Vicki Johnson

Hey, this is about patient care! I was challenged to look into what it would take for our department to start IVs and that is what I did. If you all think the idea is"procedure crazy"and "terrible" then what would the ALS providers that we respond with think. I have been on the fire dept for 15 years and worked in ER for eight years. These ALS providers are my friends. We have a good working relationship with them through the EMS system also. The way I see it, the risk of interferring with that relationship may outweigh the benifit of starting a saline lock. Oh by the way, we had a total of 118 runs last year. We usually average about 50 fire calls so the rest would have been medical related. We have probably been debating over the possiblity of starting 10 IVs per year! :roll: Thanks for all your input!

Really!? So what are your suggestions for rural America? I just talked with a MICT friend who volunteers for a rural BLS/ALS ambulance service. He is the only MICT on the service and gets $1.00/hr to be on call and said the average person gets $10.00 a run. Keep in mind that run could be a simple run to the hospital that may last one hour or a fire standby that may last several hours. You know better than I do the time and money that is involved in running an ambulance service. After he puts in the hours at his full time ALS service he gets to spend his spare time "going to meetings." for the volunteer service. It consumes his life. So lets hear it. Any of you have any ideas on how to draw MICTs to rural areas to volunteer for this lifestyle? As for my local fire department providing an ALS (or even BLS)ambulance, I just don't see it happening. We have two paid ALS ambulance services within 15 minutes, one volunteer BLS/ALS seven miles away and another 15 miles. We watch the volunteers struggle to keep enough staff around to provide their service. Some volunteer ambulance services have to have fund raisers just to keep their department going. We have a good thing going at our department and will continue to keep that going. In the meantime we will continue to look for ways to improve our care.

WOW, did I ever submit a productive forum with my one little question! :wink: I have learned several things from this experience. One is that the practices and regulations in the Emergency Services System vary greatly from state to state. Another is there is a lack of knowledge regarding rural medicine. Even though I have since received the answer to my question I would to respond to a couple of comments made. Two of our dual responding ambulance services are BLS/ALS providers. These are volunteer services that provide the care pending the staff that are assigned to call. This is not an uncommon practice in rural area. Are you saying that just because a small community can not provide around the clock ALS providers then they should not be allowed to use the ones they can provide? Our volunteer fire dept has approximately 28 members. All are BLS certified and about 12 of us are either certified first responders or EMTs. We have no on call time or anyone staffed at the station. When the pager goes off, if you are available you go. I respond to medical runs as a certified EMT. We have a rescue unit that does not transport patients. When we are dispatched the nearest ambulance unit is also dispatched. On a typical code blue we will provide the highest level of care that available from thoses responding. I am not aware of any code blues or MVC/trauma situations where an EMT has not responded. But when it does happen and it will, the level of care will drop to that appropriate to the responders certification. And we do more than chest compressions and ventilation. We use our AED, place a combitube, check blood sugars...just like a certified EMTs on a BLS ambulance unit would do. We average 4-7 medically trained responders to theses runs. We have times when there is more than enough help needed for the situation. This is when we could place a saline lock or even place a lock and start NS for trauma patients, if the qualified personal were available. I do not see intravenous cannulation as an advanced skill for an RN or EMT-I. Advanced skills are retrograde intubation, RSI, chest decompression...

A representative form the Kansas State Board of EMS said that I needed to get a protocol signed by our medical director that would allow an RN, or EMT-I, (and I will probably through in EMICT even though we have no EMICT volunteers at this time) to start an IV lock. And yes the RN does not have to have pre-hospital experience. Now before you all get your feathers ruffled, even if we are in poe-dunk Kansas, we do use a little common sense when it comes to allowing any Billy Bob on our fire department. There will be no new grad RN or newly certified EMT-I blowing every potential IV site for the ALS unit. I promise that anyone starting IV's will be experienced at it. Probably 99% of our firefighters who respond to medical runs are first responders or EMTs. The person I spoke with from the Kansas board of EMS was impressed that a volunteer fire department such as our has a medical director and protocols in place. He said there are many out there who do not. We work hard at providing the best care possible to our neighbors, family and friends and take pride in what we do. I am proud to be a vounteer fire fighter/EMT for our district. It is the most rewarding thing I do.

:toothy4: Hey, just talked with a gentleman from the Kansas Board of EMS and got good news. All we have to do is have our medical director approve a policy allowing EMT-I and RN's to start IV's and we are good to go. I can't believe it is that simple! Thanks all for the suggestions and positive input! It has been an interesting afternoon. Now I believe it is time for this RN/EMT to, as we say in Kansas, "Get the hell out of Dodge". But before I go I just want to remind all of you that it doesn't matter what letters fall behind our name as long as we all stay focused on one thing. And that would working together to give the best care possible to our patients!

I am not so sure what responding to a scene per private vehicle has to do with my question but I will try to answer your questions the best I can. Yes, many rural firefighters live in the county and respond to the scene per private vehicle. No, we do not use lights and sirens on our personal vehicles. When we respond we follow routine traffic rules, no acceptions! The way I understand it lights and sirens do not give you the right away even when we are responding in the rescue units or fire trucks. As far as insurance goes I have no idea if we are required to let them know that we are volunteers and occasonally respond to the scene per private vehicle. Ninety percent of Kansas firefighters are volunteer and it is not uncommon to have private vehicles responding to rural emergencies. I will follow up on the insurance thing though. By the way, are you a city boy?

I am an EMT for a volunteer fire department and 80-90% of our calls are medical related. The nearest ALS ambulance service co-responds with all of our calls as we do not transport patients. They usually are on the scene in 12-15 minutes. We usually assess the patient, tx life threatening sx, start O2, put the patient on a cardiac monitor, obtain VS, and get the pt's Hx and bag up the meds and package the pt for transport (you know the routine). We have a good response to our medical runs and usually have plenty of first responders and EMTs present. There are situations when we have time to get an IV access so when EMS walks in all they would have to do is start slamming the meds. This would be extremely helpful in insulin reactions, codes and multiple trauma patients. I am waiting for a call back from the board of EMS. (I followed paramedic Mikes suggestion) Your input is helpful as I have never heard of MICN or PHRNs. In Kansas we have EMT-I's who I believe are allowed to start and give some IV meds. We really are not interested in carrying medications. Hopefully saline flushes won't fall into the medication catagory. I am a big advocate in getting our patients the best of care possible in their critical hour. I am willing to do anything we can do speed up that process.

Dang, I hope it is that easy in Kansas!

:newb: I am a EMT/Volunteer fire fighter in rural Kansas. I also am a flight nurse and ER/CCU nurse. For years I have been the only EMT/RN on the fire department. Recently an EMT-I joined our department and soon another EMT will be an RN. One of my firefighting brothers challenged us to find out what it would take to be able to start IV's prior to EMS arrival now that we have three people who could do it. I am concerned about regulations. Are first responder units allowed to carry the supplies needed to start IV locks? If so our next challenge would be to have our medical director approve a policy to allow us to do so. Then we will need to find out if starting IV's in the field is included in the scope of practice for RN's. I have attempted to get an answer regarding IV starts in the field from the state Board of Nursing and had little success. Not many RN's work in the pre-hospital field. Another alternative would be to certified as an EMT I or EMICT. We talked briefly with our medical chief and he incouraged us to research the subject and bring back what we find to him. I am waiting for a call back from an EMS instructor from a local college for suggestions. While searching the web for RN to Paramedic info I ran EMT City and thought you all would have good input on how to get started. What do you think? Is this challenge even possible?