EMT-Bs and IV therapy

[mcdonl]

Until you can answer me the following, I am not allowing you to cannulate and infuse:

Fluid Balance
......

Homeostasis Regulation

Acid / Base Balance
.......

Trauma
.....

IV Cannulation and Complications
.....

Mr. Brown, you just summed up most of the Intermediate program -cardiology... And, in Maine 12 leads and IV's are about the only thing that separates a basic from an intermediate.

 

[MrBrown]

Mr. Brown, you just summed up most of the Intermediate program -cardiology... And, in Maine 12 leads and IV's are about the only thing that separates a basic from an intermediate.

Fantastic, doesn't pH, renin angiotensin aldosterone and K/Na+ just make you get all excited?

 

[mcdonl]

Fantastic, doesn't pH, renin angiotensin aldosterone and K/Na+ just make you get all excited?

It does indeed! I want a bumper sticker that says "My other car uses a k/Na+ pump!"

 

[Cohn]

Are you guys kidding me? I work for a rural department in southern Arizona and our base hospital UMC in Tucson allows EMT-Bs to take IV classes held by the hospital (clinic hours and what not also) and then (OMG!) they actually allow us to use our new skills OMG!!!! Because out here we get UDAs and they need fluids before a medic can get to us (usually 30 minutes to hours sometimes!)

I don't understand why you people are so against EMT-Bs giving IVs especially my rural vol. department does not have any medics.

 

[EMT11KDL]

I don't understand why you people are so against EMT-Bs giving IVs especially my rural vol. department does not have any medics.

its not that they are against it, its the fact the class is only 21 hours long. I am a basic and i had IV access when I was in Colorado, but starting out, i knew after my class and after my clinical sticks that i was still not ready to start iv's in the back of the bus. it more goes to liability issue. Personally, I dont see any problems with Basics having IV access, the problem i have is the class. I think they need to make the class longer... and go into more detail on the medications they are being authorized to use, and have an understanding why they are giving it to the patient

 

[Cohn]

Well we are only allowed Saline and Lactated Ringers and our class we need 15 (successful) sticks in the ER department.

 

[EMTSTUDENT25]

Cohn! i was starting think i was crazy. I wasnt trying to start a war, but wow...I definatly agree with you on this issue. If it wasnt safe for us to start lines as basics, then i would have to come to the conclusion that they would take it out of our curriculum. Do i think that we should have spent more time on IV Therapy, yes i do. Its a vital part of ems and can be done wrong. Considering some of the meds we are allowed to administer I would have liked to go into more detail about isotonic and crystaliod solutions, etc...More knowledge usually equals more confidence.

EMT11KDL - by liability are you refering to pushing wrong med/dosage?

 

[EMT11KDL]

Yes i am, i do not think that a 21 hour class is enough time to know which med and dosage should be pushed and also the rate it should be given at. That is why I think the class should be longer than 21 hours.

Also, in volly departments when there basics might see a handful of calls a month, how many of those calls truly need IV access and medication given to them via iv.

 

[Shishkabob]

Why do people equate putting a piece of plastic in to a vein and pushing 10cc of NS with allowing EMTs the ability to push meds?


Two separate things, so quit bunching them together.

 

[EMT11KDL]

Why do people equate putting a piece of plastic in to a vein and pushing 10cc of NS with allowing EMTs the ability to push meds?


Two separate things, so quit bunching them together.

Linuss if you read what I wrote,

I think they need to make the class longer... and go into more detail on the medications they are being authorized to use, and have an understanding why they are giving it to the patient

So I am not sure where you are seeing where it got bunched together

 

[medicRob]

Why do people equate putting a piece of plastic in to a vein and pushing 10cc of NS with allowing EMTs the ability to push meds?

EMT-IV in Tennessee can hang a non medicated drip, that's it. They can give a bolus of saline, administer D50, D5, etc but other than that this is it. The only real med push the EMT-IV is authorized to do is Subq and IM Epi in anaphylaxis.

(Weight / 2.2) * 0.01

cc x drop factor
---------------
time in min


not rocket science.

EMT-IV has 9 months of training and ample clinical time for this. Now, were the state of TN to lose their minds and allow them to push Versed, Morphine, or hang dopamine... there would be a fight, as the EMT-IV does not have the proper training behind them necessary to realize when it is appropriate to deviate from what a standing order says based on the patient's condition. There are alot of variables to consider and every patient is different. The EMT-B, EMT-IV are trained to follow protocols.. The Paramedic is trained to follow protocols and to understand the underlying mechanisms of a patient's condition as it relates to the intervention he/she is taking and to deviate from that protocol if the patient's
condition requires (within scope of practice of course)


In summation:

Having been an EMT-IV myself, I felt quite comfortable in starting IV's, maintaining them, and administering the few meds I was authorized to administer.

I do not feel however that the EMT-IV has the appropriate level of training to
push anything more than maybe narcan (which is being implemented in the state of TN with the beginning of the EMT-IV to Advanced bridge course in Fall 2011).

This is the EMT-IV skills manual for the state of TN. There have been several things added to the EMT-IV skill set since this document was published and the state director of EMS told me, personally that they are in the process of rewriting the entire thing to comply with the new national scope once they finish doing their gap analysis, etc for the new bridge courses.

http://health.state.tn.us/Downloads/EMS_Skills.pdf

 

[Cohn]

Yes i am, i do not think that a 21 hour class is enough time to know which med and dosage should be pushed and also the rate it should be given at. That is why I think the class should be longer than 21 hours.

Also, in volly departments when there basics might see a handful of calls a month, how many of those calls truly need IV access and medication given to them via iv.

We get a lot more then a handful a month, and since we are about 30 minutes from the boarder a large majority of UDAs need fluids ASAP especially during the summer months here. Also we don't push meds... We rehydrate them per our Hyperthermia standing order.

Edit: Oh and forgot to mention majority of the calls out here ARE ALS calls (where meds do need to be pushed.) You guys must be used to riding a EMT-B - Medic teams because when its down to EMT-B - EMT-B (or even EMT-B - First Responder) teams that we have out here there is not much we can do for most people, mostly package them up and try to help as much as we can.

 

[EMTSTUDENT25]

yeah, i mean, im am confident that i can start a line on most patients...In TN we, as far as i know, dont run dual emt rigs, so we are always paired with a medic and emt. We are trained to think that the medic runs almost every call and are soley responisble for everything that plays out. If we get a BLS call and they(medic) wants to let us run it, then so be it.

 

[EMTSTUDENT25]

medicrob to the rescue, didnt see your post until after i posted my last, well said.
Do other states have that different teaching criteria?

 

[Cohn]

yeah, i mean, im am confident that i can start a line on most patients...In TN we, as far as i know, dont run dual emt rigs, so we are always paired with a medic and emt. We are trained to think that the medic runs almost every call and are soley responisble for everything that plays out. If we get a BLS call and they(medic) wants to let us run it, then so be it.

And that is why I love the experience that I am getting from being on a EMT-B - EMT-B department I can be lead EMT on the worst of the worst and learn how to solve problems. I would hate it if I started out with a Medic - EMT-B department and ended up being a "ambulance driver" or a mule for the medic. Personally I think the stuff I am learning from my department will build me to be the best EMT I am capable of being.

 

[medicRob]

medicrob to the rescue, didnt see your post until after i posted my last, well said.
Do other states have that different teaching criteria?

This is one of the issues that EMS faces. In one state the EMT-B level is the EMT-IV while in another it is emt-B with IV, and another it is EMT-cc (I think), etc. The national model addressed this by presenting one set of levels for all emergency medical technicians in the US. States are asked to follow suit, however the time frame for the NREMT exams at these levels is around 2014. TN will be one of the states that goes into the initiative early, having announced that we will start licensing individuals at the EMT-Advanced level as early as Fall 2011 for EMT-IV and will begin the EMT-Advanced initial courses after that.

The national model calls for:

Emergency Medical Responder <--- Our now First Responder
EMT <--- Our current EMT-B
EMT-Advanced <--- Our current I/85
Paramedic <--- Our current Paramedic and i/99s who bridge.

South Carolina was allowing EMT-B to intubate at one point. The scope of practice is set by your individual state in adherance with national guidelines
and your individual medical director chooses which skills he wishes to authorize you to use in your service and which ones he is not comfortable with.

EMT-B varies across so many states. At last count, there were 47 different EMT titles.

I think the EMT-Advanced is going to come in handy in rural areas and in areas where services can't justify having paramedics on staff.

As far as TN goes, most of our trucks run: Medic/Medic, Medic/EMT-IV, however a lot of services still have BLS trucks that run EMT-IV/EMT-IV but remember, EMT-IV is technically not a B because this level is trained under the i/85 curriculum. This is why you see differences between lecture hours, clinicals, and scope with EMT-IV and EMT-B. Our current first responders here in TN have the scope of EMT-B, ever since Combitube and PTL were added. We can all argue over scope, etc. As a matter of fact, we do it in nursing all the time. After all, a BSN spends 4 years in school, and 2 years in clinicals in Trauma Centers, Nursing Homes, ICU, CCU, NICU, OB/GYN, ER, Med/Surg, etc, have to take Anatomy & Physiology I and I (full class, not survey), Pathophysiology, Pharmacology, English Composition, Chemistry, Fundamentals of Prof Speaking, etc. We could hold the argument that a paramedic shouldn't be allowed to perform any of their medical skills before having all these courses and all this time in clinicals, but we don't. Every one has their place in the continuation of care. I think a lot of the Paramedics here would change their mind about EMT-B and IV's if they had the chance to ride along with a TN EMT-IV. Once again, please note I am not saying that an EMT-B should be pushing meds like valium, versed, etc. IV Therapy & Med Admin are two different ballgames.

 

[Hal9000]

EMT-B and IO Therapy

Thoughts on EMT-B's performing IOs? I know it happens unsupervised in some areas. (Meaning sans ALS presence.)

 

[lightsandsirens5]

Linuss if you read what I wrote,



So I am not sure where you are seeing where it got bunched together

I think what is getting bunched together is that people think the just because a basic has an IV attachment to their cert, they can now do Intermediate drugs. In WA state at least, after a class (30 hrs I think) I basic can become an IV tech. Than means the can start lines ans flow NS under Med. Cont'l (at least in my county). No fluid w/o med cont'l, no drugs whatsoever other than already approved basic drugs, no IO.

That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.

 

[Shishkabob]

That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.

Ta-da.


I'm totally for EMTs sticking someone and pushing 10ccs of Saline to flush it. There isn't much you can screw up there....

 

[Lifeguards For Life]

That is what is getting bunched together. I think 30 hours is plenty to learn how to stick someone, call the hospital, and ask to flow NS. If they were givng drugs, then no, 30 hours is nowhere near enough.

I don't think paramedics receive as much training on IV or drug admin as people like to think.