IVs for EMT-B

CrackerBDingus said:
Well, considering basics can set-up the bags for IV, makes sense if the medic just tells them what to use and all the other stuff and just has the basic stick 'em. Wouldn't know personally though, I am not in-house with fire.
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I work as a medic for a fire department that routinely runs P/B with a 3rd person rider (student or newbie of some kind). We're busy and we run a decent amount of real-ALS (we don't have RSI). I've yet to find a patient where I can't do the essential ALS on my own while my EMT partner handles something else. Paramedics working without other paramedics just need to learn to prioritize...and an IV is usually low on the list.

At my hospital service we run double medic, are insanely busy, and have RSI. Usually one of the medics is doing the essential ALS while the other is performing something an EMT could do instead. Unless we're doing an RSI, there aren't practical cases where two paramedics need to be performing simultaneous ALS interventions.

If the EMT's are doing their jobs well, a single Paramedic can handle the ALS side. If the EMT's aren't doing their jobs well, then they don't need to be doing things like IV's :)

I don't see the utility in adding the additional liability to save time that isn't needed to be saved...
 
...and if the EMT makes a mistake, who is responsible?.....:ph34r:

Sort of like pushing rope. Sometimes it works (like when it is frozen solid) but many other times, too much likelihood of kinks.
 
I'm not saying it is safe, or even that it should be done. But it is of huge debate in the socal area. Doctor's ambulance even has an interview question about whether or not you would start one if the medic you're running with has his hands tied and asks you too.
 
Like asking if you would steal due to necessity on a JC Penney's job application.;)
 
I actually laugh to myself when I read most of this thread as it seems that most EMT's are solely ambulance drivers.....thats too bad. I work in a very progressive system (el paso county, CO) and our EMT's play a huge role on the ambulance and in the FD. Our protocols include IV, fluid administration, dextrose and narcan all without calling in for orders. IV and those drugs are standing orders from our medical directors. Combitube is actually VERY standard and expected practice from EMT's. Our city FD has recently moved to the "team" approach on all codes. Basically, the first responding ALS engine with have 3 basics and 1 medic. The medic is in charge of the monitor and scene choreography. So....if you are following along that leaves 3 BLS providers to do EVERYTHING else. Our BLS providers sink a combitube, start IV's. Our EMTs push all meds directed by the lead paramedic. When the medic shows up from the transporting ambulance they take over drug admin and intubation PRN with ROSC. I agree EMTs need to know pathophys and be able to justify their interventions, not just do it for the hospital or just do it because they can. However, there have been very valid reasons presented here for the EMT-B provider to have more advanced scopes.
 
ksmith3604 said:
I actually laugh to myself when I read most of this thread as it seems that most EMT's are solely ambulance drivers.....thats too bad. I work in a very progressive system (el paso county, CO) and our EMT's play a huge role on the ambulance and in the FD. Our protocols include IV, fluid administration, dextrose and narcan all without calling in for orders. IV and those drugs are standing orders from our medical directors. Combitube is actually VERY standard and expected practice from EMT's. Our city FD has recently moved to the "team" approach on all codes. Basically, the first responding ALS engine with have 3 basics and 1 medic. The medic is in charge of the monitor and scene choreography. So....if you are following along that leaves 3 BLS providers to do EVERYTHING else. Our BLS providers sink a combitube, start IV's. Our EMTs push all meds directed by the lead paramedic. When the medic shows up from the transporting ambulance they take over drug admin and intubation PRN with ROSC. I agree EMTs need to know pathophys and be able to justify their interventions, not just do it for the hospital or just do it because they can. However, there have been very valid reasons presented here for the EMT-B provider to have more advanced scopes.
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We have the same thing here. Except we don't use basics. Only Medics and Intermediates. Fire has basics but all fire really does for us during a code is CPR and bagging until the intermediate can drop a KING and set up the vent. Then it's just CPR, maybe gathering meds and checking a sugar while the I drills an IO and starts pushing drugs as directed by the medic.
 
ksmith3604 said:
I actually laugh to myself when I read most of this thread as it seems that most EMT's are solely ambulance drivers.....thats too bad.
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The last bit you were reading was in reference to EMT-B's without IV training starting IV's "off the record".

NC EMT's have a pretty broad scope themselves, just shy of starting IV's. I think they could have IO's added for cardiac arrests, but otherwise with only 200 hours of initial education I don't see the utility in adding IV's for EMT-B's.

When we make it 1000 hours for EMT-B, I'm all in favor of IV's, 3/12-Leads, etc :) But that is another post for another day.
 
Just my 2 cents here, In the federal area, they allow EMT-B's to start IV's and in the federal area, they follow the NREMT-B standards to the letter and every line the NREMT-B standards. Maybe it's why the Feds are pushing for a uniform standard for all states and a standard for all EMT's, regardless of where your from.
 
Kavsuvb said:
Just my 2 cents here, In the federal area, they allow EMT-B's to start IV's and in the federal area, they follow the NREMT-B standards to the letter and every line the NREMT-B standards. Maybe it's why the Feds are pushing for a uniform standard for all states and a standard for all EMT's, regardless of where your from.
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Please prove that "federal EMTs" (I assume you mean Coast Guard EMTs) can start IVs.
 
Tigger said:
Please prove that "federal EMTs" (I assume you mean Coast Guard EMTs) can start IVs.
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Go talk to the Combat Medics in the US Army, Air force (AKA, Pararescue, flight medics and combat medics). The Hospital Corpsmen in the US Navy & US Coast Guard. The rescue swimmers which are (AST = Aviation survival technician) They all follow the NREMT standards, line by line. If you Google the US Coast Guard EMT school, you can see the NREMT standards that they follow to the letter.
 
Kavsuvb said:
Go talk to the Combat Medics in the US Army, Air force (AKA, Pararescue, flight medics and combat medics). The Hospital Corpsmen in the US Navy & US Coast Guard. The rescue swimmers which are (AST = Aviation survival technician) They all follow the NREMT standards, line by line. If you Google the US Coast Guard EMT school, you can see the NREMT standards that they follow to the letter.
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No. Combat Medics, 68W and Navy Corpman do not follow the NREMT to the letter and for that I am thankful.

The NREMT also does not set the stanards. It only tests on the material from the US Department of Transportation National Standard Curriculum

68W trains for at least 16 weeks vs the civilian EMT which is about 3 weeks if you go to one of the civilian boot camps. Combat Medics can be trained to provide whatever is necessary in frontline combat or where they are needed. That includes not just starting an IV but doing a cutdown for venous access. It also can include inserting a chest tube. There would be little use for the equivalent of the civilian EMT in combat.

Corpsmen can also be trained for whatever needed. This includes anything from xrays, labs to pharmarcy. No civilian EMT is going to work in those areas.


They can still take the civilian equivalent training to be NREMT-I and P.
 
Kavsuvb said:
Go talk to the Combat Medics in the US Army, Air force (AKA, Pararescue, flight medics and combat medics). The Hospital Corpsmen in the US Navy & US Coast Guard. The rescue swimmers which are (AST = Aviation survival technician) They all follow the NREMT standards, line by line. If you Google the US Coast Guard EMT school, you can see the NREMT standards that they follow to the letter.
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Line medics are trained to an EMT-B in whiskey school but have tons of interventions that are no where near the scope of emts in the civilian world. Don't go comparing the civilian and military world. They are two different beasts. Military are generally healthy young men dealing with traumatic injuries, and the medics protocols reflect this.

PJs and flight designated 68wFs are not basics, they are paramedics so that argument doesn't work either.

Edit: I'm not sure if flight designated medics are paramedics... But they def have more experience than the grunt ground medic and do not "follow the nremt standards"
 
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JakeEMTP said:
No. Combat Medics, 68W and Navy Corpman do not follow the NREMT to the letter and for that I am thankful.

The NREMT also does not set the stanards. It only tests on the material from the US Department of Transportation National Standard Curriculum

68W trains for at least 16 weeks vs the civilian EMT which is about 3 weeks if you go to one of the civilian boot camps. Combat Medics can be trained to provide whatever is necessary in frontline combat or where they are needed. That includes not just starting an IV but doing a cutdown for venous access. It also can include inserting a chest tube. There would be little use for the equivalent of the civilian EMT in combat.

Corpsmen can also be trained for whatever needed. This includes anything from xrays, labs to pharmarcy. No civilian EMT is going to work in those areas.


They can still take the civilian equivalent training to be NREMT-I and P.
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Well How come you have Reserve and National Guard 68Wiskey Medics who are trained to the NREMT standards. Military EMS protocols would allow EMT-Bs to do IV and I have seen a AST in the US Coast Guard who is an NREMT do IV lines.
 
rwik123 said:
Line medics are trained to an EMT-B in whiskey school but have tons of interventions that are no where near the scope of emts in the civilian world. Don't go comparing the civilian and military world. They are two different beasts. Military are generally healthy young men dealing with traumatic injuries, and the medics protocols reflect this.

PJs and flight designated 68wFs are not basics, they are paramedics so that argument doesn't work either.

Edit: I'm not sure if flight designated medics are paramedics... But they def have more experience than the grunt ground medic and do not "follow the nremt standards"
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Here's the US Coast Guard's AST training
The 18-week AST 'A' School is followed by three weeks of emergency medical technician training at a training center in Petaluma, California
Link http://www.uscg.mil/hq/cg1/attc/training/ast.asp

Here's the US Coast Guard's EMT school
The EMT course is seven weeks long, and is meets or exceeds the requirements of the DOT and National Registry of Emergency Medical Technicians (NREMT) for certification and registration. EMT Recertification and Transition is a three day course which fulfills the core hours required for recertification, and also transitions the current EMT-Basic to the new NREMT standards.
http://www.uscg.mil/hq/cg1/TracenPetaluma/HS_School/EMS/default.asp

US Coast Guard's HS school
http://www.uscg.mil/hq/cg1/TracenPetaluma/HS_School/default.asp
 
Kavsuvb said:
Well How come you have Reserve and National Guard 68Wiskey Medics who are trained to the NREMT standards. Military EMS protocols would allow EMT-Bs to do IV and I have seen a AST in the US Coast Guard who is an NREMT do IV lines.
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NREMT is a test. It is not the standards.

There are liason schools to make civilian certifications available in the military.

The Combat Medic does not function with the scope of a civiliian EMT. Show me where an EMT can do a cutdown for a vein or insert a chest tube. Civilian Paramedics can not do that. The military exceeds that by far and in may ways. You can still test out to be an EMT-B once you enter civilian life. Centers that teach to the civilian US Department of Transportation National Standard Curriculum may give credit to the military trained person to help them gain a civilian cert. Your civilian cert will mean next to nothing if you want to be a Combat Paramedic or PJ.
 
JakeEMTP said:
NREMT is a test. It is not the standards.

There are liason schools to make civilian certifications available in the military.

The Combat Medic does not function with the scope of a civiliian EMT. Show me where an EMT can do a cutdown for a vein or insert a chest tube. Civilian Paramedics can not do that. The military exceeds that by far and in may ways. You can still test out to be an EMT-B once you enter civilian life. Centers that teach to the civilian US Department of Transportation National Standard Curriculum may give credit to the military trained person to help them gain a civilian cert. Your civilian cert will mean next to nothing if you want to be a Combat Paramedic or PJ.
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That would be an 18D Special forces medical Sergent. Here's what they get at the end of 8 month Special Forces medical school at Ft. Bragg, NC

SOCM (W1's) Credentials include:

EMT Basic
EMT Paramedic
ATLS
BTLS/PHTLS (Basic Trauma Life Support/Prehospital Trauma Life Support)
ACLS (Advanced Cardiac Life Support)
PALS (Pediatric Advanced Life Support)
SOCOM ATP (Advanced Tactical Practitioner)

Their are some SOCOM medics that do work as flight medics for the 160th SOAR.

Also US Air force, Air force reserve and Air National Guard Pararescue are paramedics who are trained to SOCOM medic standards.

Here's the link for the Air Force Pararescue training
http://www.specialtactics.com/paramedic.shtml

http://en.wikipedia.org/wiki/United_States_Air_Force_Pararescue

Here's a link to what the SOCOM ATP (Advanced Tactical Practitioner) entails
http://www.military-medical-technol...nced-tactical-practitioner-certification.html

http://www.jems.com/article/operations-protcols/advanced-tactical-practitioner

Also SOCOM ATP (Advanced Tactical Practitioner) is being consider as a template for what street paramedics will be doing 20 yrs down the road.
 
The links you have provided say exactly what we have been saying.
You can take the EMT-B and EMT-P test after completing some of the military training. But did you look at the prerequisites to get into some of the military programs and what military medical personnel who might have the label as medic or Paramedic do? No civilian Paramedic or EMT is going to make incisions, clamp bleeders, insert chest tubes and do some other very impressive intervention. The civilian EMT and Paramedic are very different from teh military. A civilian EMT or Paramedic must go through the military training. Think of it as saying the UK Paramedic is the same as the American Paramedic. Some things are similar but many are not.
 
As stated, I think you're misinterpreting the way the military trains its medical personnel. Yes, many of them do take the NREMT test, but that is no way the "end" of their training.

I was not aware that ASTs could start IVs, I though they were "just" EMT-Bs. I known that HS techs can, but those are two different positions, no?
 
EMT/IV Tech

In Maryland, Saint Mary's County, we do have an EMT-B (changing to EMT) IV Tech level certification, this is in part due to long transport times and is closely monitored by the County Medical Director. This certification is re-certified every six-months, AND there has to be a specific number of "sticks" over that six-month period. The MD reviews all cases during the QA meetings. If an IV is started specific reasons have to be detailed.
 
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tanner72 said:
In Maryland, Saint Mary's County, we do have an EMT-B (changing to EMT) IV Tech level certification, this is in part due to long transport times and is closely monitored by the County Medical Director. This certification is re-certified every six-months, AND there has to be a specific number of "sticks" over that six-month period. The MD reviews all cases during the QA meetings. If an IV is started specific reasons have to be detailed.
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How does an IV of NS help with "long transport times"?
 
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