IVs for EMT-B

[Tigger]

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

I think there is some merit in basics starting IOs during a code with a medic partner. I was taught IOs during my IV class for this reason, and there is at least one service in Colorado that is already doing that. If anything IO access is likely "easier" to gain than IV, no?

I do not support putting IOs on BLS trucks even if the providers in question can hang fluids, there is not enough oversight in that environment.

 

[usalsfyre]

I think there is some merit in basics starting IOs during a code with a medic partner. I was taught IOs during my IV class for this reason, and there is at least one service in Colorado that is already doing that. If anything IO access is likely "easier" to gain than IV, no?

I do not support putting IOs on BLS trucks even if the providers in question can hang fluids, there is not enough oversight in that environment.

Why not have the focus on performing really good non-invasive airway management or chest compressions?

 

[Handsome Robb]

I think there is some merit in basics starting IOs during a code with a medic partner. I was taught IOs during my IV class for this reason, and there is at least one service in Colorado that is already doing that. If anything IO access is likely "easier" to gain than IV, no?

I do not support putting IOs on BLS trucks even if the providers in question can hang fluids, there is not enough oversight in that environment.

IOs are ridiculously easy. It's literally like drilling a wood screw into a wall. That's exactly what it feels like too.

My problem with them and fluids on BLS trucks is the lack of understanding of acid-base balance along with physiology and pathophysiology. I'd be afraid of a basic running a liter of fluid wide-:censored::censored::censored::censored:ing-open into granny and fluid overloading her.

 

[DesertMedic66]

Why not have the focus on performing really good non-invasive airway management or chest compressions?

All depends on how many people you have on scene. If you have multiple EMTs on scene then airway and compressions are already being handled. Why not use one of the EMTs to place an IO instead of standing around doing nothing?

 

[Tigger]

Why not have the focus on performing really good non-invasive airway management or chest compressions?

All depends on how many people you have on scene. If you have multiple EMTs on scene then airway and compressions are already being handled. Why not use one of the EMTs to place an IO instead of standing around doing nothing?

I think firefite has the right idea here, and that's one of the intents of the Colorado EMT-IV program. There are lots of basics in Colorado (like everywhere), lets make them more useful given the scarcity of medics in some areas. A volunteer in a rural area can take this class in a fairly short amount of time and hopefully make him or herself more useful when ALS is called. Like most rural areas it is not uncommon for there to only be one or two medics available county-wide and the idea is not to tie both of them up on the same call. Obviously the best solution is to have more medics available but that's not always going to be possible.

I don't think the intent of the IV program is to get BLS ambulance crews to start IVs on their own, or at least I hope it is not.

 

[the_negro_puppy]

If an EMT-B wants to start IVs then they should do more than the 120 hours of education and become a medic.

 

[NYMedic828]

If an EMT-B wants to start IVs then they should do more than the 120 hours of education and become a medic.

Lets try to avoid starting a battle.

Why dont we try to just sum up this thread.

Is an IV technically an advanced invasive procedure? Yes.

Is an IV relatively easy to perform? Yes.

Is an IV practical at a BLS level? Not really. An IV is simply a purchase point for what may really be needed. Medications. Simply having access is worthless without the knowledge and experience that comes along with what to do after.

An IO is even easier to perform than an IV but it still lacks the same ultimate use at a BLS level.

An IM any monkey can perform. But again the knowledge base lacks.

On the other hand does an EMT/paramedic crew now serve purpose with an EMT-IV? To an extent absolutely.

 

[OzAmbo]

If an EMT-B wants to start IVs then they should do more than the 120 hours of education and become a medic.

[YOUTUBE]http://www.youtube.com/watch?v=MjoMQJf5vKI[/YOUTUBE]

 

[Bullets]

To the original poster, IVs for EMTs gets tossed about every few years, then goes no where, just like the EMT-I/AEMT.

We have been "trialing" king/combi/LMA in one of the northern counties for what seems like 20 years now, and nothing has comes. In a state like NJ where we have an over-saturation of ALS there is no impetus to expand the EMT scope outside of changing small things, like oxygen administration, aspirin, ect

 

[exodus]

I think firefite has the right idea here, and that's one of the intents of the Colorado EMT-IV program. There are lots of basics in Colorado (like everywhere), lets make them more useful given the scarcity of medics in some areas. A volunteer in a rural area can take this class in a fairly short amount of time and hopefully make him or herself more useful when ALS is called. Like most rural areas it is not uncommon for there to only be one or two medics available county-wide and the idea is not to tie both of them up on the same call. Obviously the best solution is to have more medics available but that's not always going to be possible.

I don't think the intent of the IV program is to get BLS ambulance crews to start IVs on their own, or at least I hope it is not.

My exact reasoning behind it. The basic can initiate the access, and the medic can use it. Many people missed the part of my post where I said, "Under order and direct supervision of a medic." So, no. There will NOT be IV / IO's on a BLS truck. In many systems, you have several extra EMT's just standing there, but the medics are always doing something.

 

[fast65]

My exact reasoning behind it. The basic can initiate the access, and the medic can use it. Many people missed the part of my post where I said, "Under order and direct supervision of a medic." So, no. There will NOT be IV / IO's on a BLS truck. In many systems, you have several extra EMT's just standing there, but the medics are always doing something.

I'm liking your idea, I know it would come in handy for me quite often. I'm usually the only medic on scene, and I will very rarely have an EMT-I from the FD. So if I could have a basic start a line under my order/supervision, it would make my job that much easier on occasion.

 

[bstone]

I'd like to give props and congratulate the OP for using the proper pluralization of EMT. Other than that, I am mostly against EMT-Bs being allowed to start IVs. I simply don't think their education is long or comprehensive enough for that.

 

[Tigger]

I'd like to give props and congratulate the OP for using the proper pluralization of EMT. Other than that, I am mostly against EMT-Bs being allowed to start IVs. I simply don't think their education is long or comprehensive enough for that.

I don't think anyone is arguing that IVs be added to the present curriculum. I can only start them because I took another class so it isn't like I don't know anything about them or fluid balances. I'd like to know more but given it's use I'd say the course length (20 hours) is about sufficient.

Is medic school's IV section longer? I'm sure it is, but an EMT-IV and a Paramedic are learning them for different reasons, or at least they should be.

 

[NYMedic828]

I don't think anyone is arguing that IVs be added to the present curriculum. I can only start them because I took another class so it isn't like I don't know anything about them or fluid balances. I'd like to know more but given it's use I'd say the course length (20 hours) is about sufficient.

Is medic school's IV section longer? I'm sure it is, but an EMT-IV and a Paramedic are learning them for different reasons, or at least they should be.

Paramedic IV skills aren't necessarily longer so much as they are referred back to countless times throughout the program.

I think I did around 300 IVs on patients in the ER by the end of my program. Countless more on the manikins during skills.

20 hours is more than sufficient for the skill itself and explanation of iso/hypo/hyper solutions but being able to fully comprehend the right situations to actually give those fluid challenges is what really needs more clinical and classroom experience.

And quite honestly, when I first hit the street out of my program I was iffy on which patients deserved IVs as a precautionary measure. It just comes with time and experience.

 

[Tigger]

Paramedic IV skills aren't necessarily longer so much as they are referred back to countless times throughout the program.

I think I did around 300 IVs on patients in the ER by the end of my program. Countless more on the manikins during skills.

20 hours is more than sufficient for the skill itself and explanation of iso/hypo/hyper solutions but being able to fully comprehend the right situations to actually give those fluid challenges is what really needs more clinical and classroom experience.

And quite honestly, when I first hit the street out of my program I was iffy on which patients deserved IVs as a precautionary measure. It just comes with time and experience.

I agree, and am personally not confident initiating fluid therapy on my own. That's what scares me about the EMT-IV program, there are no doubt BLS services with EMTs giving everyone a bag of NS because they can.:unsure:

Fortunately for me, college athletes have to be one of the healthier patient populations out there so it's a bit less of an issue. It's likely that I will only be starting IVs on significantly dehydrated players whose symptoms are fairly obvious. I also have my athletic trainer boss and our physician oversight to consult prior to starting any therapies, considering the breadth of his experience I think we will not have an issue with pointless IVs.

 

[bstone]

I don't think anyone is arguing that IVs be added to the present curriculum. I can only start them because I took another class so it isn't like I don't know anything about them or fluid balances. I'd like to know more but given it's use I'd say the course length (20 hours) is about sufficient.

Is medic school's IV section longer? I'm sure it is, but an EMT-IV and a Paramedic are learning them for different reasons, or at least they should be.

I am certain that 20 hours is enough to teach the academic portion of starting IVs but it's nowhere near enough to actually becoming proficient in it. I would suggest the minimal standard be something like 20 hours + 50 successful lines in the ER + 50 successful lines on an ambulance. Anything less than this and I just don't see proficiency. If this could be done then I would sign off on supporting IVs for basics.

 

[Tigger]

I am certain that 20 hours is enough to teach the academic portion of starting IVs but it's nowhere near enough to actually becoming proficient in it. I would suggest the minimal standard be something like 20 hours + 50 successful lines in the ER + 50 successful lines on an ambulance. Anything less than this and I just don't see proficiency. If this could be done then I would sign off on supporting IVs for basics.

Yea, I wish that were the case. Instead we just needed 10 successful sticks in the ER, plus whatever we got in class, so around 15. Not enough really.

 

[bstone]

Yea, I wish that were the case. Instead we just needed 10 successful sticks in the ER, plus whatever we got in class, so around 15. Not enough really.

Agreed, not really enough. After doing 100 successful sticks you're going to be really competent. 10-15 just isn't enough to even get your feet wet.

 

[OzAmbo]

Agreed, not really enough. After doing 100 successful sticks you're going to be really competent. 10-15 just isn't enough to even get your feet wet.

I think theres another issue you have to look at as well.

For arguments sake this gets legs and you get some select EMTS into hospital where they get their 100 venipunctures in both th IV and "taking bloods" (which is a different animal) and then you stick them out on the road with a restrictive rotocol that allows them to IV only time critical patients which are hard to get at the best of times and sometimes few and far between, especially in low call areas and you'd have to wonder if the guys involved can maintain competency in this without having some extensive clinical governance over it.

If the other option you guys talked about is where an EMT and a Paramedic are at a job and the Pt needs an IV (and i can say this with forst hand experience) my BLS partner doesn't place it, nor do i need them to place it as i have enough brains to delegate some duties which frees me up to do it myself.

Personally i think the priority here is a little screwed up. With calls for analgesia making up such a large proportion of EMS calls i would have though you would be after some non-invasive effective analgesia of some kind, its reprehensible that in this day and age pre-hospital care in 1st world countries still allows this unhumane practice, so i dont see the relevence of IV placement systems where the "basic" level of care doesn't cover the basics.

 

[ZootownMedic]

Here in Colorado Springs to even get hired you have to have your IV certification as a Basic. Basic's being able to start IV's is nothing short of awesome. It makes life MUCH easier for the medics. And for those saying "they need more practice" well whats the harm in on the job training? As long as they are being safe then having them practice on the rig or in the patients home is only beneficial. If it is a time sensitive patient or one of the RARE patients who absolutely needs a line NOW then just let the Paramedic do it. Other than that let the Basic stick away. We all miss sometimes and we all started somewhere. There really is no downside from what I can see.