EMTs starting IV

[TraprMike]

it is up to NO BODY on this board to decide weather or not EMT-B's should start an IV.

maybe the phrase, " Local Protocol" doesn't exist anymore?

 

[JPINFV]

it is up to NO BODY on this board to decide weather or not EMT-B's should start an IV.

maybe the phrase, " Local Protocol" doesn't exist anymore?

Well...that's it. Shut down the message board since none of us have the direct power to control anything unless you're in the legislature or a medical director.
:unsure:

 

[ffemt8978]

it is up to NO BODY on this board to decide weather or not EMT-B's should start an IV.

maybe the phrase, " Local Protocol" doesn't exist anymore?

You might want to avoid absolute statements like that. We have some members that are medical directors for various agencies, and it is absolutely up to them if their EMT-B's can start IV's (subject to state regulations).

Also, local protocols generally must follow what the state and/or licensing agency allows for that level.

 

[brentoli]

All I want is d50, nebulize, fluids, maybe a 3 lead. It would cut our dependancy on MICs and speed up calls

Taking a different approach here...

From my limited billing knowledge, Medicare/Medicaid/Insurance won't reimburse for something out of the "average standard of practice" so if they get a bill for a basic truck at the ALS1 level (or wherever a stick, d50, and a 3 lead would fit) they won't pay it. Those things don't come free, so how would you expect to make up your costs?

 

[JPINFV]

Taking a different approach here...

From my limited billing knowledge, Medicare/Medicaid/Insurance won't reimburse for something out of the "average standard of practice" so if they get a bill for a basic truck at the ALS1 level (or wherever a stick, d50, and a 3 lead would fit) they won't pay it. Those things don't come free, so how would you expect to make up your costs?

Reform medicare.

Balance bill patients when it isn't illegal (illegal for medicare/medicade. Other than that, it's dependent on the contract the service signed with the insurance companies).

Make EMS 3rd service and supplement it with tax dollars similar to the fire department and law enforcement.

 

[TraprMike]

You might want to avoid absolute statements like that. We have some members that are medical directors for various agencies, and it is absolutely up to them if their EMT-B's can start IV's (subject to state regulations).

Also, local protocols generally must follow what the state and/or licensing agency allows for that level.

Exactly! !its up to the Med Dir!!!.. thank you !!!!1111!!:excl:

gesh,,, this place is to intence..

and I will not avoid Absolute statements.. ff,emt, webboard nerd.. you are on a bunch of boards, like me,

oh forget it...

 

[CAOX3]

Your right its up to your medical director. I just don't understand the benefit, I have read all thirteen pages, I have operated as an emt for fifteen years, I just can't see it, your patients are not dying or suffering because an emt can't start a line if they are them your whole system needs an overhaul.

You can't replace a medic by teaching a basic a few more tricks.

My opinion.

 

[Bullets]

Because we don't bill on either squad I ride with. One is a police based department and money comes out of tax dollars. The other is a staffed volunteer squad that is a private non-profit and survives on donations and fund raising

 

[wyoskibum]

lighten up Francis....

Exactly! !its up to the Med Dir!!!.. thank you !!!!1111!!:excl:

gesh,,, this place is to intence..

and I will not avoid Absolute statements.. ff,emt, webboard nerd.. you are on a bunch of boards, like me,

oh forget it...

The purpose of this forum is to allow EMS related discussion such as this one. Obviously there has been a lively debate for and against EMT-B's starting IV's. There are those who are very passionate about their opinions. At some point you have agree to disagree and move forward.

Just my $.02 worth.

 

[JPINFV]

webboard nerd..

I do believe that the proper term is forum trollup.

 

[MS Medic]

This is a topic that is discussed at nauseum (spelling?), both on these boards and in the truck/station. I will admit that when I was a basic, I was on the side of letting basics do it because of a lack of knowledge on the subject. So here it is:

The psycho-motor skill of starting an IV is not that hard. In fact, you could probably train a chimp to do it with enough rote repetition. The problem lies in what you do after the IV is established. IV fluids, in all of its incarnations, are FDA CONTROLLED MEDICATION (caps for emphasis only). Like all medications, IV fluids have negative effects which can be lethal if given incorrectly.
Paramedic pharmacology courses, at bare minimum, will cover the different hypotonic, hypertonic, and isotonic solutions and what effect each will have on the body. There will also be education on disease processes such as ERSD and CHF, so that you understand the effects of fluid administration. The pathophysiology of different types of shock will also be covered so that you know when to give large boluses and when to judiciously control it so the pt does not have pink kool-aid that will not carry O2 in their veins.
The reason EMT-Bs should not start IVs is because you don't get sufficient education in these areas and the potential consequences of something going wrong outweighs any benefit that might come from a Basic starting an IV to help a nurse or medic.

 

[JPINFV]

The problem lies in what you do after the IV is established. IV fluids, in all of its incarnations, are FDA CONTROLLED MEDICATION (caps for emphasis only). Like all medications, IV fluids have negative effects which can be lethal if given incorrectly.

Most of what is on the ambulance is FDA controlled. You can't just go out and buy medical grade oxygen and administer it all willy nilly either.

The reason EMT-Bs should not start IVs is because you don't get sufficient education in these areas and the potential consequences of something going wrong outweighs any benefit that might come from a Basic starting an IV to help a nurse or medic.

However I do agree with this.

 

[Veneficus]

The purpose of this forum is to allow EMS related discussion such as this one. Obviously there has been a lively debate for and against EMT-B's starting IV's. There are those who are very passionate about their opinions. At some point you have agree to disagree and move forward.

Just my $.02 worth.

EMS is like one big dysfunctional family during the holidays. If we are not arguing it means somebody is sick.

 

[MS Medic]

Most of what is on the ambulance is FDA controlled. You can't just go out and buy medical grade oxygen and administer it all willy nilly either.

Yes, that was my point.

 

[TransportJockey]

EMS is like one big dysfunctional family during the holidays. If we are not arguing it means somebody is sick.

Lol, I'll have to remember that it's so funny and true

 

[JPINFV]

Yes, that was my point.

Sorry, I thought the argument you were making was that EMTs shouldn't start IVs because IV supplies and fluids are FDA controlled.

 

[brentoli]

Because we don't bill on either squad I ride with. One is a police based department and money comes out of tax dollars. The other is a staffed volunteer squad that is a private non-profit and survives on donations and fund raising

I dont want to go too far off topic here, but being a non profit doesn't mean you can't bill. In fact one of the problems with EMS is the providers who don't bill. Theres no other facet of healthcare that doesn't bill for its services. What makes EMS diffrent?

[/offtopic]

 

[MS Medic]

Sorry, I thought the argument you were making was that EMTs shouldn't start IVs because IV supplies and fluids are FDA controlled.

No, only pointing out that it is a drug and should only be dispensed with proper training as to the effects and consequences. Sorry if I was not clear.

 

[Tigger]

In some places they can (like Colorado) but they don't have the knowledge to know what they're doing a majority of the time. Hell an Intermediate usually doesn't have all the proper knowledge and education needed to know all of why and how they're doing it.

I would certainly agree that most basics in Colorado do not have requite knowledge to start IVs. That said, in many systems there are no Basic/Basic trucks, but almost all P/B, so at least the Basic is starting the IVs under the direction and supervision of a paramedic that hopefully does have the requisite knowledge surrounding IVs.

Also, current CO protocols have provisions for Basics to push front-line cardiac drugs during arrests under the direction of the medic. Presumably this frees up the medic to intubate and work the monitor. Seems to work ok where I am. Realistically I'm not sure how that happens, at least in my area nearly all calls get a P/B ambulance and a fire unit with at least one paramedic.

Just in case your curious to how the protocols read:

SECTION 4 - Medical Acts Allowed for the EMT-Basic

4.6
An EMT-Basic with IV authorization may, under the supervision and authorization of a medical director, administer and monitor medications and classes of medications which exceed those listed in Appendices B and D of these rules for an EMT-Basic with IV authorization under the direct visual supervision of an
EMT-Intermediate or Paramedic when the following conditions have been
established:

a) The patient must be in cardiac arrest or in extremis.

b) Drugs administered must be limited to those authorized by the BME for EMT- Intermediate or Paramedic as stated in Appendices B and D in accordance
with the provisions of Section 3 of these rules.

c) The medical director(s) must amend the appropriate protocols and medical continuous quality improvement program used to supervise the EMS
personnel to reflect this change in patient care. The medical director(s) and
the protocol(s) of the EMT-Basic and the EMT-Intermediate or Paramedic,
must all be in agreement.

 

[Veneficus]

Also, current CO protocols have provisions for Basics to push front-line cardiac drugs during arrests under the direction of the medic. Presumably this frees up the medic to intubate and work the monitor. Seems to work ok where I am. Realistically I'm not sure how that happens, at least in my area nearly all calls get a P/B ambulance and a fire unit with at least one paramedic.

Cut for brevity.

Since there is no evidence of the effectiveness of medication in cardiac arrest, giving meds to basics is the capitulation of treating people based soley on epidemiology with all but bogus treatment modalities.

In my opinion, a fail.