EMT-B starting IVs
- Thread starter combiguy
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A really brief search turned up this for your perusal.
http://www.emtlife.com/archive/index.php/t-29763.html
http://www.emtlife.com/archive/index.php/t-29763.html
DesertMedic66
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Because its not needed everywhere
xrsm002
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Texas EMS are delegated meaning our individual services medical director can train and sign off on basics doing skills outside of their level. I volunteered at a service that allowed basics to start an IV on certain types of calls only after they had been there a year.
xrsm002
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The basics at the service I'm at now can do IN narcan
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Colorado allows EMTs to do IVs after an IV add on class of around 20 hours. Most hospitals there have their EMT techs start lines in the ED as well. Every 911 service I know of in the state requires the IV endorsement before they hire an EMT.
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EMT-B's aren't allowed to start IV's because many times they're not needed and additional education is needed before they'd be allowed to start one. While starting a line isn't normally dangerous, it's not entirely a benign thing to do. While most of the time people can handle a full liter of fluid (because they're down that much fluid) some people aren't and if you inadvertently drop in a liter of fluid because you forgot to TKO the line, it very easily could result in pulmonary edema.
The other reason is that EMT-B's aren't allowed to give any meds through the IV route. D50 would be one thing that might be a good thing to allow, but that stuff kills tissue if it gets out of the vascular space. D10? Well, it's not as bad... but in either case, they'd also need the ability to check blood glucose, which is it's own additional education. So, what you're ending up with is something more like an AEMT with less education.
Also, since it's not in the national scope and not everywhere needs to have the EMT-B start lines, it's probably better if the EMT-B is trained to the same national level and let the local EMS agencies decide to add-on those additional skills. Later, if it's beneficial locally, then perhaps it could be added to the state or national scopes.
The other reason is that EMT-B's aren't allowed to give any meds through the IV route. D50 would be one thing that might be a good thing to allow, but that stuff kills tissue if it gets out of the vascular space. D10? Well, it's not as bad... but in either case, they'd also need the ability to check blood glucose, which is it's own additional education. So, what you're ending up with is something more like an AEMT with less education.
Also, since it's not in the national scope and not everywhere needs to have the EMT-B start lines, it's probably better if the EMT-B is trained to the same national level and let the local EMS agencies decide to add-on those additional skills. Later, if it's beneficial locally, then perhaps it could be added to the state or national scopes.
wanderingmedic
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In AZ EMT's can start an IV with online medical direction and additional training at the discretion of their medical director. Most juridictions do not allow it (i'm not immediately aware of any that do).
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Why WOULD an EMT be allowed to start IV's?
An IV is simply a route of administration for fluids or medications. If the EMT can't administer fluids or medications - which is the case in most states - they have no need to establish IV access.
The places do allow EMT's to start IV's and give fluids or meds are the exception, not the rule.
FWIW, I would estimate that about 1% of the IV's started prehospital are actually necessary to the positive outcome of the patient.
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Christopher
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You're not an EMT if you cannot check a BGL.
We need to start shaming States that disallow this practice for any level of provider.
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As stated, with an add on training class, 10 successful starts under supervision, and approval of the service's medical director, EMTs can start IVs in Colorado. In addition we can hang fluids as well as push dextrose, Narcan, and frontline cardiac arrest drugs at a paramedic's direction.
I will say that it is useful, however I wish we would just increase the minimum certification to staff an ambulance to AEMT. I think a longer class would legitimize the providers a bit more, as well as make them more useful. The IV certification has two purposes, to make EMTs more useful to their paramedic partner, and to allow very rural services to deal with some common calls without waiting for ALS.
That said in my experience, the rural volunteers that we run with do not often have a good understanding of when an IV and/or fluid is indicated and when it is not. They also rarely get a chance to start them, which means that they either do not at all, or do not do a great job with them. If they blow the AC before we show up, that can be a problem. They'll also start fluids on almost everyone. More than once I've asked one of them to stop rooting through our med bag looking for a bag of fluid to spike. This is not a knock on volunteers mind you, it's just a comment that when EMTs are left to their own devices with minimal education, the results are questionable. I start an IV when my paramedic partner tells me too, and that's about the extent of it.
As for making the EMT more useful to a paramedic partner, here is where the certification is useful. While the paramedic interprets the monitor and starts getting meds ready, I can get access. During an arrest, he or she can run the monitor and manage the airway while I get access and push frontline cardiac arrest meds. I don't think it's essential for EMTs to be able to do these things, but having worked in systems that do not allow this, I find that scenes are definitely run more efficiently. I would still like to see a bridge to AEMT, mostly so that IO access could be added for arrests and that the lowest level provider would actually have some degree of useful education.
I will say that it is useful, however I wish we would just increase the minimum certification to staff an ambulance to AEMT. I think a longer class would legitimize the providers a bit more, as well as make them more useful. The IV certification has two purposes, to make EMTs more useful to their paramedic partner, and to allow very rural services to deal with some common calls without waiting for ALS.
That said in my experience, the rural volunteers that we run with do not often have a good understanding of when an IV and/or fluid is indicated and when it is not. They also rarely get a chance to start them, which means that they either do not at all, or do not do a great job with them. If they blow the AC before we show up, that can be a problem. They'll also start fluids on almost everyone. More than once I've asked one of them to stop rooting through our med bag looking for a bag of fluid to spike. This is not a knock on volunteers mind you, it's just a comment that when EMTs are left to their own devices with minimal education, the results are questionable. I start an IV when my paramedic partner tells me too, and that's about the extent of it.
As for making the EMT more useful to a paramedic partner, here is where the certification is useful. While the paramedic interprets the monitor and starts getting meds ready, I can get access. During an arrest, he or she can run the monitor and manage the airway while I get access and push frontline cardiac arrest meds. I don't think it's essential for EMTs to be able to do these things, but having worked in systems that do not allow this, I find that scenes are definitely run more efficiently. I would still like to see a bridge to AEMT, mostly so that IO access could be added for arrests and that the lowest level provider would actually have some degree of useful education.
Michigan removed glucometer use from EMTs last year... kind of ridiculous.
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I don't understand why the EMT-IV class doesn't include IO access as well. They're easier to do than IVs. Make it so its only in the presence of cardiac arrest or if the medic orders it on a pt in extremis.
You basically described how my arrests go. I do the airway, run the monitor and ask for a basic story (events leading up complaints, last seen, recent hospitalizations, illness, meds, trauma), partner does stickies, pads, IO, meds, FFs do CPR/BGL/spike a bag, fire captain gets the more in depth story, demographics, history, allergies and medications, deals with family, LZ if needed, gear to package the patient if we get ROSC (partner does this too once I've got the airway done and the vent connected because they know where stuff is in the unit rather than fire digging through everything trying to find something and I can run the monitor and push drugs while they're gone.)
Makes it WAY easier than me having to do everything except CPR and information gathering.
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Arovetli
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Because its not called the EMT-IVIO class.
That is probably the extent of the logic employed.
A more serious response would be as a mean to funnel folks into AEMT.
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While it's an easy thing to do, not all states allow the EMT-B to do it. I, personally, would be a whole lot happier allowing the Basics to check the BGL than I'd be with them starting a line.
Jim37F
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And here I was thinking EMT-IV was an EMT 4 (as in the Roman numeral) figuring it was what some state called a Basic or Intermediate. Silly me 
In Army Combat Life Saver we used to always do IVs. That's generally a week or two course, designed for Soldiers without any medical training. In most of the CLS courses I we t through we'd spend a day getting instructed on how to start an IV, and then practice on each other. However in the CLS course I just went through we didn't do IVs at all. The rationale of the instructors (who were all experienced Paramedics) was that Soldiers would want to start IVs on a casualty before the ABCs were secured (well, MARCH is the acronym CLS uses, Massive Hemorrhage, Airway, Respirations, Circulatory, Head Injury/Hypothermia). Yet we still spent a full day on chest needle decompression (is it Needle Thoracostomy? I could never spell it). So after 120 hours of training LA County won't trust me with a Glucometer yet after 4 days the Army'll trust me to stick a 3.75" 18 gauge needle in your chest. Go figure
I can easily see an overexcited Basic here in the States starting an IV before fully securing the ABCs. I'd personally feel a bit more comfortable leaving that up to an Intermediate or Medic, or in a rural area where you only have two guys/gals on the ambulance treating you, a Basic doing it under supervision. However, the folks here from Colorado keep saying an IV trained EMT works well in their system, so I guess if it works, don't try and fix it.
In Army Combat Life Saver we used to always do IVs. That's generally a week or two course, designed for Soldiers without any medical training. In most of the CLS courses I we t through we'd spend a day getting instructed on how to start an IV, and then practice on each other. However in the CLS course I just went through we didn't do IVs at all. The rationale of the instructors (who were all experienced Paramedics) was that Soldiers would want to start IVs on a casualty before the ABCs were secured (well, MARCH is the acronym CLS uses, Massive Hemorrhage, Airway, Respirations, Circulatory, Head Injury/Hypothermia). Yet we still spent a full day on chest needle decompression (is it Needle Thoracostomy? I could never spell it). So after 120 hours of training LA County won't trust me with a Glucometer yet after 4 days the Army'll trust me to stick a 3.75" 18 gauge needle in your chest. Go figure
I can easily see an overexcited Basic here in the States starting an IV before fully securing the ABCs. I'd personally feel a bit more comfortable leaving that up to an Intermediate or Medic, or in a rural area where you only have two guys/gals on the ambulance treating you, a Basic doing it under supervision. However, the folks here from Colorado keep saying an IV trained EMT works well in their system, so I guess if it works, don't try and fix it.
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You just highlighted something... CLS and EMT are two different knowledge and skill-sets. They're designed with different purposes in mind... It's also not too difficult to understand why they removed IV's from the basic CLS skill-set.And here I was thinking EMT-IV was an EMT 4 (as in the Roman numeral) figuring it was what some state called a Basic or Intermediate. Silly me
In Army Combat Life Saver we used to always do IVs. That's generally a week or two course, designed for Soldiers without any medical training. In most of the CLS courses I we t through we'd spend a day getting instructed on how to start an IV, and then practice on each other. However in the CLS course I just went through we didn't do IVs at all. The rationale of the instructors (who were all experienced Paramedics) was that Soldiers would want to start IVs on a casualty before the ABCs were secured (well, MARCH is the acronym CLS uses, Massive Hemorrhage, Airway, Respirations, Circulatory, Head Injury/Hypothermia). Yet we still spent a full day on chest needle decompression (is it Needle Thoracostomy? I could never spell it). So after 120 hours of training LA County won't trust me with a Glucometer yet after 4 days the Army'll trust me to stick a 3.75" 18 gauge needle in your chest. Go figure
I can easily see an overexcited Basic here in the States starting an IV before fully securing the ABCs. I'd personally feel a bit more comfortable leaving that up to an Intermediate or Medic, or in a rural area where you only have two guys/gals on the ambulance treating you, a Basic doing it under supervision. However, the folks here from Colorado keep saying an IV trained EMT works well in their system, so I guess if it works, don't try and fix it.