EMTs starting IV

[JPINFV]

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.

The problem is that the IV itself solves very little in most patients. Most patients don't need fluids, so what's the point of establishing a medication route when you lack the ability to administer any medications via that route? At least in a paramedic/EMT ambulance, the paramedic can use the IV. A pure EMT ambulance, not so much.

 

[Bullets]

How much additional education are you planning on adding to the EMT program in order to provide a sufficient education background on both the interventions listed (including rhythm interpretation for the 3 lead), as well as both the diseases that those interventions treat and the common diseases that presents similarly?

However long it takes to properly educate and cover the material if it takes 40 hours, fine, 100 then fine, I don't know a specific number

 

[EMS49393]

However long it takes to properly educate and cover the material if it takes 40 hours, fine, 100 then fine, I don't know a specific number

I spent somewhere in the neighborhood of 3000 hours over a little more than two years obtaining my paramedic. Are you ready to engage in that much education? If so, there is no time like the present.

Do you see how ridiculous an additional 40 or even 100 hours of training seems to someone that has over 3000 hours under their belt?

It has nothing to do with being better than you in life, it has to do with patient care and what is in that patient's best interest. Invasive skills performed by those that do not understand them is dangerous and is likely to cause more harm then good. Understand this very important point that was drilled into me during my time in the classroom:

Screw up, you WILL be sued. Don't try to use the "I didn't know" argument because it will not work and you'll be handed to the wolves (judge and jury).

Be responsible, get an education, understand what you are doing, then proceed with all your "cool skills." I bet they'll seem much less cool when you truly understand the consequences of everything you do for a patient.

 

[Bullets]

I spent somewhere in the neighborhood of 3000 hours over a little more than two years obtaining my paramedic. Are you ready to engage in that much education? If so, there is no time like the present.

Do you see how ridiculous an additional 40 or even 100 hours of training seems to someone that has over 3000 hours under their belt?

It has nothing to do with being better than you in life, it has to do with patient care and what is in that patient's best interest. Invasive skills performed by those that do not understand them is dangerous and is likely to cause more harm then good. Understand this very important point that was drilled into me during my time in the classroom:

Screw up, you WILL be sued. Don't try to use the "I didn't know" argument because it will not work and you'll be handed to the wolves (judge and jury).

Be responsible, get an education, understand what you are doing, then proceed with all your "cool skills." I bet they'll seem much less cool when you truly understand the consequences of everything you do for a patient.

I don't think I need 3000 hours to learn how to start an IV and draw blood labs.
Maybe in york, als is used more. And if I had to take a patient from new oxford or berlin to gettysburg, I'd want als for that transport. But where I operate, Als is only needed on about 20% of all the calls the hospital gets.

We don't need more als providers in our area we already have a good system, probably the only good thing about nj ems. I also don't think put patient need to get an $1100 bill just because "everyone should get medics" for the 5-10 minute ride to the hospital after a jammed finger or bad gas. We rarely get a bad dispatch that requires medics when they weren't requested, I literally can't recall a time when that was an issue

A 2 tiered system can work, we just need to work on it. As a profession, and as a medical field we are a baby, we are growing and beginning to understand that there is something better out there. We aren't far removed from fire departments fighting in the streets over who puts out a fire, we just fight on line and at conferences instead. We wil get there, it will take time

 

[Veneficus]

OK, did some reading/remembering and I think I'm almost with you. I had forgotten about the compensatory increase in intracellular cations, and never knew about the increase in intracellular organic osmoles, but do now. My last hang up is that as cations and other osmoles increase in the cellular space, the cellular interior becomes progressively hyperosmotic compared to NS, leading to increased water movement into the cells when NS is administered..

I don't understand what the hang up is? Yes there would be some movement of water into the cells. But you still have excess solute.

Obviously dilute fluids would lead to more water entry into cells, but NS should lead to some water moving in, shouldn't it? And actually, if we're concerned about too rapidly increasing intracellular volume, wouldn't we be more worried about more dilute IV fluids too rapidly moving water into cells?.

I think the idea is oral fluids being best in somebody capable of drinking it. Then you are adding no solutes, and the body is regulating absorbtion. As for more dilute IV, yes, it would move water faster so the regulation become the amount and speed administered by the provider.

 

[Cohn]

I got a better question whose protocols allows eating a drinking in the box?

 

[AustinNative]

This is not going to turn into a Basics vs Intermediates vs Paramedics thread.

Have you seen that video of the trooper and the EMT???

 

[Shishkabob]

Have you seen that video of the trooper and the EMT???

What does that have to do with anything?

 

[Chimpie]

Have you seen that video of the trooper and the EMT???

What does that have to do with anything?

Nothing. So let's keep this on topic. Thanks.

 

[Lola99]

I got a better question whose protocols allows eating a drinking in the box?

-raises hand- ...but that's BLS transport, not lights and sirens. Actually one of our ex-employees was fired for not letting a patient (or pt's family member, I don't remember) bring their water because "it could get spilled in his rig" and he was rude abouit it.
On second thought, I suppose if it were lights and sirens and our patient wanted to bring something, we'd let them there too, just never had to worry about it.

 

[AustinNative]

What does that have to do with anything?

Nothing. It was a joke about beating a dead horse. This topic has been flogged more than once. Relax a bit, eh?

 

[Cohn]

-raises hand- ...but that's BLS transport, not lights and sirens. Actually one of our ex-employees was fired for not letting a patient (or pt's family member, I don't remember) bring their water because "it could get spilled in his rig" and he was rude abouit it.
On second thought, I suppose if it were lights and sirens and our patient wanted to bring something, we'd let them there too, just never had to worry about it.

The big thing about eating and drinking in the box is from what I am told is that its dirty and if the pt needs surgery a full tummy is not ideal.

 

[Lola99]

The big thing about eating and drinking in the box is from what I am told is that its dirty and if the pt needs surgery a full tummy is not ideal.

BLS transport. In that case I'm usually not taking pt's in for surgeries they don't already know about, and then they would know prior and would be directed by their Dr. not to eat or drink.
At that company, the rigs are rarely worth worrying about. Private ambulance service usually taking pt's to&from dialysis and running light and sirens mainly when they feel sick and call us because it's familiar. We also have hospital to hospital (hicktown, own hospital is little more than a bandaid station with cool cameras).
Anyway... too many examples to explain. I understand, though.

 

[HappyParamedicRN]

The problem is that ems unfortunatly has the highest risk for iv related infections, so why put patients through this if they really do not need it prehospital. Also a service would not be able to reccoop that money from insurance companies at the bls level. Also most ERs in this area draw bloods when they put the line....

just my two cents


happy

 

[usalsfyre]

The big thing about eating and drinking in the box is from what I am told is that its dirty and if the pt needs surgery a full tummy is not ideal.

Dirtier than a hospital room? How many of your able to orally hydrate dessert walkers need emergent surgery? This is a pretty easy thing to assess for, but again requires more than 3 weeks worth of medical knowledge.

While not normally a fan of situation specific protocols, this one kinda calls out for one.

 

[Shishkabob]

The problem is that ems unfortunatly has the highest risk for iv related infections,

No.

I have yet to see a single big study that has shown any major, let alone minor, increase in infection between pre-hospital and hospital initiated IV lines. Heck, here's just one study.



http://www.annemergmed.com/article/S0196-0644(95)70266-0/abstract

"There was one infection in the prehospital group and four in the in-hospital group (infection rate: .0012 for prehospital patients and .0017 for in-hospital patients"

 

[JPINFV]

I got a better question whose protocols allows eating a drinking in the box?

Um, that's more directed at the crew (who is more likely to eat and drink on an ambulance) since the crew is not supposed to eat unless there's a partition between the cab and the back, they change clothes before entering the cab, and they wash their hands. Generally, I've found that unless you're in a station deployment model very few people follow this rule, and even if you are in a station deployment system, then if it's extremely busy the rule isn't followed. Now, the big question is how strictly is this enforced.

 

[jrm818]

I don't understand what the hang up is? Yes there would be some movement of water into the cells. But you still have excess solute.



I think the idea is oral fluids being best in somebody capable of drinking it. Then you are adding no solutes, and the body is regulating absorbtion. As for more dilute IV, yes, it would move water faster so the regulation become the amount and speed administered by the provider.

I think I may have misinterpreted your original statement. I thought you said that NS administration would lead to increased Na+ concentration and baddness because of that increase in concentration. It will increase total body sodium, but I'm still not seeing how it would increase the actual concentration since NS is a dilute fluid relative to hypernatremic serum or cells.

I do understand why oral is better and NS isn't the best choice, but I don't see where the actual harm would be from administering it to someone whose sodium is above 154 meq/L.

 

[Shishkabob]

There's a reason why we like to use half-NS when a patient is hypernatremic. B)

 

[Sandog]

After reading this thread I decided to read up on some of the issues discussed here. I found this really good read on fluid physiology, it is quite comprehensive and I thought it may be of interest to some of you.

http://www.anaesthesiamcq.com/FluidBook/index.php