EMT-B starting IVs

[Aprz]

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.

+1

We need to start shaming them with a lot more than just checking BGL. :[

 

[Akulahawk]

+1,000,000

We need to start shaming them with a lot more than just checking BGL. :[

Too true... starting with lack of general education....

 

[Tigger]

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.

The curriculum has never changed as far as I can tell. It was designed well before widespread IO use.

 

[Arovetli]

The curriculum has never changed as far as I can tell. It was designed well before widespread IO use.

Huh?

Right, there's no sense to nickel and dime little additions to basic EMT and try to push a new provider level simultaneously.

 

[Tigger]

Huh?

Right, there's no sense to nickel and dime little additions to basic EMT and try to push a new provider level simultaneously.

Just pointing out that the IV add on certification is a very old (well for EMS) class in Colorado and has seen no updates, which explains why IO is not included. I agree that it serves to potentially prevent the widespread adoption of AEMT.

 

[Arovetli]

Just pointing out that the IV add on certification is a very old (well for EMS) class in Colorado and has seen no updates, which explains why IO is not included. I agree that it serves to potentially prevent the widespread adoption of AEMT.

ah i got ya.

 

[chaz90]

Just pointing out that the IV add on certification is a very old (well for EMS) class in Colorado and has seen no updates, which explains why IO is not included. I agree that it serves to potentially prevent the widespread adoption of AEMT.

My old service in CO was considering taking all their EMTs to AEMT when I left. Scope wise, the only additions from CO EMT-IV would be Glucagon, IM Epi, IO access, and using their own NTG. They already have D50, Narcan, Albuterol, and King airways. The additional education would have been a lovely boon for the EMTs as well.

 

[TheLocalMedic]

IMHO, I simply do not see the benefit in having an EMT who can start IVs on an ambulance. Sure, you could delegate IV starts to them, but to what end? So you can stand there and watch them do it? I think someone said that they could talk to the patient further about history and meds while the EMT starts an IV, but I have never had a problem talking and working with my hands at the same time...

Besides, after seeing the volly departments around here, I can't imagine letting them play with needles. Whoever said that they'd go right for the IV before assessing the patient or checking the ABCs is right on. Do you know how many times I've walked in and the only report they have given me was the pulse ox reading? No BP, no pulse, no respirations... just staring at that little box stuck to their finger like it's some kind of divining rod that will magically tell them whether the patient is really sick.

If an EMT wants to upgrade to AEMT, great! Let them start IVs and push some of the commonly used meds and drop King tubes. But always stress that all of the ALS procedures come after a good exam and BLS interventions.

 

[Arovetli]

Sure, you could delegate IV starts to them, but to what end? So you can stand there and watch them do it?

Less work for me. I excel at delegation and supervision.

 

[Tigger]

On your garden variety calls my partner puts the patient on the monitor and reads the strip or 12 lead while I get an IV. I don't know anyone who can do both of this things simultaneously.

Truthfully I would prefer EMT-IVs to work only with a higher level provider but I think I would settle for more medical director scrutiny in who gets authorized and who doesn't. Technically the medical director must individually approve each of their providers however it most cases if you're hired and have the card, then you're good to go.

 

[txmedic5]

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.

This! Emts can do king tubes where I work. No ivs though, don't really see a need for it.

 

[MTEMTB]

Depends upon transport time and whether we can get the helicopter in to our scene.
We have an IV endorsement here signed off by our medical director. We are to check blood sugar before starting any fluids.
Also depends upon pt's condition.

 

[AlphaButch]

Our EMTs get signed off on IVs after training. This allows for BLS transport of patient's who have IV access. It also speeds up scene times for those patients that may need access in the field (as they can do either the 12 lead placement or IV start while their partner does the other). The phlebotomy course (part of the IV training) is also for the other services we provide (such as PD draws, stat labs during transport, etc).

 

[medic2100]

Here in Tennessee every EMT is trained initially to the EMT-I level. We are licensed as As an EMT-IV state of TN and EMTB NR. Under Tennessee guidelines we are allowed to establish IV access, hang NS or LR as indicated, administer D50, BGL, ntg tablet or SL, ASA, albuterol neb, epi 1:1000, combitube, and king airway. With the new AEMT upgrade they say we will be able to so narcan, IO, nitrox, and possibly CPAP.

As to the OP, it is not uncommon for a ift service to run a handful of basic trucks and just a couple als trucks. The service I work for has a 911 contract and we usually run a basic and an ALS truck in the city. The bls truck can transport things that do not require als skills. It is not uncommon for two EMT-ivs to run a patient to the hospital if there isn't an als unit available.

 

[Lolli2]

In Wisconsin we can start them but we have to first be a Basic, then take the IV Tech course. We had to do a bunch of clinical time in an ER and get so many successful sticks before we could pass the course.

 

[rednecksoccer]

IVs for basics

I work for a very rural 911 service where sometimes we don't have a choice but to run double basic with an on call medic who doesn't ride out unless ALS assistance is required. In the time it takes for the medic or helicopter to get there we can have an IV inserted and ready even if we aren't giving meds. However with extra training, our basics are allowed to administer certain medications. We also use the King Airway at the basic level.

 

[unleashedfury]

I can see this going both ways. here

My opinion having a EMT-Basic starting IV's with no fluid challenges, No med administration, and placing a Saline lock for just putting it there. Kinda useless IMO.

OTOH, I can see where it can be beneficial, A lot of ALS units in the State of PA well probably most of them run a Basic, and a Paramedic per truck. So under the supervision of a paramedic could a EMT perform invasive procedures Sure I don't see why not especially if its a critical patient and an extra set of hands to provide additional interventions would be great.

I strongly believe that BLS should be upgraded to the AEMT level. which seems to be kicked around everywhere but no initiative is taken.

My final rant about PA State BLS guidelines, State requirement is to have oral glucose present on your trucks.. 45grams. But Glucometers are not part of the BLS scope of practice. Lets run with this one. So a EMT can believe that a patient is experiencing a Hypoglycemic emergency and administer 1 tube of oral glucose under standing orders. But never know what the patients Blood sugar is at the present moment. So what if your patient is experiencing a head bleed.... the symptoms AMS. noted diaphoresis pale ashen appearance are all too similar.
King LT, Combi-tube, and LMA's are also BLS skills. but we save them for a "last chance airway" if the ETT was unsuccessful, Intra Nasal Narcan is handed out at Needle clinics for junkies,, Yet as a provider you cannot utilize it at a BLS level.

IMHO - I believe that as the EMS system evolves we should be moving the BLS side of things to a EMT-I or AEMT level at which EMT's would be initiating IV therapy, and administering a short list of medications within the scope of practice as a BLS provider.

So should a BLS provider be able to perform some advanced skills under the supervision of a paramedic, Sure...... The biggest problem I could see is what was stated earlier, tunnel vision. Its been proven that BLS skills have been most effective in SCA, so instead of worrying about getting IV access immediately keep on the chest. Older medics can remember the days of dumping the drug box on a code. Now we narrowed it down to effective CPR and early defibrillation.

that's my nickel.. Used to be 2 cents but I increased for inflation.

 

[bonesaw]

I can see this going both ways. here

My opinion having a EMT-Basic starting IV's with no fluid challenges, No med administration, and placing a Saline lock for just putting it there. Kinda useless IMO.

OTOH, I can see where it can be beneficial, A lot of ALS units in the State of PA well probably most of them run a Basic, and a Paramedic per truck. So under the supervision of a paramedic could a EMT perform invasive procedures Sure I don't see why not especially if its a critical patient and an extra set of hands to provide additional interventions would be great.

I strongly believe that BLS should be upgraded to the AEMT level. which seems to be kicked around everywhere but no initiative is taken.

My final rant about PA State BLS guidelines, State requirement is to have oral glucose present on your trucks.. 45grams. But Glucometers are not part of the BLS scope of practice. Lets run with this one. So a EMT can believe that a patient is experiencing a Hypoglycemic emergency and administer 1 tube of oral glucose under standing orders. But never know what the patients Blood sugar is at the present moment. So what if your patient is experiencing a head bleed.... the symptoms AMS. noted diaphoresis pale ashen appearance are all too similar.
King LT, Combi-tube, and LMA's are also BLS skills. but we save them for a "last chance airway" if the ETT was unsuccessful, Intra Nasal Narcan is handed out at Needle clinics for junkies,, Yet as a provider you cannot utilize it at a BLS level.

IMHO - I believe that as the EMS system evolves we should be moving the BLS side of things to a EMT-I or AEMT level at which EMT's would be initiating IV therapy, and administering a short list of medications within the scope of practice as a BLS provider.

So should a BLS provider be able to perform some advanced skills under the supervision of a paramedic, Sure...... The biggest problem I could see is what was stated earlier, tunnel vision. Its been proven that BLS skills have been most effective in SCA, so instead of worrying about getting IV access immediately keep on the chest. Older medics can remember the days of dumping the drug box on a code. Now we narrowed it down to effective CPR and early defibrillation.

that's my nickel.. Used to be 2 cents but I increased for inflation.

+1 to this

Do away with EMT-B, I, P, I89 etc...

Make it Paramedic and EMT,
( Do away with basic...make EMT the scope of I, I99, advanced etc.)

 

[Handsome Robb]

Umm...pretty sure the NREMT already basically did that with the EMT, AEMT and Paramedic designators when they redid everything...

 

[PaulEMT]

EMTBs can't start IV lines because it's not in our scrope. If you try to start an IV line as an EMTB then you're action is out of scope. and you can be subject to disciplinary action.