IVs for EMT-B

[musicislife]

I heard that they do it, or that they may add it in NJ, is that true?

 

[Medic Tim]

I heard that they do it, or that they may add it in NJ, is that true?

There are a few areas that have expanded scope emts. As a general rule though a basic does no do anything invasive.

 

[mycrofft]

Feds are trying to rein in the continued blurring and expansion of scopes of practice. No teeth in it, though.

 

[Milla3P]

I feel as though I've seen some state that allowed Bs to transport IVs but not initiate them (Washington?). Rhode Island just took ET Intubation away from basics (good move).

 

[HMartinho]

I can't see any benefit in EMT's can start IV lines.

It is a procedure that requires practice, and is not as easy as it looks like.

 

[DesertMedic66]

I feel as though I've seen some state that allowed Bs to transport IVs but not initiate them (Washington?). Rhode Island just took ET Intubation away from basics (good move).

Alot of states/counties will allow for EMTs to transport patients with IV lines but not start them (my county included).

 

[exodus]

I'd rather have EMT's be able to start IO under the supervision and order of a paramedic. Very useful for cases like full arrests.

 

[rwik123]

I can't see any benefit in EMT's can start IV lines.

It is a procedure that requires practice, and is not as easy as it looks like.

Really? I can see plenty of benefit for basics being able to start IVs. Its really not rocket science. Basics could easily learn how to do it....I just think they'd lack the clinical judgment and overall physiology behind IV therapy. Theres a fine line between allow basics to establish a lock on the patient and allowing them to initiate fluid therapy.

 

[Backwoods]

With how little training a basic has, I don't think it would be a good idea to cram IV skills into their scope. They can learn that when they go to medic school.

 

[STXmedic]

Really? I can see plenty of benefit for basics being able to start IVs. Its really not rocket science. Basics could easily learn how to do it....I just think they'd lack the clinical judgment and overall physiology behind IV therapy. Theres a fine line between allow basics to establish a lock on the patient and allowing them to initiate fluid therapy.

If they can't do anything with it, then what's the point? I can understand basics doing IOs in cardiac arrests (our basics do it here), but I see no purpose of a basic starting a lock other than to increase the patients risk for infection.

Edit: I agree it's not a difficult skill to perform. However with them not being able to use it, and it likely to still be an uncommon skill to perform, why not just let the more experienced nurse at the ED start one in a slightly more aseptic environment.

 

[NYMedic828]

EMTs starting IVs comes up a lot. I know some members here have EMT-IV next to their name. NY has no such title. But honestly, starting an IV just to have a lock does nothing. Its what you can do with it that requires further knowledge and understanding that comes with an advanced provider course. Even normal saline has its serious risks.

Here on Long Island we have critical care and paramedic ALS providers. CCs basically a little higher than EMT-I but even they have to call medical control to give fluid challenges. Medics don't.

I feel as though I've seen some state that allowed Bs to transport IVs but not initiate them (Washington?). Rhode Island just took ET Intubation away from basics (good move).

NY allows for this, well at least in NYC you can. Not sure about the state.

Intubation will definitely never be a basic skill in NY.

I can't see any benefit in EMT's can start IV lines.

It is a procedure that requires practice, and is not as easy as it looks like.

I'd have to disagree. Some patients with garbage for veins, sure. But quite honestly, most patients it isn't much of a technical skill. You put the needle into the tube and push it in. Pretty hard to not understand the procedure itself.

I'd rather have EMT's be able to start IO under the supervision and order of a paramedic. Very useful for cases like full arrests.

Yes and no. It has its place if the medic is tubing or something but in many places the EMT is doing CPR and the medic is doing the other things. Someone has to do CPR. (considering meds are nonsense anyway and have no proven benefits in cardiac arrest.)

 

[rwik123]

If they can't do anything with it, then what's the point? I can understand basics doing IOs in cardiac arrests (our basics do it here), but I see no purpose of a basic starting a lock other than to increase the patients risk for infection.

I never said they should just have locks in their scope. Obv locks alone would do no good. I'm saying the skill of the IV isn't that complicated but would be useless if they didn't have the ability to give fluids...but lack the educational knowledge to apply that skill correctly...sorry I wasn't explicit in my first post. I was talking about the skill of initiating a lock not that they should have the skill without fluids.

 

[rwik123]

If they can't do anything with it, then what's the point? I can understand basics doing IOs in cardiac arrests (our basics do it here), but I see no purpose of a basic starting a lock other than to increase the patients risk for infection.

Edit: I agree it's not a difficult skill to perform. However with them not being able to use it, and it likely to still be an uncommon skill to perform, why not just let the more experienced nurse at the ED start one in a slightly more aseptic environment.

Meh, I wouldn't want basics doing IOs in an arrest. The last thing we need is giving them all a fancy tool and focus on that instead of doing good BLS CPR. The drugs are mostly bs as we all know.

 

[STXmedic]

Meh, I wouldn't want basics doing IOs in an arrest. The last thing we need is giving them all a fancy tool and focus on that instead of doing good BLS CPR. The drugs are mostly bs as we all know.

If it was a small team working the arrest, I'd agree. Many things would take precedence over that. However, here we have an over abundance of resources (EMT-Bs) on any full arrest, with not near as many medics. So instead of having two to three guys twiddling their thumbs, our medical director decided to give them something fairly low-risk and easy to do to make them more productive and time-saving while waiting for the medics to get there.

Ours can also place king tubes in an arrest. Again, a lot of idle hands given an easily performed skill.

Yes, I agree the drugs are not proven to do much of anything. That doesn't change the fact that our medical director wants them administered.

 

[rwik123]

If it was a small team working the arrest, I'd agree. Many things would take precedence over that. However, here we have an over abundance of resources (EMT-Bs) on any full arrest, with not near as many medics. So instead of having two to three guys twiddling their thumbs, our medical director decided to give them something fairly low-risk and easy to do to make them more productive and time-saving while waiting for the medics to get there.

Ours can also place king tubes in an arrest. Again, a lot of idle hands given an easily performed skill.

Yes, I agree the drugs are not proven to do much of anything. That doesn't change the fact that our medical director wants them administered.

Sounds like a very progressive system. I like the King protocol.

 

[STXmedic]

Sounds like a very progressive system. I like the King protocol.

We're definitely getting there. We're about halfway through of a several year swing from being an archaic taxi service to one of the more progressive systems in the country.

 

[HMartinho]

In my opinion, is much more useful allow an EMT-B to insert an laryngeal mask or king tube, when it's indicated.

 

[Tigger]

In my opinion, is much more useful allow an EMT-B to insert an laryngeal mask or king tube, when it's indicated.

There's no reason that an EMT cannot do both, it's not like those to skills are somehow incompatible with one another.

As a basic in Colorado, I can start IVs and give fluid challenges without med control. Same goes for D50 and Narcan. Honestly, while I feel like I am competent in these areas, the additional training is not long enough for most EMTs. I took the times to look up the physiology (basic mind you) on my own time. I did get plenty of practice though, so it's not the actual skill I'm worried about.

For most systems in Colorado it's a fairly useful certification though. Most ambulances are P/B so the basic is usually just doing what the medic asks while the medic does something else. As mentioned it's useful for codes, medic does the airway and monitor, basic gets IV access and pushes epi under the medics direction (which is allowed for under state protocol). Someone else does CPR, if there is no else then the basic just does CPR.

For a double basic truck I am not so sure that allowing IVs is the greatest idea, it seems like it would be too easy for EMTs without proper training to jump to the IV when there are other more pressing issues that need to be dealt with. I think the military has some experience with this?

 

[firecoins]

Transporting an I've is widely allowed because Medicare rules allow it. It doesn't have anything to with EMT-b scope of practise or treatments.

 

[pa132399]

the problem with giving emt's the skill to do iv's is it is just a skill like said before its the actual effects and why. A monkey if trained correctly could probably start an iv better yet my three year old could as well but neither would no why. basically you would have a bunch of whacker emt's with a skill and tons of bls pt who didnt need a line coming in with a lock just because they can do it. BAD IDEA

GOOD IDEA like the king/ lma stuff that was talked about not that hard to understand why and not a hard skill to learn.

just my $.02