is being exaggerated. The training I was given on the precautions of IV therapy can be summed as follows: 1)Watch for fluid overload by monitoring lung sounds and BP while giving a fluid bolus. If either become abnormal discontinue treatment. 2) Use an aseptic technique and cover the IV site. 3) Monitor IV site for infiltration. 4) Clear the infusion set of air and don't ever advance the catheter past the stylet as to avoid emboli.



The training you received could be summed up in 4 points. I am not even sure what to say. I seriously pay too much for my education. You really think that’s all there is to it?




emtbill said:


> Do those precautions really take months of instruction to properly train providers? No. Providers can be taught how to safely start IV's in a weekend, but it will take longer for them to become efficient at it.



the psychomotor skill yes, enough to choose when to use the skill or not which may cause harm, no.



emtbill said:


> Providers do not realistically need to be educated in the finer points of osmosis to administer saline. Get real. Do you expect people to be worrying about hypernatremia while bolusing their crashing hypotensive patient? Hyperkalemia? There's not enough potassium in an entire bag of LR to cause any significant cardiac arrhythmias..



I clearly spend too much time studying as well. Providers do need to be educated in the finer points of osmosis, otherwise all those MDs and RNs wouldn’t bother with it either. Do you really think that is just information to fill up time in lecture? The patient may already be hyperkalemic before the LR. How does one without a lab or monitor figure that out before the bolus? If you want to save crashing patients adding complications in the rush to provide cookbook medicine will probably not increase the save rate.



emtbill said:


> Practically every intervention in medicine has risks.



The risks for one patient may be different for others. That is why we practice risk stratification.



emtbill said:


> For example, oxygen is toxic at elevated partial pressures. Should EMT-B's have to take university level chemistry and physiology to understand gaseous partial pressures and how it affects their patients?



I say yes, then maybe they would stop putting 15L or NRB on every patient, when it makes no difference from a cannula most of the time.




emtbill said:


> but one has to consider the risks and benefits of any intervention.?



One has to know them to do that.



emtbill said:


> In EMS, most of our interventions are clearly beneficial to the patient when they are indicated,



Says who? Interventions like fluid for penetrating trauma patients? MAST pants? Spine boards? The plethora of drugs used in cardiac arrest algorithms? 



emtbill said:


> This is evidenced by EMT-B's being allowed a more liberal scope of practice such as the addition of IV therapy and supraglottic airway devices, and standing orders for the administration of nitroglycerin, epinephrine, albuterol, atrovent and glucagon. Is this acceptable



Considering we give those by prescription for patients to administer on themselves? Probably it is a good idea. But that s not an apples to apples comparison. Those are basically treatments that are designed to work for a specific life threatening condition that will probably result in death if left untreated. Fluid therapy is not that specific and rarely will save a life on its own. A pt in cardiogenic shock and a BP of 80/60 will be harmed by fluid. A penetrating trauma patient with a high degree of blood loss or massive wound and a bp of 70/40 will be harmed by fluid. Pt with renal failure, harmed by fluid. Exhausted/dehydrated endurance athletes, sometimes harmed by fluid. (most dramatically usually resulting in death when it happens)



emtbill said:


> Should the provider be educated in the chemistry of the polypeptide and how it causes conformational changes in protein receptors, thereby activating adenylate cyclase along with several other steps in the pathway, ultimately resulting in an increase in blood sugar levels?



 If I need to spend time learning it, why not other providers giving it as well? If for no other reason it might lead to a pay raise? But in my opinion if you are a health care provider administering a drug, you should know why it works. No matter what your level. Not simply if you see X then you do Y.



emtbill said:


> Remember, we are technicians, not clinicians, and as such we follow orders from a physician in treating our patients.



Why do I bother trying to help EMTs gain professional status with this kind of mindless laborer mentality. No wonder Providers laugh at me when I tell them prehospital providers are more than just ambulance drivers. How long does a radiology *Tech* need to go to school? I have seen those students do some pretty advanced physics homework to even meet the prereqs.



emtbill said:


> I would like to see EMS become more respected and autonomous which would require more education. This seems a blatant contradiction to my arguments above, and frankly I'm not sure how to address that. On one hand I _do_ think that the education level of EMS providers as a whole is lacking, but on the other hand I have see too often patients denied the care they need because of unrealistic expectations placed on the provider.



I would take a closer look at "need" and base the care performed by the environment that is involved. (like wilderness, remote, etc) But then I would require education to match the increased scope, understanding that those providers needed a legitimate exception to an established rule of higher education for all providers.



emtbill said:


> The person whom balances this dichotomy will have accomplished a great feat.



I think the dichotomy is fairly simple. If you are in need of a lower level provider performing treatments (notice I didn’t say skills) then those providers need to be educated (in addition to trained) on what they are doing, why it works, and when not to do it based on medical principles, not time of transport or intercept. I don’t think we need to require basic providers to memorize liver enzymes and functions, but I also don’t think it is too much to ask them to listen to a lecture on how glycogen breaks down into glucose and get the gist of it if they are going to be giving glucagon. (similar idea for other treatments)


----------



## Veneficus (Jan 23, 2009)

emtbill said:


> EMT-B's already obtain 12 leads in my area. See page 13: http://odemsa.vaems.org/index.php?option=com_docman&task=doc_download&gid=8..



Big difference between obtain and interpret. But I cannot think of one reason why an EMT-B anywhere shouldn't be able to put on monitor leads and print a strip and transmit it to the hospital, even if they are not providing treatment for it in the field. 

BLS providers already do so. See page 50: http://www.western.vaems.org/index.php?option=com_docman&task=doc_download&gid=169



emtbill said:


> Virginia Enhanced providers are able to start peripheral IV's, place supraglottic airways, etc and can give ASA, NTG, Albuterol, Narcan, Benadryl, Thiamine, Epinephrine, Valium, Morphine, D50, etc. They have no training in reading EKG's and no ACLS training. For this reason they are generally not considered ALS providers as their cardiac assessments are non-diagnostic. Still, in many regions they are allowed to preform paramedic level interventions because the patient will benefit form them..



I noticed reading through the protocols that almost all of the advanced procedures are regarded as psychomotor skills and the decision to perform these skills rests with online medical direction, not the provider in the field. Seems very reasonable to me, but I would not call it an advanced scope until it comes with independant decision making.

I also noticed that paramedics need online direction to administer epi IM to an anaphylactic patient. I seriously hope that is just a misprint.


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## Shishkabob (Jan 23, 2009)

Veneficus said:
			
		

> Considering we give those by prescription for patients to administer on themselves?




See, here's the thing... you can't confuse your agency's / states protocols for someone elses.

Some states give 7 BLS drugs, none of which require the PT to already be prescribed.  This includes NTG.  If a pt meets the criteria, but has no prescription, we don't go "Well you're SOL".


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## Veneficus (Jan 23, 2009)

Linuss said:


> See, here's the thing... you can't confuse your agency's / states protocols for someone elses.
> 
> Some states give 7 BLS drugs, none of which require the PT to already be prescribed.  This includes NTG.  If a pt meets the criteria, but has no prescription, we don't go "Well you're SOL".



sorry if i was unclear. I support basic providers giving nitro, albuterol, atrovent, IM epi, and glucagon provided they are properly educated to do so or the decision is made by online medical direction.


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## Shishkabob (Jan 23, 2009)

Veneficus said:


> sorry if i was unclear. I support basic providers giving nitro, albuterol, atrovent, IM epi, and glucagon provided they are properly educated to do so or the decision is made by online medical direction.



Ah ok then, sorry for the misunderstanding.  Been  long day =)


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## lightsandsirens5 (Jan 23, 2009)

Veneficus said:


> I support basic providers giving nitro, albuterol, atrovent, IM epi, and glucagon provided they are properly educated to do so or the decision is made by online medical direction.



I agree. It isnt that tough to figure out the indications/contras for these basic drugs. And with OLMC, us "uneducated, blind BLS monkeys" almost can't go wrong!

*sigh*


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## medic417 (Jan 23, 2009)

lightsandsirens5 said:


> I agree. It isnt that tough to figure out the indications/contras for these basic drugs. And with OLMC, us "uneducated, blind BLS monkeys" almost can't go wrong!
> 
> *sigh*



I would disagree.  Even with online control you as a basic may miss an important detail that would cause the doctor to change which if any med to have you administer.  Yes much can go wrong.  Plus nitro should not be given to a patient w/o a 12 lead and IV access.  No that does not mean basics should do those so they can give nitro.


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## Shishkabob (Jan 23, 2009)

medic417 said:


> I would disagree.  Even with online control you as a basic may miss an important detail that would cause the doctor to change which if any med to have you administer.



Same with medics...


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## medic417 (Jan 23, 2009)

Linuss said:


> Same with medics...



More education makes it less likely.  If I was the patient I want the best chance.


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## Veneficus (Jan 23, 2009)

lightsandsirens5 said:


> I agree. It isnt that tough to figure out the indications/contras for these basic drugs. And with OLMC, us "uneducated, blind BLS monkeys" almost can't go wrong!
> 
> *sigh*



Are you suggesting that anyone should give medications without education on its use or in its absence of that, somebody who is educated about its specifics?

I do not think it is asking a lot to require some classes in pharm, especially the specifics of the meds you are giving before writing a blank cheque on EMT-Bs dolling out medications that require a prescription. I never said anyone was stupid or a monkey. I don't know how to fix a car because I was never taught, I would definately make an effort to learn something about it before I tried. If I thought it was too complicated a repair for me I would also defer to somebody more capable than myself. 

Does it sound that unreasonable?

I have had to clean up after basics who thought the local swelling from a bee sting was an early anaphylaxis sign and stabbed a pt with an epi pen. The agency was quite fortunate we were not sued. Sometimes treatments are limited to protect the providers. I would much rather be told by my medical director I didn't know enough to do something than a personal injury or malpractice attorney.

In addition, all chest pain is not cardiac in nature, you can't give everyone complaining of CP nitro "just in case" anymore than you could stab people in the chest with a needle cause they "might have a spontaneous pneumo."  

I do not think a monitor or an IV is required in order to give meds and it is no substitute for education or clinical judgement. My mom doesn't take her bp, put herself on a monitor, or start a line before she takes her nitro. I doubt anyone does. 

Nobody is immune from making mistakes.


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## Shishkabob (Jan 23, 2009)

medic417 said:


> More education makes it less likely.  If I was the patient I want the best chance.



Are you saying that just because someone isn't a medic they have less education?

So much for all those pharmacy techs that are EMTs. So much for all those pre meds. Or PAs. Or nurses.   Or other medical professionals that are also EMTs.

What about a 20 year EMT when compared to a 1 month medic?



You can't make blanket statements like that.


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## rmellish (Jan 24, 2009)

Because all EMTs are pharmacy techs. 

Or maybe we should grant special privileges to those who are.


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## Shishkabob (Jan 24, 2009)

rmellish said:


> Because all EMTs are pharmacy techs.
> 
> Or maybe we should grant special privileges to those who are.



Yes, I am glad you caught on to the concept I was trying to convey......

Or you can just prove his point. Whichever works.


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## lightsandsirens5 (Jan 24, 2009)

Veneficus said:


> Are you suggesting that anyone should give medications without education on its use or in its absence of that, somebody who is educated about its specifics?
> 
> I do not think it is asking a lot to require some classes in pharm, especially the specifics of the meds you are giving before writing a blank cheque on EMT-Bs dolling out medications that require a prescription. I never said anyone was stupid or a monkey. I don't know how to fix a car because I was never taught, I would definately make an effort to learn something about it before I tried. If I thought it was too complicated a repair for me I would also defer to somebody more capable than myself.
> 
> ...



I am not at all saying people should give medications without education on its use! I may be _just_ a basic, but I am _not_ an idiot!!!

I'm saying that basics should be allowed to give a certain things _with the proper training._

About the basic sticking epi in the pt with local swelling, he/she was _obviously_ not following protocols! If you link all basics would do this, if you think basics think all CP is cardiac, if you think that a basic would give nitro "just in case". If you think that these things are stereotypical of a basic.........you my friend are sadly mistaken and I feel very sorry for you.

There are _thousands_ of basics in this country who, every day, follow protocols and apply their training and save lives. Sometimes that training includes 1 or 2 more drugs or procedures. _SO WHAT!!!_ They have been trained for it!


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## JPINFV (Jan 24, 2009)

Linuss said:


> Are you saying that just because someone isn't a medic they have less education?
> 
> So much for all those pharmacy techs that are EMTs. So much for all those pre meds. Or PAs. Or nurses.   Or other medical professionals that are also EMTs.
> 
> ...



Sure, I'll make the argument that the average EMT-P has more education than your average EMT-B. I'm not about to go around saying, "Zomg, I have an undergraduate degree and am in grad school, I should be able to do X, Y, and Z because my education far surpasses EMT-B training," because you can't just go around asking for special privileges for specific providers. After all, it's called EMT-B, not EMT-JPINFV.


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## Veneficus (Jan 24, 2009)

rmellish said:


> Because all EMTs are pharmacy techs.
> 
> Or maybe we should grant special privileges to those who are.



Sorry, I don't understad. What has having to take a couple of weeks worth of extra class if you are going to give out meds have to do with pharm techs?

There is no way to cover the topic in the 120 hours that is EMT class.


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## Veneficus (Jan 24, 2009)

lightsandsirens5 said:


> About the basic sticking epi in the pt with local swelling, he/she was _obviously_ not following protocols! If you link all basics would do this, if you think basics think all CP is cardiac, if you think that a basic would give nitro "just in case". If you think that these things are stereotypical of a basic.........you my friend are sadly mistaken and I feel very sorry for you.



Ummm, there is more than a fair share of medics who give things "just in case." I was not trying to imply that all basics are somehow bad, I have thrown a lot of support behind basics as of the late. Please consider that following a protocol without judgment doesn't make anyone at any level a good provider. Handing out medication to people who they are not indicated for is not always "helping" even if you don't see immediate harm. medications are toxins, you must forgive me that I do not think there is enough education for EMTs as a whole in the US currently to have them determine when they are going to use a controlled poison on another human. But my opinion of the education has no bearing on whether or not I think EMTs, medics, or anyone else does a good job based on what is expected of them. Also please see the forest from the trees. You may be the greatest basic that ever lived, you may find you are surrounded by such providers, but as a whole, that is not the average ability of all the people practicing today. 




lightsandsirens5 said:


> There are _thousands_ of basics in this country who, every day, follow protocols and apply their training and save lives. Sometimes that training includes 1 or 2 more drugs or procedures. _SO WHAT!!!_ They have been trained for it!



I disagree that basics should be given extra training to do extra things unless there is some kind of mitigating circumstance such as remote area, etc. The more EMS providers base their value to society on how many procedures they can do or drugs they can give the farther from a respectable profession (an consequently a pay raise) EMS becomes.I was an EMT-B once too, for many years in fact. At the time I didn't know what I didn't know. I still teach medic classes and it is difficult to teach them what they need to know in the alloted time. My professors tell me they cannot teach me what I need in the alloted time. (and assign a great deal of homework for what they could not cover on any given day) How is it that EMT class suddenly makes people ready to expand their scope so disproportionately to their education?


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## medic417 (Jan 24, 2009)

Linuss said:


> Are you saying that just because someone isn't a medic they have less education?
> 
> So much for all those pharmacy techs that are EMTs. So much for all those pre meds. Or PAs. Or nurses.   Or other medical professionals that are also EMTs.
> 
> ...



You can't make the blanket statement that all meet those criteria either.  In fact if a study were done I would bet it would end up less than 5% meet your criteria.  So why should the rules be changed for all for the few with real medical education?

I would trust the 1 month medic more as they have education behind them.


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## Shishkabob (Jan 24, 2009)

Education means absolutely nothing without practical experience.


Again, the part I think you guys are FAILING to understand is that with more skills and meds, more education is required. 

I'm not saying give all basics every drug and skill. I'm saying, why not allow a few more things with the PROPER education. 

If you disagree with that statement then you need to explain why other then "They don't have enough education" as I have stated 5 times already WITH THE PROPER EDUCATION.


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## ffemt8978 (Jan 24, 2009)

JPINFV said:


> After all, it's called EMT-B, not EMT-JPINFV.



You been looking at WA state's certification levels again?


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## JPINFV (Jan 24, 2009)

Linuss said:


> I'm not saying give all basics every drug and skill. I'm saying, why not allow a few more things with the PROPER education.



The problem is that a lot of us don't think that EMT-Bs have enough education to do what we're doing already.


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## ffemt8978 (Jan 24, 2009)

medic417 said:


> One of the services I work for is ALS 24/7 and has fewer than 200 calls.  Just means prioritys need changing.  Do whats best for the patients.



So what you're saying is that you work for more than one service, correct?  I'm guessing that you do so in an effort to pay all of your bills.  Could you meet all of your financial obligations if that service was the ONLY one you worked for, or if you had to drive 1-2 hours one way to another job?


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## Shishkabob (Jan 24, 2009)

JPINFV said:


> The problem is that a lot of us don't think that EMT-Bs have enough education to do what we're doing already.





6th time I'll say it;

With the proper education.


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## VentMedic (Jan 24, 2009)

Linuss said:


> 6th time I'll say it;
> 
> With the proper education.


 
How much education? Teaching one little skill with just a little education about that one skill and indications may miss the rest of the body.

Example: Albuterol: indication - wheezes/shortness of breath. What if the wheezes are cardiac in orgin? Without a cardiac monitor you may miss that HR of 220 because the perfusing pulses you feel may only be 100. New onset A-fib can happen to anyone of any age at any time. No previous history needs to be present. 

Phlebotomists now need at least 140 hours of initial training for essentially doing ONE skill and some require 1040 hours of clinical time for the "skill" to be recognized for certification. 

CNA may require 150 hours of training in some states, which is more than EMTs for most, and CNAs may be required twice that in a specialty area or *each* specialty area they work in. Yet, we have all read on these forums what the EMT thinks of the CNA.

PCTs who do IVs and EKGs (just the skills) in hospitals may require 700 hours of training in some states along with an addtional Phlebotomy cert. That is almost more than some states require for the Paramedic. 700 hours is still a lot less then becoming an RN and some PCTs do use that argument to not advance or some just say they prefer not to have the responsibility of an RN.

There are all considered "non-licensed" technicians. 

For EMS to get recognized as a profession, something more concrete has to be decided upon rather than this piece mill skills patch work of "certs".


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## medic417 (Jan 24, 2009)

ffemt8978 said:


> So what you're saying is that you work for more than one service, correct?  I'm guessing that you do so in an effort to pay all of your bills.  Could you meet all of your financial obligations if that service was the ONLY one you worked for, or if you had to drive 1-2 hours one way to another job?



Actually I make $20/hr plus overtime plus benefits.  All hours paid.  I actually pay all my bills with that job. I drive over 200 miles one way to get there.

 I work regular part time about 3 days a month at another service and make similiar but do it more for the challenge. 

 I also will occasionally fill in for 3 other locations but usually no more than 1 day a month and not every month.  I make sure I have at least 15 days a month off work.  Including at least 1 off period that is 7 days long.

My part time jobs pay for me and my family to travel when and where we want.


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## gillysaurus (Jan 24, 2009)

Okay, I'm not going to lie, I only really skimmed this whole thread just to see if the OP had gotten his question answered, which it doesn't look like.

OP, in Colorado you have to complete an extra 24 hour class to get your IV certification. You can do that at nearly any community college that offers an EMS program, you just need a valid, current copy of your state EMT certification and health insurance (for the clinical). Once you've finished the course, you'll be "certified" to start IVs, do blood draws, do glucose checks, and administer D50 and Narcan IN. 

The 24 hour course covers reasons you would give an IV, what fluids there are and how they affect the cells, drug calculations (not so the basic can administer but so they have a better understand of ALS procedures) and IV administration techniques. Then you get to do a few clinical rotations in a busy trauma center to practice your skills.

Keep in mind, the rest of you, that most ambulances outside of the metro Denver area in Colorado are ALS ambulances, staffed mostly with one paramedic and one basic. The basic is always receiving advice and training from their partner on how to improve their skills and understand the deeper meanings behind fluid administration beyond class. They don't just throw a no-nothing kid in back with needles and yell "have fun!"


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## medic417 (Jan 24, 2009)

WOW 24 hours.  Now I feel very safe and secure. NOT!!!!!!!!!!!

Not nearly enough time for even just IV much less the other items you include.


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## Sasha (Jan 24, 2009)

medic417 said:


> WOW 24 hours.  Now I feel very safe and secure. NOT!!!!!!!!!!!
> 
> Not nearly enough time for even just IV much less the other items you include.



So. just how much education to you feel cannulating a vein takes                 ?     

(forgive spacing. typing on my phone.)


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## Shishkabob (Jan 24, 2009)

Sasha said:


> So. just how much education to you feel cannulating a vein takes?





Obviously more than my "proper education" provides.


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## Sasha (Jan 24, 2009)

Linuss said:


> Obviously more than my "proper education" provides.



But how much? forgive me, i may have missed it but what do thopponents of basics gaining iv access feel is an adequate amount of proper education to safely cannulate a vein? how much education did you get on it?


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## Shishkabob (Jan 24, 2009)

Sasha said:


> But how much? forgive me, i may have missed it but what do thopponents of basics gaining iv access feel is an adequate amount of proper education to safely cannulate a vein? how much education did you get on it?



I've been asking that question for 9 pages now without so much as an answer.

For some reason, they think that "proper education" is not enough.  Funny.  I thought it was called proper for a reason.


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## medic417 (Jan 24, 2009)

Linuss said:


> I've been asking that question for 9 pages now without so much as an answer.
> 
> For some reason, they think that "proper education" is not enough.  Funny.  I thought it was called proper for a reason.




Proper education is a Paramedic course from a quality program.  What we have been saying for the last 9 pages that all these add on certs are part of what is killing EMS.  The best idea would be do away with basic and have Paramedic be the minimum.


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## Shishkabob (Jan 24, 2009)

medic417 said:


> all these add on certs are part of what is killing EMS.





Wait wait wait.  So, you're saying more education is a must, but when it comes to more certs, WHICH REQUIRE EDUCATION, that's bad for EMS?



Now, I understand not wanting an alphabet soup of abbreviates, but c'mon.


As I stated a couple pages back, an I should be the lowest level and B gone, but alas, the country as a whole is going in the opposite direction, having B's and P's and not I's (with exceptions).  So why not, WITH EDUCATION, have the B's fill the void?


You will have no valid answer to that because it does not exist.  There is no reason not to let someone do something if they are properly educated and certified, and has an MC.


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## VentMedic (Jan 24, 2009)

Linuss said:


> Wait wait wait. So, you're saying more education is a must, but when it comes to more certs, WHICH REQUIRE EDUCATION, that's bad for EMS?
> 
> 
> 
> ...


 
A 24 hour TRAINING cert is NOT education. If one does not understand the rest of the A&P behind that skill, it is just "training for a skill" with a few indications to "get by" until you get to the ED. 

Welders get a better understanding of their craft and they have also realized the need for an EDUCATION to make themselves more marketable and to compliment their "skills". 

Once EMS starts to understand the difference between the votech mentality of training and actual education, it will then start to progress. 

I think it is time to make a reference to this thread:

*Basics before Advanced*

http://www.emtlife.com/showthread.php?t=4830

And *NO*, it is not referring to EMT-B vs Paramedic.


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## Shishkabob (Jan 24, 2009)

Vent, show me where I said 24 hours is proper?  Heres a hint: I didn't. 


So for time 7;

 With proper education and clinical time, there is not a single logical reason not to.


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## triemal04 (Jan 24, 2009)

I don't see what the problem is with the country "going the other way" and only allowing uneducated and untrained providers to perform minimal interventions.  Fact is, that's entirely appropriate.  Just as the EMT-I (or whatever the hell it's called in various states) is an inappropriate thing to have.  For instance, in Oregon it is possible to go from nobody to EMT-I (which has a huge scope of practice...not a lot less than a paramedic) with only 260 hours of education.  Think that's appropriate?  Think that's a proper education for all that they are now allowed?  The fact that people are starting to wise up to that fact and remove EMT-I's is great.  

If you are a basic and want to do more of those fun things you can't now then suck it up and go to paramedic school.  Don't look for a short cut.  As someone has allready said, the proper education for even starting an IV in EMS is a paramedic's education.  

Live with it.


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## reaper (Jan 24, 2009)

Proper education would be 14 months. It is called Paramedic school!!


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## Ridryder911 (Jan 24, 2009)

Linuss said:


> I've been asking that question for 9 pages now without so much as an answer.
> 
> For some reason, they think that "proper education" is not enough.  Funny.  I thought it was called proper for a reason.



Three years. Why do things half arse? If you receive the proper education truly needed; then you would be an educated Paramedic. Now this has been answered, we can close this mindless thread. 

R/r 911


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## Shishkabob (Jan 24, 2009)

See, was that so hard. Damn, for a bunch of people with college educations none of us can understand eachother. 

Logic gets lost in feelings far too often.


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## ffemt8978 (Jan 24, 2009)

That's enough of this one.


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