EMT-Bs and IV therapy

[ILemt]

So how much did this course cost to take?

 

[daedalus]

I would love the opportunity to take such a course. If not only to be able to start IV in the ER.

 

[Blacke00]

Found a good source (I think it's current):

http://en.wikipedia.org/wiki/Emergen...-_Intermediate



Quote:
Tennessee EMTs are licensed at either the EMT-IV (Intravenous Therapy) Level or the EMT-Paramedic Level. EMT-IVs are trained to the NREMT-B standard in accordance with DOT regulations, as well as receive additional training in advanced airway management, administration of Epinephrine 1:1000 in Anaphylaxis, administration of nebulized and aerosolized Beta-2 Agonists such as Xopenex and Albuterol, administration of D50W and D25W, IV Therapy and Access, and trauma life support including the use of MAST Trousers. EMT-IVs can also administer nitroglycerine and aspirin in the event of cardiac emergencies, and can give Glucagon. EMT-IVs can also administer the Mark 1 Autoinjector kit for Organophospate poisoning and suspected nerve gas exposure. The State of TN Board of EMS is currently evaluating allowing EMT-IVs to administer NARCAN and Nitrous Oxide, as well. The Board is also considering going to an Emergency Medical Responder, EMT-B, EMT-Advanced, and EMT-P format and eliminating the EMT-IV rank.

That's more than I would have expected for what would be an EMT-B anywhere else, right?

Posted this on the "scope of practice" thread...

 

[Ridryder911]

Perhaps I should clarify Mr. Rid, children or adults (not neonates) with small veins,. My point was and is, you can admin D50W through a 20g.

Gottcha... Just wanna clarify for those that are learning. The same myth that RBC's cannot be administered through 24g IV's. Yes, it may damage if the blood volume is many and needs to administered fast, but how do you think they administer blood to neonates or than central or umbilical lines?

R/r 911

 

[emtlady76877]

EMT-B starting IVs

I'm a EMT-B/paramedic student however I volunteer for a rurual ems that just started the protacol that EMT-Bs are going to be able to start IVs after being trained but can not push drugs or d50. However, I still have to be tested out from on our ems even though I learned it at college, which I have no problem with.

 

[bstone]

I believe that if EMT-Bs want to start IVs they should take a 140 hour course to become an EMT-Intermediate. That's what I did. It's another semester long and you learn the right way the hows and whys the IV therapy. Also you learn 3-lead EKG, some rhythms, what they mean, etc and (in some areas) endotracheal intubation. Other than that, I cannot see any way or reason how Basics can learn how to do IV therapy appropriately or properly.

 

[Ridryder911]

There are only two purposes for prehospital IV therapy. Administering fluids (hypovolemia)and IV medication. If you cannot perform either one of those, then there is NO reason.

If you have NOT received an in-depth course of fluids and electrolytes as well, there is NO reason for you to administer fluids. The IV meds is a gimmee... if you cannot interpret ECG's and have not had a in-depth pharmacology course, then there is no reason for an IV for medication.

Remember, we should be able to justify any procedure we perform. Basics are not able to justify this.

Skills are not "something" that one should be able to do. There is severe and even life threatening consequences and dangers of IV therapy that many are not aware of.

Again, if you want to do Paramedic procedures... then become a Paramedic.

 

[bstone]

Again, if you want to do Paramedic procedures... then become a Paramedic.

Or an Intermediate....to do Intermediate procedures.

 

[apagea99]

I'll be taking my course here in middle TN. I selected it on the advice of my county's EMS director who said he considers it the best in the state. It's 213 hours + labs and such and will include everything in Blacke00's post. Is 213 hours enough to learn the EMT-B skills as well as IV maintenance? For an EMT student in TN there really isn't another option for learning the skills required by the state. I know there are other programs, but eventually you have to learn IVs here in order to get your license.

 

[BossyCow]

We start an IV while enroute to meet up with ALS. The veins might not be there, or the pt too combative to sucessfully start one 15 - 30 minutes later when ALS is on scene.

 

[IrishMedic]

I have to agree with a lot of people on thread, good luck and respect for planning to further yourself in this field, but i have to say there is a reason EMT-I, Paramedic courses are long and thats because we have a responsibility to the people we vow to save..we have a responsibility to get the best training and understand exactly why we do what we do....it all come back to understanding and justifying everything we do with a patient. Unless your course extensively teaches you about pharm and Med Admin, IV Therapy etc, and you have a lot of experience sticking the tough patients, i'd search for a better course. you owe to yourself and patients, i mean on my course we had to get over 100 - 150 successful sticks before we were signed off on being proficient on doing them. we had verbally give our preceptors the indications, contra indications, side effects, routes, doses and other pertinent info before we were allowed to adminster the med...a lot of work but im happy i did it, i feel very confident now as a medic because of this training. good luck

 

[mcdonl]

I believe that if EMT-Bs want to start IVs they should take a 140 hour course to become an EMT-Intermediate. That's what I did.

Me too... thats what I am doing.

 

[EMT11KDL]

Out here in Colorado EMT-Bs can take a quick and dirty course (mine was about 24 hours lecture with an 8-16 hour clinical rotation, some are shorter) to get "IV approval" allowing them to start peripheral IVs and administer crystalloids such as normal saline and lactated ringer's as well as D50 and Narcan (curriculum teaches intranasal admin but medical directors may allow for IV narcan admin).

Any opinions on this? I just completed the course but still need to do my clinical rotation. I've gotten 5 or so successful sticks on other students in class, but I'm pretty nervous to stick a patient.

i believe also in the new rule 500, basics can also do front line cardiac and something else if an I or P is on board and tells them to push it. Its been awhile since i worked in CO (about 2 years)

 

[medicRob]

Tennessee has EMT-IV as the minimum level, we spent 2 full college semesters in class + clinicals. Our EMT-IVs do a great job! I have absolutely no problem with it.

 

[MrBrown]

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

Fluid Balance
• Define the boundaries of each of the three fluid compartments and state the proportional volumes typically found in each

• Define the terms: electrolytes, ions, cations, anions. Give examples of each found in the body, and state their physiological functions. (half page)

• Define the term non-electrolyte and give three examples

• Give a brief explanation of the following electrolyte disorders. Include signs and symptoms that may manifest as a result of these.
o Hyponatremia
o Hypernatremia
o Hypokalemia
o Hyperkalemia

• Explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law.

• Define the following terms and explain the role each process plays in human fluid dynamics.
o Diffusion
o Osmosis
o Active Transport
o Facilitated Diffusion

• Define the following terms
o Shock
o Perfusion
o Inotropic
o Chronotropic
o Pulse Pressure
o Mean arterial pressure (MAP)

• Explain these complications of irreversible shock and how we may pre• vent and help treat them.
o Renal Failure
o Acute Respiratory Distress Syndrome (ARDS)
o Disseminated Intravascular Coagulation (IDC)

• Describe the pathophysiology, common presentation and briefly outline the management of distributive, cardiogenic and hypovolaemic shiock

• Discuss the differences between how children and adults (particularly the aged) maintain and respond to blood pressure changes

• Provide a definition of the peripheral resistance and stroke volume

• What factors about a blood vessel determine its peripheral resistance?

• During exercise stroke volume will increase. How is that achieved?

• Explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock.

• Blood transports a number of substances around the body. What are those substances and how are they transported in the blood

• Pulse Oxymetry measures the oxygenation of the blood flowing through the capillary beds and peripheral tissues. Explain how this concept works and when the use of pulse oxymetry is not indicated and why?

• Define isotonicity, hypertonicity and hypotonicitiy

List the constituent of various IV fluids and there respective tonicity.
o normal saline
o 0.45% NaCl
o 5% Dextrose
o Hartmanns

Homeostasis Regulation

• Explain the Renin-angiotensin pathway and explain how homeostasis of blood pressure and volume is maintained.

• Describe how the kidneys regulate the excretion of water in urine, and the role of the hormones ADH, and Aldosterone

Acid / Base Balance

• What is the normal pH range of body fluids?

• Define the term buffer system and list the 3 major buffer systems involved in acid / base balance

• Briefly describe the renal and respiratory compensatory mechanisms of acid/base balance

• A person presents with hyperventilation syndrome, classic signs of carpopedal spasm, peri-oral parasthesia. Explain the physiology that results in these signs and symptoms.

Trauma

• Explain the difference between blunt trauma and penetrating trauma, the difference in the types of injuries commonly encountered and their MOI (mechanism of injury) and the difference in the management of shock occuring as a result of each.

• Describe causes of shock, other than hypovolaemia, in trauma patients, and how to recognize and manage them.
o Tension pneumothorax
o Myocardial contusion
o Acute Myocardial Infarction
o Spinal injury

• Explain the shock management of this patient (on your 20min ride to hospital) with this head injury?
o B.P - 80/30
o Pulse – 128
o Resps – 28
o GCS - 13

IV Cannulation and Complications

• Indicate the anatomical location of common cannulation sites

• Discuss and explain factors that influence choice of vein for cannulation

• Intravenous cannulas are colour coded. List the colour, gauge and flow ware of various sized IV cannulas.

• Define ‘aseptic technique’ and explain universal safety measures taken while cannulating.

• Describe and discuss the concept of ‘informed and implied consent’.

• When gaining informed consent. List the information that you would inform the patient. (6234 – P.C 3.4)

• Prior to the administration of I.V fluids to a patient what checks should you perform? (6231 – P.C 4.4)

• State the clinical procedure for administering IV fluids to the shocked patient.

• List the signs and symptoms of the three IV complications below.
o Infiltration
o Phlebitis
o Extravasation

• For the following complications of IV cannulation describe the signs and symptoms and management of each.
o Fluid Overload
o Air Embolism
o Catheter Shear

 

[mgr22]

MrBrown, if a score of 100% is required, I think you just ruled out most of the medics in the U.S.

 

[MrBrown]

MrBrown, if a score of 100% is required, I think you just ruled out most of the medics in the U.S.

Those are a sampling of questions from the Ambulance Paramedic intravenous therapy theory assignments.

Yes, you have to be classed as "competent" on each one in order to move on to the practical part of the module, and no it's not that bloody hard!

After all, Brown stumbled his way through it

Seriously, it is something I would expect a first year Student Paramedic would be able to answer.

 

[mgr22]

Those are a sampling of questions from the Ambulance Paramedic intravenous therapy theory assignments.

Yes, you have to be classed as "competent" on each one in order to move on to the practical part of the module, and no it's not that bloody hard!

After all, Brown stumbled his way through it

Seriously, it is something I would expect a first year Student Paramedic would be able to answer.

I'm not disagreeing about the way things should be. I'm talking about reality in the U.S.

There's probably a better chance that a paramedic student could answer some of your questions than a seasoned medic, unless the medic just completed a refresher (even then it's questionable).

 

[Shishkabob]

Shoot, I knew all that theory stuff back in school, now it's just "poke and push"

 

[Jinkx]

We start an IV while enroute to meet up with ALS. The veins might not be there, or the pt too combative to sucessfully start one 15 - 30 minutes later when ALS is on scene.

I have to agree with a lot of people on thread, good luck and respect for planning to further yourself in this field, but i have to say there is a reason EMT-I, Paramedic courses are long and thats because we have a responsibility to the people we vow to save..we have a responsibility to get the best training and understand exactly why we do what we do....it all come back to understanding and justifying everything we do with a patient. Unless your course extensively teaches you about pharm and Med Admin, IV Therapy etc, and you have a lot of experience sticking the tough patients, i'd search for a better course. you owe to yourself and patients, i mean on my course we had to get over 100 - 150 successful sticks before we were signed off on being proficient on doing them. we had verbally give our preceptors the indications, contra indications, side effects, routes, doses and other pertinent info before we were allowed to adminster the med...a lot of work but im happy i did it, i feel very confident now as a medic because of this training. good luck

I couldnt agree more. However, your medical director can sign you off on this skill. As with any skill practice makes it easier. As always, take advantage of any opportunity to advance your clinical and or educational experience. I dont know about other states but practicing a skill outside of your certification or a Med direc sign off even in the presence of a higher cert is not just frowned on but can and will most likely result in immediate decertification. If in doubt call the state.

Good luck.