EMT-Bs and IV therapy

[Level1pedstech]

I think what is getting bunched together is that people think the just because a basic has an IV attachment to their cert, they can now do Intermediate drugs. In WA state at least, after a class (30 hrs I think) I basic can become an IV tech. Than means the can start lines ans flow NS under Med. Cont'l (at least in my county). No fluid w/o med cont'l, no drugs whatsoever other than already approved basic drugs, no IO.

That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.

Your pretty much spot on with the IV tech program here in WA. The course our ALS transport company provides was an additional 56 hours of class time and some clinical time on top of the 150+ hour basic class and included IO. You needed to have a year as a basic or able to obtain a waiver from your agency if less than a years experience. Both the basic and IV tech classes were longer than what the state requires. Most of the agencies in our area have extended transport times so there is extra emphasis placed on extrication and trauma.

We practiced sticking each other and then showed competency by getting 10 successful IV starts before we were allowed to sit for the state exam. IO competency was shown on the old stand by,chicken legs.

 

[Level1pedstech]

I don't think paramedics receive as much training on IV or drug admin as people like to think.

Many RN's I know received zero training on starting lines before they hit their clinicals. I see RN grads that are still struggling even after their clinicals and some time in the ER.

 

[medicRob]

Your pretty much spot on with the IV tech program here in WA. The course our ALS transport company provides was an additional 56 hours of class time and some clinical time on top of the 150+ hour basic class and included IO. You needed to have a year as a basic or able to obtain a waiver from your agency if less than a years experience. Both the basic and IV tech classes were longer than what the state requires. Most of the agencies in our area have extended transport times so there is extra emphasis placed on extrication and trauma.

We practiced sticking each other and then showed competency by getting 10 successful IV starts before we were allowed to sit for the state exam. IO competency was shown on the old stand by,chicken legs.

How did you guys do your EMT program? Did they train you to i/85 standards like they did us in TN or was it just EMT-B + an IV Endorsement?

In TN, IV Therapy is a section of our EMT-IV course, topics covered included indications for intravenous therapy, drip calculation, parkland formula, conversion factors, special considerations such as fluid overload in the elderly and pediatric fluid replacement.

We also had a quiz every class after we covered IV Therapy on drip calculations and weight conversions. There was no middle ground on these quizzes, you either made a 100% or a 0% because if you missed one that represented one patient you compromised and that is not acceptable. This is why I feel our EMT-IVs are more than proficient at starting and maintaining lines as well as hanging non-medicated fluids. It amazes me how little time it takes to become an EMT-B in other places. EMT-IV takes 9 months and you do clinicals throughout. You are required a certain amount of patient contacts, IV starts, etc before finishing the course. Are there any i/85s here that can tell me how IV therapy was addressed in your course? As I've said before, TN is kind of an oddity, since the lowest level of EMT here is trained to i/85 but tests nationally as an NREMT-B. They actually tell you before taking your national registry to not think as an EMT-IV, because it is an EMT-B test and the scope is different.

 

[Leonidas1]

In this area (Chicago) BLS units that are not "one on one" (an ambulance staffed with an EMT-B and EMT-P), can only transport patients who have saline/heparin locks. Personally, I feel they (BLS units) should be able to transport patients with .9NS @ TKO rates at least.

 

[8jimi8]

In this area (Chicago) BLS units that are not "one on one" (an ambulance staffed with an EMT-B and EMT-P), can only transport patients who have saline/heparin locks. Personally, I feel they (BLS units) should be able to transport patients with .9NS @ TKO rates at least.

what happens if they don't notice that fluids are extravastating? or if they don't notice the patient is becoming fluid overloaded?

People get fluids for a reason. If you didn't need to know anything to run fluids, they would send people home with fluids running from the hospital all the time.

 

[lightsandsirens5]

How did you guys do your EMT program? Did they train you to i/85 standards like they did us in TN or was it just EMT-B + an IV Endorsement?

In WA we are trained to the I-85 standard. We are actually trained to somewhere between 85 and 99, but my county holds us back to the 85 level. Even though we used the 1999 textbook. :-S

 

[lightsandsirens5]

what happens if they don't notice that fluids are extravastating? or if they don't notice the patient is becoming fluid overloaded?

What happens when you or I don't notice? How about a medic? An RN? Same problems no matter what level you are trained to. A medic has to pay attention to that stuff too. Just because you are a baisc with IV endorsement dosent mean you can't see an infiltrated IV.

Or am I wrong?

 

[Shishkabob]

Psh, I don't have to pay attention. I warn the fluids before we leave the hospital that if it does one thing I don't like, off to the trash it goes.

 

[8jimi8]

What happens when you or I don't notice? How about a medic? An RN? Same problems no matter what level you are trained to. A medic has to pay attention to that stuff too. Just because you are a baisc with IV endorsement dosent mean you can't see an infiltrated IV.

Or am I wrong?

Eactly. The level you are trained to. That is the point of this thread. Someone who has only 120 hours of experience plus a 30 hour class, might not know the difference. I also disagree philosophically to the word "trained." Would you rather training or an education?

 

[lightsandsirens5]

Good point. I suppose a monkey can be "trained." Although I guess that EMS is (should be?) mostly education followed by some training.

 

[Jon]

What's a UDA?

And really? Taking over an hour for ALS? Sounds like your EMS system sucks.

 

[Akulahawk]

What's a UDA?

And really? Taking over an hour for ALS? Sounds like your EMS system sucks.

I'm going to guess that UDA is "UnDocumented Alien" Aka Illegal Alien. An hour for ALS to arrive at some locations does sound a LOT like rural Nevada or Arizona.

 

[Cohn]

I'm going to guess that UDA is "UnDocumented Alien" Aka Illegal Alien. An hour for ALS to arrive at some locations does sound a LOT like rural Nevada or Arizona.

You got that right, and sometimes some of the roads at my station the normal ALS ambulances can't get to, luckily we have a 4 wheel drive and a higher then normal rescue.