Any IV training in East Bay?

[Lugiahua]

I was trained as an EMT-B, with ACLS, TCCC, and PHTLS capacity.
We were taught to start IV in the class, but since I never work as EMT as a career, my IV skills are getting rusty.

I would like to know if there is any IV class in the East Bay area, that does not require me to be a current RN/Paramedic?

[themood]

Nope. If you aren't a doctor you need to be working under a physicians license-nurse, medic, etc. Just curious, why are you looking for this?

[SloChicken]

yeah, that is not going to happen.

I would be curious what instructor would teach an emt-b IV skills. That would be treading on some pretty thin ice, and certainly not in the curriculum (as this is outside an emt's scope of practice.
For that matter, (depending on your county's scope) emt's usually can only turn off normal saline that is already running. No starting, no adjusting. Nada ...

Not to step on you, but often I work with some emt's that want to be 3 month medics, or RNs.
Not trying to step on you, but I see all too many emt's that are trying to be RNs or Paramedics without doing the work (and earned knowledge/experience) that goes along with starting that line you are talking about.

Like it tell the emt's, and sometimes patients.
2 minutes to start the line. 10 years to know why and when.

Further, ACLS is useless to a EMT-B as they cannot administer drugs, nor intubate, nor defibrillate (except with an AED). Good CPR should be your focus.

What is TCCC ??? Do you mean TNCC ???

[jocww]

Supposedly EMTBs can soon start lines with locks. I sorta like this idea as I can roll up and prep my drugs tubes etc. and do other things while they play monkey. But this has not happened yet at least not in S.F. where I work, they just got the ok to pulse ox and are fighting to do BGL.

I work NCTI and we do teach ACLS to EMTs as its nice for them to know the flow charts. But we do not teach IV skills. You can do it at fast response if you want to be a flow bot

[SloChicken]

I know emt's are allowed in ACLS, but I never saw the point. Frankly, I appreciate the enthusiasm, but sometimes it muddies what their actual job role is and it is a little aggravating when I roll with emt's that are looking at artifact, calling it a dysrhythmia and freakin' my patient out.
Further, and back to the point.
If you are starting a line, you are also introducing a drug; just a saline flush, but still this is crossing into territory where emt's simply do not have the knowledge base to enter.

Not trying to be a dick, but the fact that I start lines, make clinical decisions and perform interventions as indicated and per my clinical judgment does not come overnight.

I was an EMT-B, EMT-I, EMT-P (wilderness cert), Civilian Contractor, and Ski Patroller, and now for some 10 years a CCRN, now doing transport I would suggest I have walked the path.

I can tell you this, it is nice to have a line started, but I would just as soon do it myself so I know the access has not gotten jacked by misses or blown veins on bad attempts.

As far as even running simple saline, there are many contraindications to even giving fluids. And even if they are clinically justified, does an emt know how much to give, how fast, and why?
(examples: Parkland formula?; Pediatric Trauma fluid resuscitation protocol?; CHF history?; Renal Failure?, etc?)
So, you should know, and I do know, why or why not, how much, and how fast.

An EMT?
Not so much.

Last thing I need is some cowboy EMT throwing my CHF pt in rapid Afib into flash pulmonary edema because they thought they would chase a fast heart rate with a fluid bolus ...

Hypothetically speaking, of course.

See where I am going with this?

[Lugiahua]

I understand your concern, but I am looking into this only to enhance my knowledge, nothing else, not trying to break law or scope of practice.
Not currently even working as EMT anyway.

While it is true that EMT-B cannot start IV in California, it is not so in the rest of the country or outside US.
A number of states allow their EMT-B or equivalent to use IV therapy. I know at least Colorado, Montana and Tennessee do this.

How is ACLS useless for EMT-B? Many new AED models now have Lead-II ECG attached, ability to interpret them could make difference in patient outcome.


TCCC stands for Tactical Combat Casualty Care, it's developed from PHTLS, sponsored by NAEMT.

http://www.naemt.org/education/TCCC/tccc.aspx

Forgot to mention, but I also went through the Combat Life Saver/EMT-Tactical(as called by NPS and other Fed agency) course in the past. It was this course that first taught me IV/IO, not the California EMT-B course.

[jocww]

SLo they aren't allowed to push more than a flush, they can only lock if memory serves me right. Ive been in the field for about 7 years, and while there are some dumb EMT-Bs there are some equally as dumb Ps as well. Unlike some in our field, to me EMT-B does not equate to Empty My Trash *****, just as Paramedic doesn't equate to passenger. If I trust my EMT partner I let them do my assessment, hx. And I need them to do that so that way I can sit back and manage the situation instead of up to my elbows doing everything myself.

Yes I agree I like to know that I have good flash and and good access, but if I have burns and a ALS rig is 10 min out, but there is a BLS engine with a drill, IO my butt and give me fluids or stick me and at least try.

With saying that I believe that CA should have Intermediates again. Where they can combi, IV, and push a limited amount of drugs, and let Basics be gophers, drivers, etc. The extra time in class does a lot. So if I could have my way I would keep Basics on the basic level and let Intermediates do a lot more which is what most states allow.

Lug, I didn't know the new AEDs have lead2. But Lug what good does 1 lead tell you? Since your ACLS does 1 lead tell all?

[Lugiahua]

Not much, since you can't really confirm STEMI or heart blocks without a 5 or 12 lead. But I can see it being useful to tell apart cardiac arrest rhythms and provide some information for incoming paramedic.

[diveRN]

Regarding IV skills, good luck with that. Prolly not going to happen because even in a training environment, IV starts are currently out of the scope of a B's practice and no training company's insurance that's worth a damn is going to cover the instruction time. Hit a nerve or nick an artery and cause a significant hematoma and the person it happened to will own the training institution. Have seen these injuries happen more than once.

ACLS is good for EMT-Bs though - having knowledge of life-threatening rhythms, protocols, and rationale will never hurt a pre-hospital team. Every EMT-B working on an ACLS bus SHOULD have the training.

I won't ever dismiss any advanced medical training, but IMO, TNCC is kind of a waste for a B unless working in an ER somewhere as a tech, but even then... there'll be significant limits on many of the TNCC protocols you'll be able to do.

[jocww]

Never heard of a 5 lead. I can see them on a 4 lead. The only rhythms you can tell are asystole, vfib, vtach, sinus tach, sinus brady on a 2 lead. maybe heart blocks if its on tape. But I can tell a lot of that by feeling for a pulse as well.

If you want training, Id say go to fast response for your flow bot. Or you can go practice on a orange peel, straw, or on the casings of the iv caths. I use to do that

[Lugiahua]

I know Fast Response, got my both BLS/ACLS card from them.

[jocww]

Then the only other option is to go volunteer somewhere gain somebodys (RN, MD, etc.) trust and see if they will let you stick people on rotation.

[RobG]

Maybe a phlebotomy class? IV skills are perishable. If you aren't doing it often, you are not going to be proficient.

[Lugiahua]

I will consider that too. I know there are 36 hours IV therapy classes for LVN, just don't know if they will let me to attend it for the above liability reasons mentioned diveRN.

BTW, since we were discussing about training level and scope of practice.
When I was in Yosemite for a college class years ago, I was told by the Park Rangers and Educational Guides that some of them carry IV sets in their vehicle/pack. But they were only WEMR trained, how did that work out? Maybe I was confused?

[jocww]

When did LVNs start doing IVs?