Can first responder units start IV locks?

[vs-eh?]

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.

What is an "insulin reaction"? "Slamming in the meds"?

You are an ER/CCU nurse and just used this terminology? Hmm....

[VentMedic]

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.

Camp and school nurses administer medications already prescribed to the students. They assess and call EMS.

Physicians' offices and clinics are under direct supervision of physicians. They may not be required to maintain a code cart or keep a large variety of emergency medications so they also assess and call EMS.

Is her service licensed by her state to do more than an EMT scope? Would they have to upgrade to a higher classification of service? Would their service have to maintain a higher insurance for liability?

And, that doesn't include the questions the nursing board will ask? They don't want RNs doing something against their license just because "a doctor says so". The same is true inside the hospital. That is why it sometimes takes months to get P&Ps written by physicians approved. RSI and conscious sedation are two examples that take serious review before policy is made. The nursing board is there to protect the nurse and the public.

When you have dual credentials, you will have these gray areas. If licensed as an RN, one will always be a nurse but must play by the rules that govern the current job description and certification/license.

[tinman694]

agreed with VS--

and NS Flushes ARE prescription meds...read the packaging---

Most anything having to do with an invasive procedure (such as performing IV cannulation) requires physician oversight---that's US Federal law.

(cannot quote exact one at the moment--but it is true)

If this is something you are pursuing, you should consult the EMS board of the state you are in and get an ALS license. Then if you are appropriately staffed, this would become a non issue.

hmmmm........

[Vicki Johnson]

: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!

[VentMedic]

Vicki,

I've gotta ask this since it has been discussed a hundred times in my home state.

Are you saying RNs without EMT-I and/or RNs with EMT-I can start IVs?

In other words, is it okay for an RN without prehospital credentials to do scene response and treat in your state?

[strippel]

Darn, they are nice in Kansas.

In PA, you'd need to fully stock (by state standards--12 lead monitor with capnography, drugs and fluids) and provide a list of providers able to provide 24 hour coverage, and then apply for an ALS license. Then they would inspect your vehicle before allowing the license.

[Vicki Johnson]

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.

[ccmedoc]

I, personally, think this whole thing is a bit ridiculous. :shock:

[co_student_87]

All-

Please bear in mind, I am a new nursing student and am wondering the benefits of starting an IV lock. Yes I know what an IV lock is, and I do not see what benefit that would provide for the patient besides an increased risk of infection. I do, in a small way, understand if you have a paramedic unit a few minutes away and the patient will need immediate drugs. Even in a scenario such as that, it does not take that long to start an IV.

On another note, as Viki stated "I promise that anyone starting IV's will be experienced at it." Will you be doing the training for the department to ensure that everyone starting an IV will be experienced? In my understanding, when a protocol is written up and approved it is for the general membership of a department, not for specific people. Therefore, if you get a protocol approved for your RN's and EMT-I's to start IV locks, then everyone covered by that protocol will be allowed to perform that skill. Since you have promised to make certain that everyone who starts the IV will be experienced, I certainly hope you understand what you are getting your self into.

It is also my understanding that EMT-I's (87 and 99) are allowed to start IV's peripherally, so I am not sure how they are being incorporated into your protocol. Unless your state varies in that sense.

I apologize for the edit of this post, but it was only after I re-read some of the previous posts that I decided to add to my message. Again, I apologize.

---I am a student and my comments and replies should be taken as such and not that of a practicing medical provider. My words and thoughts are my own and do not reflect the views or opinions of the educational institute I am associated with nor that of my fire department.---

[JPINFV]

All-

Please bear in mind, I am a new nursing student and am wondering the benefits of starting an IV lock. Yes I know what an IV lock is, and I do not see what benefit that would provide for the patient besides an increased risk of infection.

Well, saline locks are useful for administering medications, which it doesn't look that the OP will be doing given the post. Umm, not really much besides that, hence the EMS tongue-in-cheek term "magic IV of life."