EMT-Bs and IV therapy

LucidResq

LucidResq

Forum Deputy Chief
Messages
2,031
Reaction score
3
Points
0
Out here in Colorado EMT-Bs can take a quick and dirty course (mine was about 24 hours lecture with an 8-16 hour clinical rotation, some are shorter) to get "IV approval" allowing them to start peripheral IVs and administer crystalloids such as normal saline and lactated ringer's as well as D50 and Narcan (curriculum teaches intranasal admin but medical directors may allow for IV narcan admin).

Any opinions on this? I just completed the course but still need to do my clinical rotation. I've gotten 5 or so successful sticks on other students in class, but I'm pretty nervous to stick a patient.
 
ntsa.jpg
 
IVs? Go directly to medic school (or other appropriate health profession school such as nursing or medical). Do not pass go. Do not collect $200.
 
OK... I think 24 hours to teach the "monkey skill" of IV initiation is a little light - depends on how many additional clinical hours are required, etc.

I don't have that much of a problem with it - I mean the US Army has EVERYONE now trained on IV initiation. I'm cool with Saline and Narcan... but I question D50. Why not just teach you how to do an IM and give you Glucagon (Heck a Google search shows studys showing that IN - by nose - glucagon works OK). D50, given through a non-patent IV, can cause all sorts of tissue damage... and I've seen medics have that problem... I'd be worried about EMT's with an additional 24 hours of education.

I guess the bigger question is "Why?". Why does the EMT-B need this skill set?

The only answer I can think of is if it was the EMT-B partner to a paramedic... that way, I can get an IV while my partner gets the tube. But we manage OK without that now.
 
Last edited by a moderator:
"Fast forward"

Only 24 hours of classroom time and 8 to maybe 16 hours of clinical? I'm sorry, but is this type of "training" that gets EMT-B's into trouble. If something of that magnitude is going to be taught, then why in the world should it be taught with such haste and almost too little theory involved? Not to mention the understanding of pharmacology. It is one thing to be able to stick a healthy person in class. It is a completely different story when it comes to someone that is very sick or critically injured. Dehydration, disease processes, and shock are only a few problems listed here. One of the first things that go out the window are the patient's veins, period.

I am also an EMT-B (Here in California we are called EMT-1) but I strongly believe that certain skills are meant to in the scope of an EMT-I and definitely for the scope of practice of EMT-Paramedic. I think it is very important to keep up to date the latest theory and continuing education and training, but not by taking these "fast ward" classes. These skills require many more hours of theory, the practice of techniques, and many observed patient contacts than just the days and hours as mentioned above.

Respectfully submitted.........-_-
 
I'll admit, going through medic school, before we were allowed to start IV's during clinicals, we probably had similar hours of lecture and lab. (Don't misunderstand, that is just on starting and maintaining IV's, NOT pharmacology). But then, we were practicing in our clinicals for the rest of the year. So I can see, the theory of JUST starting IV's in that amount of time... eh maybe. But, definitely as far as med administration and such, needs to be waaaaaaaaaaayyyyyyyyy longer and waaaaaaaaayyyyy more clinical hours. Pharmacists don't get their degree's over night and there should be no short cuts either in EMS for things like this that can easily make a patient get worse or dead. (Intubation and other ALS skills included). Like mentioned before, practicing on healthy partners in class is one thing, but the little old septic lady, or obese diabetic with lymph edema is another story.

Glad to hear you are interested in advancing your knowledge and skill set though.


Respectfully my 2 cents.
 
Well, I'm currently finishing up EMT-Basic-Advanced over here in Indiana.It's a subsequent certification which replaces EMT-B, and adds IV access and basic 3-lead monitoring (7 rhythms and manual defibrillation). I dont have the actual didactic hours, but its as long as EMT-B was.

Our IV access includes normal peripheral IVs and EJs, normal saline, D5w, and ringers. We cannot administer any more meds than an EMT-B, but we can check a blood glucose level.

All in all its not a bad certification. It was offered free through one of the services I work for, so I took advantage of it to get more IV practice before I go off to paramedic.

Its still no replacement for paramedic though.
 
not that bad

This class is more then this is your angiocath there’s the vain. I had to take this class at one point too. It went in to detail of the physiology of cardiovascular system, and the pharmacology around the different fluids available to the basic IV LR NS D 5W.

It also went further in to detail with the sodium potassium pump and the cellular aspects of this skill. It also covers the pharmacology aspects of using D50 and narcan and ways to make sure that you didn’t blow the vain and how to tell.

This is also the reason why you have to do clinical hours and I know I had to personally have 20 live sticks under the eye of a skilled preceptor witch was either a medic or one of the nurses and once under the doc. This isn’t the army’s stick your fellow solider for his life class.

And don’t be nervous about your first sticks, look for all available options go for the easiest one that will give you the flow rate that you need. Start with the hands and work in, if your really not comfortable with it give it to your preceptor. And remember to remove your tourniquet. Also just review your IV class materials along with your book from time to time to keep your skills sharp and knowledge at hand for when you need it most. Good luck.
 
Last edited by a moderator:
Here in BC BLS can use IV's. I cannot yet personally.. but I'm sure a PCP will discover this sooner or later and elaborate more on the issue. I do know that NS and D50, Narcan and all that, they can administer.
 
Jon said:
I guess the bigger question is "Why?". Why does the EMT-B need this skill set?

The only answer I can think of is if it was the EMT-B partner to a paramedic... that way, I can get an IV while my partner gets the tube. But we manage OK without that now.
Click to expand...

Many SAR teams use EMT-B as the baseline medical training. When faced with a heat exhausted patient with a long transport time; IV's might have a place. The problem seems to be that even on very active SAR teams an active volunteer might only stick a patient once or twice a year; probably not enough to keep the skill proficient.
 
I don't know the specifics of the IV 'elective' course, but what is actually taught? Just how to start an IV or indications/contraindication, the physiology of the veins/curriculaiton system?
 
A common thing around here is ED techs starting IVs on patients... It could have application in that setting as well.
 
This is slightly similar here. But you have to get special approval as a PCP to take the course and the clinical is one day...maybe 8 hours max.

MDKEMT
 
It is OK. i am from Colorado as well, i think Colorado standard is 20 hours for an IV certification. No, you can't start centrals, or push meds, or go IO routes...but hey, most IV's in the field are just to pump NaCl anyways, might as well have someone who can do it with you. Don't worry about patients, try and do your sticks in the Dialysis center, i doubt they will complain or squirm on ya. heed this warning though, take all the tough patients while your learning in lou of the easy ones, when you get in the field in crunch time you don't want it to be your first time on a hard patient or stick.
 
BrianJ said:
Many SAR teams use EMT-B as the baseline medical training. When faced with a heat exhausted patient with a long transport time; IV's might have a place. The problem seems to be that even on very active SAR teams an active volunteer might only stick a patient once or twice a year; probably not enough to keep the skill proficient.
Click to expand...

FYI: my SAR team's medical director will not allow anyone regardless of level of cert to start IVs unless they are employed in some kind of capacity that has them sticking regularly. Having the IV approval will be worthless to me while working SAR until I get a job.

And just for everyone's info... I do feel like the course was inadequate for what it was intended to be - a crash course in prehospital intravenous therapy. It's a lot like the EMT-B course: a lot of "what", a little "how", and very very little "why".

The reason I took this course was to improve my chances of being hired in the hospital setting where techs often start IVs and leave the fluid-choosing, rate-selecting, and drug-pushing to the nurses and docs. And no, I'm not stopping at the EMT-B with IV level. I'm entering a BSN program in the next year or so.

But out here, many of the ambulances staff a medic and a basic, and almost every basic has IV approval. How do you all feel about EMT-Bs starting IVs and administering some of these fluids and drugs under a paramedic's supervision?

PS thanks for the tips everyone. My clinical rotation will be completed in the ER, which is probably a good thing because it'll be more relevant and realistic, you know?
 
Last edited by a moderator:
thats all fine and dandy until that same person starts a 20ga in the hand, checks a blood sugar, gets a reading of 'low', and tries to push D50 through it, causing severe necrosis.

yes, i believe more time is needed, along with more ride time, and the consequences of screwing up.
 
fcfiremedic said:
thats all fine and dandy until that same person starts a 20ga in the hand, checks a blood sugar, gets a reading of 'low', and tries to push D50 through it, causing severe necrosis.

yes, i believe more time is needed, along with more ride time, and the consequences of screwing up.
Click to expand...

Actually you can admin D50W through a 20g. Yes it goes more slowly, but you can. I have done this many times, especially on Peds. Ideally 18g or bigger is best.
 
Bosco578 said:
Actually you can admin D50W through a 20g. Yes it goes more slowly, but you can. I have done this many times, especially on Peds. Ideally 18g or bigger is best.
Click to expand...

Actually D50w is contraindicated in pediatrics as one should administer D25w or even D10w. It is too highly caustic and hypertonic and one can receive the same results with such.

R/r 911
 
Ridryder911 said:
Actually D50w is contraindicated in pediatrics as one should administer D25w or even D10w. It is too highly caustic and hypertonic and one can receive the same results with such.

R/r 911
Click to expand...


Perhaps I should clarify Mr. Rid, children or adults (not neonates) with small veins,. My point was and is, you can admin D50W through a 20g.
 
Last edited by a moderator:
I learned IV therapy when I went through Intermediate school. I went that the extra 140 hours was just what we needed to learn IV therapy, several IV meds, ETT and 3 lead EKG with a bunch of rhythms.
 
You must log in or register to reply here.
Back
Top