EMTs starting IV
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This is not going to turn into a Basics vs Intermediates vs Paramedics thread.
Shishkabob
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Honestly, I don't get enough chances at an IV myself, so regardless of whether or not my partner can do IVs (or in the case of Intermediates, tubes) doesn't matter. I get first go. And second. And maybe third.
I needs the excitement!!!
I needs the excitement!!!
bstone
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WolfmanHarris
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PCP's start IV's in various jurisdictions in Canada.
In Alberta it's part of their scope.
In Ontario some services have implemented a program expanding the PCP scope to include IV starts, D50, gravol, independently. This is usually done in Counties without ACP. In some areas PCP's can start IV's, but only when on scene with an ACP.
Keep in mind though that IV starts or not, PCP education covers fluid balance as part of the A&P courses.
I understand the desire on the part of Basics to want to push their scope forward to better care for their patients, but the skill without the background is cart before the horse thinking.
In Alberta it's part of their scope.
In Ontario some services have implemented a program expanding the PCP scope to include IV starts, D50, gravol, independently. This is usually done in Counties without ACP. In some areas PCP's can start IV's, but only when on scene with an ACP.
Keep in mind though that IV starts or not, PCP education covers fluid balance as part of the A&P courses.
I understand the desire on the part of Basics to want to push their scope forward to better care for their patients, but the skill without the background is cart before the horse thinking.
TransportJockey
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Apples to Oranges comparison, since EMT-Bs are completely undereducated, even for what little they have in their scope, especially when you compare them to any other developed country's EMS
medic417
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Heck even underdeveloped countries. In fact many countries lowest level has a higher education required than our highest level which is Paramedic.
Shishkabob
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Meh. I'm tired of hearing another country has better EMS education in comparison to ours when they cannot be compared.
medic417
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Education can be compared. Most require much more actual education. Now in the field it seems USA allows it's lesser educated more skills that are reserved for doctors elsewhere.
WolfmanHarris
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That was my point. The skill can be taught in a few hours, the knowledge base required to understand it and implement it requires a greater education then can be provided as part of a 120 hour course.
I used to run into this quite a bit when I was still active on the board for the Association of Campus Emergency Response Teams (ACERT; like NCEMSF, but much smaller). Teams trained to the FR or EMR level would get together at conferences and many of them would all want to add new toys to their toy box; whether it was pulse ox, epi, etc. While I had no control over the actual decision within their team I'd always ask the person "Cool. Explain to me how it works."
bstone
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America is the best damn country in the world....except when it comes to education standards of our EMS professionals.
Shishkabob
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We're often demanding science based medicine, but I've yet to see a single study showing higher survival rates, or lower morbidity / mortality when comparing the US system to another country's 'more educated' providers of the equivalent level.
"Their" PCP might have more education but does it make a difference when they can do the exact same (minimal) skill set?
Heck, on average, you could argue that a British Paramedic has more education than an American Paramedic, but when I'm having a cardiac episode, I want someone who can actually do stuff for it, which, right or wrong, the US outpaces many other country's on our interventions in the cardiac arena. Yes, 'skills' don't mean everything, but having knowledge, without the ability to intervene, is edging on uselessness. In an emergency, I'd rather have a Paramedic that can do what they do, than an MD from another country who can't do anything but go "Oh, he has ______, to which he would be given ______... too bad you have to wait since I can't practice"
And before someone gets their panties in a bunch--- yes, education should match our interventions we provide.
I'm the first to say we need more education... but there is also a limit to where you go "Ok, you learned enough" (no, I dont think we are quite there yet). There has to be a soft-limit on the education required to do our job, the rest learned with time and experience. If there wasn't, then EVERYONE in medicine would have to be a doctor, which just isnt realistic.
"Their" PCP might have more education but does it make a difference when they can do the exact same (minimal) skill set?
Heck, on average, you could argue that a British Paramedic has more education than an American Paramedic, but when I'm having a cardiac episode, I want someone who can actually do stuff for it, which, right or wrong, the US outpaces many other country's on our interventions in the cardiac arena. Yes, 'skills' don't mean everything, but having knowledge, without the ability to intervene, is edging on uselessness. In an emergency, I'd rather have a Paramedic that can do what they do, than an MD from another country who can't do anything but go "Oh, he has ______, to which he would be given ______... too bad you have to wait since I can't practice"
And before someone gets their panties in a bunch--- yes, education should match our interventions we provide.
I'm the first to say we need more education... but there is also a limit to where you go "Ok, you learned enough" (no, I dont think we are quite there yet). There has to be a soft-limit on the education required to do our job, the rest learned with time and experience. If there wasn't, then EVERYONE in medicine would have to be a doctor, which just isnt realistic.
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18G
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I'm kinda in the middle on the question of EMT's being allowed to do IV's. IV's are simple and really just take practice so it's not about rather or not they would be capable of doing them.
I would have to look at the benefit. How would patients be better served by having an EMT-Basic start an IV? I agree it could add some efficiency to the field with Paramedic/EMT teams but in how many situations is it really gonna matter if the EMT can start the line?
So I would have to say I'm not really for it or against it.... Basics around here cannot do IV's. I'm fine with it either way.
I would have to look at the benefit. How would patients be better served by having an EMT-Basic start an IV? I agree it could add some efficiency to the field with Paramedic/EMT teams but in how many situations is it really gonna matter if the EMT can start the line?
So I would have to say I'm not really for it or against it.... Basics around here cannot do IV's. I'm fine with it either way.
The overall perfect answer for any question or debate regarding "Do you think...should be allowed to..." should always be "depends". One size fits all doesn't work! In a rural area like mine, IV's- YES! In Boston, maybe not so much...ALS will be right there.
EMT11KDL
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even in rural area. I still have to go with depends. What is ur call volume. Will you get enought sticks in each month to keep ur skill level up? If one or two sticks a month. Than no. But if ur area requires iv access on a daily bases. you area might want to look at putting a higher level of care in place
OP
OP
lampnyter
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8/10 calls an IV is started
WolfmanHarris
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Really? Why? Not one of those gain IV access just in case things is it?
jjesusfreak01
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Exactly...I would like someone to point out a situation where there is a need to start an IV and the paramedic is busy with a more complicated procedure. Other than intubation, I can't think of anything, although I think EMTs should he able to intubate, especially if a medic is there to confirm placement afterwards. You aren't going to be defibrillating while a medic is starting a line, so that's out. If you are working a cardiac arrest, the medic will probably be skipping the iv and going to the io, while the EMT will be doing compressions. In most other situations, time is probably not so critical that the EMT needs to be doing something above their skillset. The EMT can be getting a history or doing a thorough exam, or just assisting the medic with whatever they are doing. So, what i'm really saying here is that although I think many EMTs could handle IVs just fine, there is very little reason for them to need that skill when working with a medic.
Shishkabob
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Wait wait wait wait....
You don't want EMTs doing IVs, but you want them doing endotracheal intubation?
You don't want EMTs doing IVs, but you want them doing endotracheal intubation?
Out of all that, I see your EMT is always with a medic. That's not true. For my county, we have one working medic. The other is commissioner and doesn't go out very often, if at all. I'm not saying basics should absolutely, hands-down be able to start IVs (frankly, I don't see it happening, but for the sake of conversation...), but I would always err on the side of education. If it were an option, I'd feel comfortable with them learning, but as I see it now, go advanced or hands off the needles.
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