IV certification??

[kp14]

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

 

[vquintessence]

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

 

[medic417]

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.

 

[Shishkabob]

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.

 

[medic417]

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.

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.

 

[Sasha]

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.

 

[Shishkabob]

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.

 

[Sasha]

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.

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

 

[Shishkabob]

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)

 

[Sasha]

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.

 

[Veneficus]

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.

 

[EMTWintz]

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

 

[medic417]

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.

But wheres the fun in that.

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

 

[Veneficus]

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

 

[rmellish]

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.

 

[medicdan]

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.

 

[Ridryder911]

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

 

[BossyCow]

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.

 

[futuremedic]

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.

 

[mikeN]

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.