IVs for EMT-B

[Nohero]

As Tigger explained we can start IV's up here in Colorado, but I'll have to add that it requires a totally seperate class...I believe mine was 24 hours total plus ten successful sticks in the clinical setting. So you can be a Basic in Colorado and NOT have authorization to start IV's. You can also be a Basic WITH IV approval, but it requires the extra class and clinical time.

 

[Achilles]

What about IO and IM?

 

[wildmed]

As Tigger explained we can start IV's up here in Colorado, but I'll have to add that it requires a totally seperate class...I believe mine was 24 hours total plus ten successful sticks in the clinical setting. So you can be a Basic in Colorado and NOT have authorization to start IV's. You can also be a Basic WITH IV approval, but it requires the extra class and clinical time.

I also am from co. Emt -iv is pretty much the standard here. It has been very Successful but I'm guessing it may be phased out by the integration of AEMT in the next 5 years. As someone who initiates iv access on very small children on a daily basis and has at least 1000+ ivs under his belt, id say it has been is a very appropriate add on for EMTs here. I must admit that with the first bunch of AEMT students rotating through my ED, I am fully convinced that this should be the entry level to EMS, and a lot of the EMS leaders in the frontrange seem to agree.

 

[the_negro_puppy]

Little point if they can't give anything through it. Even if they had a limited scope such as in cardiac arrests etc to help prep for ALS- they would not be performing the skill enough to remain proficient

 

[NYMedic828]

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

Thank goodness for you grammar and understanding of the english language is not a requirement of EMS.

But yes, this is the main argument against the protocol.

Little point if they can't give anything through it. Even if they had a limited scope such as in cardiac arrests etc to help prep for ALS- they would not be performing the skill enough to remain proficient

The less people that could potentially slow CPR to administer vasopressors the better. The last thing we need is more people racing to shoot someone up with 5mgs of epi.

 

[Achilles]

Still waiting for an answer....

 

[usalsfyre]

Still waiting for an answer....

Our service allows deep IM injection of epi for anaphylaxis (because epi pens are $100+), but I see ZERO reason to give Basics IO access...

 

[Shishkabob]

but I see ZERO reason to give Basics IO access...

To start IOs. ^_^

 

[NYMedic828]

Still waiting for an answer....

What do you intend to do with the IO once you insert it? Just because I can tell anyone to press the button on a cordless screwdriver doesn't mean I should.

IM has the same issues of understanding of medications. Only real difference is I don't need an IV in place which is preferable regardless. Sure many people can pick up on it and all will be well but not all people. You can't do something in the light of some people when the ultimate group is far larger.

Even narcan the simplest of drugs has its potentially lethal side effects.

 

[Achilles]

What do you intend to do with an IO over an IV? Just because I can tell anyone to press the button on a cordless screwdriver doesn't mean I should.

And IM has the same issues of understanding of medications. Sure many people can pick up on it and all will be well, but you can't do something in the light of some people when the ultimate group is far larger.

Even narcan has its potential major side effects.

You can't always get into a vein, you can almost always get into the femur.

 

[Shishkabob]

You can't always get into a vein, you can almost always get into the femur.

Except we typically don't do IOs in the femur.

 

[usalsfyre]

You can't always get into a vein, you can almost always get into the femur.

What life-saving heroics are you going to perform with said vascular access?

 

[NYMedic828]

You can't always get into a vein, you can almost always get into the femur.

You are 100% correct. We can't. Thats why the IO is the last resort. It is not the first. And the fact still remains that once you have an IO, what do you plan to do with it? A patient better be circling the drain or already down the pipes if you decide to start an IO. At that point, we have bigger concerns than just "having access."

I don't know how things are done by you. But that statement by me would be digging your own grave on the matter. The sternum in some areas is accepted and everywhere else I know of goes for the tibial site. The femur is not accepted anywhere I know of pre-hospitally. You would need a specialized set to do it to begin with. (longer needle)

 

[Shishkabob]

Thats why the IO is the last resort. It is not the first.

This is where I disagree. I don't label things as "first" or "last", but as needed. I have no issue jumping to IO right off the bat, and although my medical director doesn't like IOs and prefers IVs, the protocols he wrote specifically state that if IV access is deemed to be difficult, to skip right to the IO.

 

[NYMedic828]

This is where I disagree. I don't label things as "first" or "last", but as needed. I have no issue jumping to IO right off the bat, and although my medical director doesn't like IOs and prefers IVs, the protocols he wrote specifically state that if IV access is deemed to be difficult, to skip right to the IO.

Sorry I probably could have worded that better. I don't mean last resort in the sense that I wasted 5 minutes trying to stick someone 10 times without success so I finally grabbed the IO. I meant that if we can easily get an IV instead, we should. If my patient is still alive id prefer not to drill a hole in their bone if I don't need to.

I certainly have looked at a patients arm/neck and decided to go right for the IO. It definitely saves time and effort but that still adds no viability at the EMT level.

 

[Achilles]

You are 100% correct. We can't. Thats why the IO is the last resort. It is not the first. And the fact still remains that once you have an IO, what do you plan to do with it?

I don't know how things are done by you. But that statement by me would be digging your own grave on the matter.

The femur isn't the primary IO site. You would need a specialized set to do it to begin with. (longer needle)

I will let you know what I plan to do with as soon as I become a para-magician.
Btw, Michigan btw.
I'm also just a basic, so i was just asking a question.

 

[usalsfyre]

I will let you know what I plan to do with as soon as I become a para-magician.
Btw, Michigan btw.
I'm also just a basic, so i was just asking a question.

IO access as a medic, useful. As a basic? Pointless.

 

[NYMedic828]

I will let you know what I plan to do with as soon as I become a para-magician.
Btw, Michigan btw.
I'm also just a basic, so i was just asking a question.

Smoke and mirrors my friend.

You were defending your argument so we defended ours. No harm done we are all here to learn from one another.

 

[Achilles]

I certainly have looked at a patients arm/neck and decided to go right for the IO. It definitely saves time and effort but that still adds no viability at the EMT level.

The OP is an MFR, do you think he should be starting IV's?

 

[NYMedic828]

The OP is an MFR, do you think he should be starting IV's?

No... I thought that was made pretty apparent by this point. :unsure: