EMT Students Practicing IM Injections

EMSWA

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In WA state all EMT’s are required to know how to administer IM epi for anaphylaxis. Since epi pens are expensive, most are agencies are opting for vials of epi. This can be problematic for EMT’s who really never do IM injections.

I’m teaching an anaphylaxis class for new EMT’s including epi administration from vials. Do you see any issue with having them practice one IM injection on each other, with supervision, of 0.3 mL of saline? I think it’d be a lot more beneficial than the typical orange they have students practice on. If I can't trust them to do an IM injection of a benign substance on each other in a controlled environment, how can I trust them to do one in an emergency on a critical patient? I’ve been a part of 2 similar trainings a long time ago and don’t recall any issues, but haven’t done it since.
 

NPO

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In Paramedic school we did just that. As long as it's supported by state protocol and your medical director, I don't see a problem.
 

DesertMedic66

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In Paramedic school we did just that. As long as it's supported by state protocol and your medical director, I don't see a problem.
Same here. We did IM and SC injections on each other.
 

PotatoMedic

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Worst case scenario, buy some raw chicken breasts with the skin still attached. Half decent simulator... And if you make a home made brine and use that as the "epi" you can do a BBQ after 😅
 

NPO

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Worst case scenario, buy some raw chicken breasts with the skin still attached. Half decent simulator... And if you make a home made brine and use that as the "epi" you can do a BBQ after [emoji28]
Practice topical BBQ sauce application.
 
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EMSWA

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Use expired epi pens.

Agencies around here don't buy epi-pens at all anymore due to costs, only vials. But from the talk of others it sounds like it's common for paramedic students to practice on each other which is helpful to know.
 

KingCountyMedic

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We have a few thousand EMT's in King County that learned the skill just fine with oranges. I would strongly suggest you speak to your Medical Director. If you just start having new folks give each other IM injections without full support and authorization from your MPD you are heading for a world of trouble.
 
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EMSWA

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We have a few thousand EMT's in King County that learned the skill just fine with oranges. I would strongly suggest you speak to your Medical Director. If you just start having new folks give each other IM injections without full support and authorization from your MPD you are heading for a world of trouble.

I would respectfully challenge your definition of learning it "just fine". How many of those EMT's have since had to do it on an actual call? Probably very few, and i'd imagine some also balked until ALS arrived to have them do it instead. I strongly believe your first time giving an IM injection on a real person should not be on scene of a severe anaphylaxis emergency.
 

DesertMedic66

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I would respectfully challenge your definition of learning it "just fine". How many of those EMT's have since had to do it on an actual call? Probably very few, and i'd imagine some also balked until ALS arrived to have them do it instead. I strongly believe your first time giving an IM injection on a real person should not be on scene of a severe anaphylaxis emergency.
It’s really not a huge issue. IM injections are a very easy and simple skill to learn how to do. A lot of nursing schools do not allow them to do IM injections on each other, they have to wait until they start doing their clinical rotations before they can actually do it.

Having done IM injections on other students when I was in medic school, I feel did not benefit me in the slightest.
 
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EMSWA

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It’s really not a huge issue. IM injections are a very easy and simple skill to learn how to do. A lot of nursing schools do not allow them to do IM injections on each other, they have to wait until they start doing their clinical rotations before they can actually do it.

Having done IM injections on other students when I was in medic school, I feel did not benefit me in the slightest.

I would also argue that level of comfort comes from being a medic, which I am as well, since IM injections are something we do on an occasional basis. We also commonly do other things that involve poking people with needles like IV's. EMT's don't at all, and I can tell you from watching EMT's with multiple full-time fire departments that it's not something they commonly think about. Many look like Michael J. Fox their first time trying to do it on a real person, that were fine minutes earlier when practicing on an orange.
 

Tigger

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We stopped doing it at the community college I teach at as student's were only covered by liability insurance when on clinical rotations. Your mileage may very. When I teach in-services to vollie departments in the prairie we have the option of allowing providers to give NS injections to each other but I do not think it is that much more helpful than an orange. The reality is that these folks will likely go years if ever before they do this (low call volume), and a single training is not likely to have much impact.
 

DesertMedic66

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I would also argue that level of comfort comes from being a medic, which I am as well, since IM injections are something we do on an occasional basis. We also commonly do other things that involve poking people with needles like IV's. EMT's don't at all, and I can tell you from watching EMT's with multiple full-time fire departments that it's not something they commonly think about. Many look like Michael J. Fox their first time trying to do it on a real person, that were fine minutes earlier when practicing on an orange.
The actual skill of doing the IM injection is very simple. The more difficult part is learning and remembering how to do basic med math and figuring out how many mL needs to be administered. Then you have to remember the maximum mL recommended per muscle group and also the areas you want to avoid (we teach EMTBIAS).

The actual skill itself is: grab, stab, stabilize, aspirate, inject, pull out. All of those are easily done on an orange or IM trainers. Actual human skin doesn’t change anything. It is completely different from starting an IV on a trainer arm vs a human arm.
 
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EMSWA

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We stopped doing it at the community college I teach at as student's were only covered by liability insurance when on clinical rotations. Your mileage may very. When I teach in-services to vollie departments in the prairie we have the option of allowing providers to give NS injections to each other but I do not think it is that much more helpful than an orange. The reality is that these folks will likely go years if ever before they do this (low call volume), and a single training is not likely to have much impact.

To be fair I work in a busy area, and most medics still rarely if ever give IM epi, let alone EMT's. Which is also my separate argument for regular training vs single event training.
 
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EMSWA

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The actual skill of doing the IM injection is very simple. The more difficult part is learning and remembering how to do basic med math and figuring out how many mL needs to be administered. Then you have to remember the maximum mL recommended per muscle group and also the areas you want to avoid (we teach EMTBIAS).

The actual skill itself is: grab, stab, stabilize, aspirate, inject, pull out. All of those are easily done on an orange or IM trainers. Actual human skin doesn’t change anything. It is completely different from starting an IV on a trainer arm vs a human arm.

To clarify this is just meant as healthy discussion, but I will very confidently say you're wrong about human skin not changing anything, or that IV's have nothing to do with it. It's the psychological aspect of putting a needle into a live person that takes getting comfortable with for a decent amount of people. Getting comfortable takes actually doing it a few times for them. Having done this training in the past, you could watch an EMT have zero difficulty practicing on an orange, only to turn around minutes later and look like someone with parkinsons playing darts trying to put an IM needle in another person's arm.
 
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Tigger

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To clarify this is just meant as healthy discussion, but I will very confidently say you're wrong about human skin not changing anything, or that IV's have nothing to do with it. It's the psychological aspect of putting a needle into a live person that takes getting comfortable with for a decent amount of people. Getting comfortable takes actually doing it a few times for them. Having done this training in the past, you could watch an EMT have zero difficulty practicing on an orange, only to turn around minutes later and look like someone with parkinsons playing darts trying to put an IM needle in another person's arm.
And? If they do it correctly does it matter if it was the "prettiest?" I really do not think that doing it one time on a person they already know is going to get them comfortable. n=a few, but none of the folks I trained when we rolled out draw and give IM epi said they were comfortable doing it when they first did on a live patient, which is why we do yearly trainings on just that. Everything single one said they were somewhat afraid and this is after practicing on each other. Many of our EMTs take IV classes where they learn IV and IM skills and they still are not comfortable. The reality is that volunteer EMT who does not have a job in some sort of medical field simply lacks the clinical exposure to be comfortable in these skills. While there may be value in practicing on a person, I don't think it has the value you think it does.
 

DesertMedic66

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To clarify this is just meant as healthy discussion, but I will very confidently say you're wrong about human skin not changing anything, or that IV's have nothing to do with it. It's the psychological aspect of putting a needle into a live person that takes getting comfortable with for a decent amount of people. Getting comfortable takes actually doing it a few times for them. Having done this training in the past, you could watch an EMT have zero difficulty practicing on an orange, only to turn around minutes later and look like someone with parkinsons playing darts trying to put an IM needle in another person's arm.
In my time in EMS, I have yet to see any provider of any level struggle or develop Parkinson’s when they do an IM injection. They may have a quick moment of hesitation but that does not equal them preforming the skill poorly.

Anytime you have a brand new provider dealing with a critical patient there will be some hesitation. Heck, I did many IVs during my clinical rotations however once I got to the field and had to start an IV on a critical patient I had some hesitation but was still able to do the skill correctly.
 

ExpatMedic0

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I went to P school about 12 years ago in WA state. At that time we where doing IM, Sub Q, and IV's on each other in class. In fact, we had a log sheet and had to do X many on each other in class before we got released to do them on real patients. This was under the direct observation of instructors. I have herd this is no longer done at many places which is a shame. If you can get it cleared from the department head and the medical director, I say go for it. That being said, I've stabbed an IM Versed into a combative patient through his clothing in a pinch... ;-)
 

Rano Pano

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To be fair I work in a busy area, and most medics still rarely if ever give IM epi, let alone EMT's. Which is also my separate argument for regular training vs single event training.

I found this comment sort of interesting. A busy system & IM Epi is RARELY given? Real allergic reactions with anything more then hives I’ve found can be unpredictable in regards to how fast they can progress/deteriorate. It’s a first line tx, so I would think it would be given frequently enough.
 

KingCountyMedic

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I found this comment sort of interesting. A busy system & IM Epi is RARELY given? Real allergic reactions with anything more then hives I’ve found can be unpredictable in regards to how fast they can progress/deteriorate. It’s a first line tx, so I would think it would be given frequently enough.

This 100% I work in the busiest system in Washington State and we give IM Epi via check and inject all the time. The majority now is being done by BLS EMT units prior to ALS arrival. I'm positive our BLS crews give more IM Epi now days than our ALS, which is the whole reason behind the program to begin with. Like I said, we have trained thousands of EMT's in this procedure with oranges and they do a spectacular job. The most difficult part of the evolution isn't the actual IM injection, it's drawing up the medication from the vial.
 
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