Can first responder units start IV locks?

[Vicki Johnson]

: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?

[spenac]

In Texas medical director for service decides who can do what.

[paramedicmike]

You spoke with the wrong people. You need to speak with the State EMS office. They'll be better able to guide you through the questions you have. You should also follow up with your medical director and see what he thinks about this.

When you refer to "first responder units", do you mean people who respond to the scene in their POV? There may be regulations regarding this, too. If your station has any legal counsel on retainer it may be wise to discuss with them the liability involved. The State EMS office may be able to help with this, too.

Good luck!

-be safe

[Vicki Johnson]

Dang, I hope it is that easy in Kansas!

[JakeEMTP]

Welcome to EMT City Vicki.

As you know, it takes very little time to start an IV. I'm not sure what benefit would come from 1st responders starting them.

Do you function as a flight nurse under the medical director? I only ask because the flight service here has a different Medical director than the rest of us. If the former is true than I would think you could start one provided your Dept is designated as Medical 1st responders and not just Fire. ( just a thought, I don't know for sure ). Nurses here cannot function on an ambulance as a RN. They have to be certified at the appropriate EMT ( I hate the "T" thing )level to do so.

The alternative of course is to become EMS based fire suppression. Than you can function at the paramedic level. :wink:

[VentMedic]

Are IVs in the scope of practice for EMTs in your state? If not, then you would have to petition the state to change its scope or create another certification by skill only. Washington State is an example of that alphabet soup.

Your service may be unique in that ALS will follow shortly. However, many areas have only BLS and starting an IV may be of little use if no medications can be given. So, now you have a BLS service wasting more time at scene. Skills with only minimal education is not good either.

As far as your own credentials, are you working on that ambulance as a nurse or an EMT? That is the job description you follow. That ambulance or FD service may not be licensed in your state to provide more than BLS services.

Nurses can work in prehospital in some states with MICN or PHRN. Other than that they hold EMT or EMT-P and function under that certification and scope as determined by their state and in the job descripton designated by their employer for the services that ambulance or FD is licensed to provide.

So, check what an EMT is legally allowed to do in your state.

http://www.emsresponder.com/survey/KS.jsp

The other issue, if your medical director wanted to write protocols for you as an RN, you must ensure there are no conflicts with your nursing board and the protocols must designate this would be for an RN. Again, the way your service is licensed would play a factor. It could also open up a can of worms in the EMS world in your area.

And of course Texas is different.

[Vicki Johnson]

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.

[spenac]

Cost wise you might as well use a bag of normal saline. Plus what good is a lock on a trauma patient that needs fluid.

Since your responding POV please respond on my topic about that subject.

http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight=

[ccmedoc]

MFR--absolutely no

EMT-B----No

EMT-IV in some states---yes

EMT-I----Yep

In Most states I am aware of, If the Department of health determines that it is necessary to certify prehospital RN, then you can under this mandate, other than that, RN=in hospital or interfacility situations only..This as far as I have been told.

We have to have a prehospital license to practice prehospital.(ie. Paramedic).

Not sure what good a saline lock will do without the ability to administer meds through it?? :?

Kinda what VentMedic said, I guess.. :oops:

Critical hour??? Sounds like a TV show :?

[JPINFV]

Since nurses operate outside of the hospital (camp nurse, school nurse, doctor's office, etc) as well as in critical care transports, wouldn't it be possible for her departments medical director to write up some standing orders for her at the RN level? I know this is oversimplifying it a bit, but to a point I fail to see how standing orders would work for 1 provider and not another.