# EMT Basic Question IV Transport



## Derrick (Dec 2, 2014)

Sorry, to ask you guys this question, but I don't know where else to turn lol. I was asked a question during an interview that I still am not sure of. So are EMT Basics allowed to transport patients on IVs? I was searching it in the protocols of the nearby counties and am coming up shorthanded. I mean in class we always talked about maintenance of the IV with a paramedic. But I mean in a bls ambulance with only EMTs, is it allowed?


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## CodeBru1984 (Dec 2, 2014)

Derrick said:


> Sorry, to ask you guys this question, but I don't know where else to turn lol. I was asked a question during an interview that I still am not sure of. So are EMT Basics allowed to transport patients on IVs? I was searching it in the protocols of the nearby counties and am coming up shorthanded.


It all depends on the fluids that are hung and if they are medicated fluids or not. For example, as an EMT in my last county system, we were only allowed to transport non-medicated fluids (NS and LR) without having to upgrade to a CCT. We were not allowed to adjust the flow of the medication, with the exception of turning off the flow if it was to become infiltrated or disconnected.


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## Jim37F (Dec 2, 2014)

It all depends on your local scope of practice. Check with your LEMSA. 

Here in LA County an EMT can: 
"D. Monitor and adjust to maintain a preset rate of flow, or turn off the intravenous (IV) fluid if indicated:
1. Glucose solutions
2. Isotonic balanced salt solutions (Normal Saline)
3. Ringer's Lactate

...

I. Monitor intravenous (IV) infusions with additives to a keep open (TKO) rate:
1. Folic acid
2. Multi-vitamins (MVI)
3. Magnesium Sulfate (only when in conjunction with multi-vitamins)
4. Thiamine

J. Monitor IV infusions with additives at pre-set rate via infusion pump:
1. Potassium Chloride 20mEq/1000mL
2. Total parenteral nutrition (TPN)

K. Transport patients with specialized infusion pumps:
1. Any prescribed medication with an automated or patient operated medication pump.
2. Any prescribed pain medication via a patient controlled analgesia (PCA) pump."


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## DesertMedic66 (Dec 2, 2014)

As everyone else already stated its going to depend solely on your protocols. Some areas allow it while others don't. Areas will also allow different fluid and/or medications to be monitored by EMTs.


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## Christopher (Dec 2, 2014)

Derrick said:


> Sorry, to ask you guys this question, but I don't know where else to turn lol. I was asked a question during an interview that I still am not sure of. So are EMT Basics allowed to transport patients on IVs? I was searching it in the protocols of the nearby counties and am coming up shorthanded. I mean in class we always talked about maintenance of the IV with a paramedic. But I mean in a bls ambulance with only EMTs, is it allowed?


The answer is definitely YES.
The answer is definitely NO.
The answer is definitely SOMETIMES.

Please let us know which answer is correct for your agency, County, State, and/or Country. ;-)


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## EMT11KDL (Dec 2, 2014)

In Idaho Basic can transport Saline Locks.  Also, if the basic has gone through the option module for IV, they can transport with Fluid running, Non-Medicated.  It all depends on what state you work in, and agency protocols


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## Akulahawk (Dec 2, 2014)

The last time I worked on an ambulance (about 10 years ago), an EMT could monitor IV solutions without additional medications being added, including potassium. These were Saline, 1/2 NS, and 1/4 NS, Lactated Ringers, and D5 or D10 in any of those fluids. We could adjust the drip rate to maintain a preset/predetermined infusion rate but we could not change that rate on our own, except to turn the infusion off. If we did that, we were not allowed to restart the flow of fluid. We could not establish or reestablish the line if it became dislodged or disconnected. 

We couldn't use a pump.


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## EMTinCT (Dec 2, 2014)

EMT-Bs don't start IVs and can't transport a PT who has an IV and is infusing. If PT has an IV catheter but it isn't infusing then it's OK. You may not initiate an IV or begin infusion.


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## EMT11KDL (Dec 2, 2014)

EMTinCT said:


> EMT-Bs don't start IVs and can't transport a PT who has an IV and is infusing. If PT has an IV catheter but it isn't infusing then it's OK. You may not initiate an IV or begin infusion.


Like said before, your statement is not completely accurate.  It depends on the State.  Idaho, EMT basics can, Same with Colorado, and I believe Montana also. It depends on the State that you are working in.


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## EMTinCT (Dec 2, 2014)

EMT11KDL said:


> Like said before, your statement is not completely accurate.  It depends on the State.  Idaho, EMT basics can, Same with Colorado, and I believe Montana also. It depends on the State that you are working in.



I've never heard of anything like that. They must be Intermediate EMTs.


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## EMT11KDL (Dec 2, 2014)

EMTinCT said:


> I've never heard of anything like that. They must be Intermediate EMTs.


Nope, When I was a basic in Colorado I could start IV, I have basics (in Idaho) that are on my rig that can start my IV's for me and run non medicated fluid.  It just depends on your local protocols.  I believe Montana is the same way as both Colorado and Idaho.


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## EMTinCT (Dec 2, 2014)

EMT11KDL said:


> Nope, When I was a basic in Colorado I could start IV, I have basics (in Idaho) that are on my rig that can start my IV's for me and run non medicated fluid.  It just depends on your local protocols.  I believe Montana is the same way as both Colorado and Idaho.


I've never heard of this. How can an EMT-B be allowed to start IVs? Were not trained to do that. In my Basic class we never learned anything about IVs and the textbook had nothing in it about IVs.


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## EMT11KDL (Dec 2, 2014)

EMTinCT said:


> I've never heard of this. How can an EMT-B be allowed to start IVs? Were not trained to do that. In my Basic class we never learned anything about IVs and the textbook had nothing in it about IVs.


It is not hard to gain IV access, and I do know for Idaho and Colorado (at least when I was still living there) it was an option module, you just took a psycomotor exam for IV access, and after passing, you are allowed to do them.  Idaho allows Basics to test for IV, IO, and King Airway.  All three just require psycomotor exam, and medical director approval to preform skills within your agency


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## EMTinCT (Dec 2, 2014)

EMT11KDL said:


> It is not hard to gain IV access, and I do know for Idaho and Colorado (at least when I was still living there) it was an option module, you just took a psycomotor exam for IV access, and after passing, you are allowed to do them.  Idaho allows Basics to test for IV, IO, and King Airway.  All three just require psycomotor exam, and medical director approval to preform skills within your agency



That sounds like an Intermediate EMT to me.


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## EMT11KDL (Dec 2, 2014)

Nope, it is EMT-Basic.  Each state has their own set of protocols for each provider level.  The state decides what they allow and do not allow.  Some states allow Basics to have a larger skill set, and some states do not allow larger skill set.


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## EMTinCT (Dec 2, 2014)

I didn't know.


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## EMT11KDL (Dec 2, 2014)

EMTinCT said:


> I didn't know.



You would be surprised what some states allow Basics and Intermediates/advanced to do.


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## johnrsemt (Dec 2, 2014)

Where I worked in Indiana basics could transport active IV's with NS, LR, D5 and 10; and Potassium up to 40meq (maybe only 20meq, it has been 6 years since I have been there, and 10 since I was a basic there).   Also depending on the circumstances we could transport more, with doctors orders


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## Tigger (Dec 2, 2014)

In responding to these posts, it would be useful if everyone would post their locations...

Here in Colorado I can start IVs, IOs, and initiate crysalloid fluids as well as dextrose (D5-50). I am *not* an Intermediate, we just have a 28(?) hour add on class.

I believe EMTs in Wisconsin, Arizona, and Tennessee can also start IVs depending on training. There could be more as well.


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## ViolynEMT (Dec 2, 2014)

In some parts of Az., EMT basics can start iv's. In Maricopa County  (Phoenix  area) we cannot  in the field, but can in an ed.


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## drl (Dec 2, 2014)

As everyone said, it all depends on location and state/county protocols. In CA, EMT-B's are not allowed to start IVs as far as I'm aware. We do, however, transport patients on NS, dextrose, or lactated Ringer's all the time in Santa Clara and Alameda counties. PCA pumps are also okay, but provider-controlled pumps require CCT transport.


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## Derrick (Dec 2, 2014)

Thank all of you guys for your great information; I live in California btw. Seriously, you guys couldn't have been a better help.


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## Ensihoitaja (Dec 3, 2014)

Tigger said:


> In responding to these posts, it would be useful if everyone would post their locations...
> 
> Here in Colorado I can start IVs, IOs, and initiate crysalloid fluids as well as dextrose (D5-50). I am *not* an Intermediate, we just have a 28(?) hour add on class.



21.5 if you do the optional Albuterol module... https://www.colorado.gov/pacific/si...rapy-and-Medication-Administration-Course.pdf

Is IO a waiver for you? I didn't think it was part of the IV cert.


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## Akulahawk (Dec 3, 2014)

drl said:


> As everyone said, it all depends on location and state/county protocols. In CA, EMT-B's are not allowed to start IVs as far as I'm aware. We do, however, transport patients on NS, dextrose, or lactated Ringer's all the time in Santa Clara and Alameda counties. PCA pumps are also okay, but provider-controlled pumps require CCT transport.


At one point Santa Clara County Basics weren't prohibited from starting IV lines per se, they could (in theory) be accredited to do it. However only the Paramedics were considered "accredited" to start IV lines. I suspect that this was the beginning of a process to create an expanded scope Basic that was nearly an EMT-II or an Advanced EMT. I've been away from there for a while so I'm not sure what they allow as far as scope of practice or if there are any enhancements to the scope that are authorized.


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## Tigger (Dec 3, 2014)

Ensihoitaja said:


> 21.5 if you do the optional Albuterol module... https://www.colorado.gov/pacific/si...rapy-and-Medication-Administration-Course.pdf
> 
> Is IO a waiver for you? I didn't think it was part of the IV cert.


Yes tis a new waiver for us, though my understanding is that it's getting pretty common across the state.


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## Ensihoitaja (Dec 3, 2014)

Interesting, I wasn't aware of that. Our EMTs don't do IOs.


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## DesertMedic66 (Dec 3, 2014)

Ensihoitaja said:


> Interesting, I wasn't aware of that. Our EMTs don't do IOs.


Once again it is going to vary greatly by country, state, county, and service. 

Some medical directors will let their EMTs do a lot while others will not


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## Tigger (Dec 3, 2014)

DesertEMT66 said:


> Once again it is going to vary greatly by country, state, county, and service.
> 
> Some medical directors will let their EMTs do a lot while others will not


I think he's just commenting on changes here, Colorado has a "unique" waiver process that allows medical directors to add skills to the allowable acts. IOs for EMTs is starting to become a thing in some areas despite makeup (rural and urban), yet in the metro Denver area it's not happening yet.


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## Ensihoitaja (Dec 4, 2014)

Yup. It probably makes more sense for you- we don't have very many medic/basic ambulances and our EMTs never go anywhere (except the detox van) without a medic.


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## Tigger (Dec 4, 2014)

We are P/B only (west of Colorado Springs), but we might be the only certified EMS folk on a lot of calls. I play skill monkey for my partner since she's not getting help from anyone else. I'm not sure how useful it is in the springs when you have three medics on a lot of calls...ugh.


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## chaz90 (Dec 5, 2014)

Wow, I think that's actually a cool change! I loved having EMTs able to do IVs in Colorado. Really, an IO is much simpler then an IV and only needed in priority patients anyway, so it seems like a natural progression to allow EMT IO placement to assist a solitary medic. I wouldn't say there's much sense in having IO set ups in BLS kits, but as a medic assist skill it sounds great.


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## Tigger (Dec 5, 2014)

Several our BLS fire districts have voiced a desire to start doing them, however. They are a call in for conscious patients, but we don't have the ability to make base contact in most of our area. I'm hoping the cost dissuades them as we already have an occasional issue with inappropriate IVs and frankly I don't really care if we arrive on a critical patient without access as I can get the IO soon after arrival. It's not like we walk in right now and push medications as soon as we reach the patients.


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