EMTs are now authorized to obtain blood samples on DWI stops

[Doczilla]

This may not be as bad a thing as many are making it out to be. The law specifies what level of certification may draw the blood, not what service does so. The EMT drawing the blood may be the officer himself, a contract or full time employee of the police department, a jail employee, or the EMT at triage in the ER. While I'm sure that some departments would interpret this as we fear and tone out ambulances for it, a meeting between the EMS chief and police chief should straighten that out. I think this law will expedite the obtaining of blood samples on suspected drunk drivers.

Not much training is required above the typical phlebotomy training. As far as chain of custody goes, that would depend on who's drawing the blood. We do plenty of exams and collect evidence in the hospital and maintain CoC with minimal training, largely because the officer is right there to receive the evidence from us. For most of these cases, I forsee the officer being present for the blood draw and logging it himself as evidence. In large jail systems, it may be worthwhile to have a full time EMT employee drawing the blood and processing it as another jail employee might log evidence collected among personal belongings.

Alternatively, you could send the supervisor in the fly car to meet the cop and perform the draw. Or the officer could stop by the nearest fire station and get it done. This takes only one person and usually doesn't take a medic out of service. In these FDs that are trying to increase call volume, this is an easy way to do it with minimal personnel and expense and minimal liability exposure.

'zilla

[ccmedoc]

This may not be as bad a thing as many are making it out to be. The law specifies what level of certification may draw the blood, not what service does so. The EMT drawing the blood may be the officer himself, a contract or full time employee of the police department, a jail employee, or the EMT at triage in the ER. While I'm sure that some departments would interpret this as we fear and tone out ambulances for it, a meeting between the EMS chief and police chief should straighten that out. I think this law will expedite the obtaining of blood samples on suspected drunk drivers.

Not much training is required above the typical phlebotomy training. As far as chain of custody goes, that would depend on who's drawing the blood. We do plenty of exams and collect evidence in the hospital and maintain CoC with minimal training, largely because the officer is right there to receive the evidence from us. For most of these cases, I forsee the officer being present for the blood draw and logging it himself as evidence. In large jail systems, it may be worthwhile to have a full time EMT employee drawing the blood and processing it as another jail employee might log evidence collected among personal belongings.

Alternatively, you could send the supervisor in the fly car to meet the cop and perform the draw. Or the officer could stop by the nearest fire station and get it done. This takes only one person and usually doesn't take a medic out of service. In these FDs that are trying to increase call volume, this is an easy way to do it with minimal personnel and expense and minimal liability exposure.

'zilla

I 100% agree. I have not heard a compelling argument to the contrary. Simply not wanting to do it is not an effective argument. There are benefits to the on scene or at the station draws. There are not many realistic drawbacks.

I have seen and I am sure you have to seen an infected IV site, an infected injection site and the like. So don't lecture me on the fact that it won't happen. It does.

There are many IV starts in the field that are initiated for no other reason than because they can be. I would wager that the chance of infection from a simple venipuncture blood draw is much less than placing a catheter in one's arm for extended time. Again, I say, if the infection is a consistent problem, then there are much larger problems here than having to do the draw to begin with.

It is income generation, it helps keep the flow from the ED, it helps the law with deterrence, and it does not paint EMS as anything other than community minded..Protocols are easy to put into place with the right system. This also is a non-issue.

As a matter of fact, will you have protocols that will address this issue? Will you have protocols that cover your butt with your medical director's butt as a umbrella when you cannot get the blood? What if you cause a cellulitis and the patient requires IV antibiotics or god forbid there is a resultant staph or MRSA exposure and illness when you didn't wash your hands after the last nursing home patient you took care of, put on your gloves and you exposed the driver to the infectious agents on your gloves or whatever.

Does this not apply to any invasive procedure in the field. Be professional and take necessary precautions. See above infection statement.. :wink:

(-My opinion. Any use of the word 'you' is a generalization and not directed to any one person..)

[Just Plain Ruff]

no disclaimer needed ccmedoc

my opinion was also stated too yet ctx resorted to an immature response.

I've discussed this with our service directors and if this is passed in Missouri if it ever comes up this will be a non-issue with them since we are already hospital based they will continue to come to the lab here at our hospital to get the blood drawn. Non-issue.

By the way, who will bill for this service that these emt's provide? How will it be billed?

what happens when your only aLS truck is on a scene of a wreck or at the jail providing this service to the police and a chest pain or whatever comes out on the other side of the county when you could have been in a central location. A lot of what if's on this one but is the community going to stand for this-oh yeah, if they don't know this is happening they can't complain right.

[Doczilla]

By the way, who will bill for this service that these emt's provide? How will it be billed?

As a general rule, any medical care provided to individuals in custody is the responsibility of the agency that has them in custody (i.e., the state). The crack dealer who complains of chest pain after being chased down by the po-po? His bill is paid by the state as long as he is in their custody. Same thing with all other prisoners.

Blood draws for etoh levels or drug screens, though, are not medical care. These are part of the investigation, and are therefore investigative costs, which will be borne by the police department. If contracted out to the hospital or EMS, this fee will be negotiated. Depending on the fee for the draw and the volume of draws, it may be cheaper to train one of the jailors to do it or hire full time EMTs for this purpose.

As far as complications go, I've seen plenty of thrombophlebitis from IV starts, but never from phlebotomy. I wonder what the true incidence is. Couldn't find anything in a quick Pubmed search.

'zilla

[CTXMEDIC]

I have seen and I am sure you have to seen an infected IV site, an infected injection site and the like. So don't lecture me on the fact that it won't happen. It does.

We do very little to our patients in the ambulance that a physician already has not ordered or has not approved via standing orders.

Actually the only infected injection sites ive ever seen were due to IV drug use. maybe you guys need to revamp your stick procedures if this is a rampant problem in your service. I got 'all snippy' with you because we can what if this thing into the ground along with every other procedure we do. You also said a doctor had to order a blood draw. you have since clarified your comment. My protocols are meant to be thought through as all patients are different to a degree. Few to none of my protocols are 'orders'. your arguments border on the ridiculous. your only ALS truck could be tied up on a runny nose when the 'big one' comes in. does that mean you arent going to respond to the runny nose because the world might end in the next 5 minutes? we cant be everywhere at once and unfortunatley EMS has degenerated into taxi rides for the poor and/or lazy. The true reason for EMS has long since been trampled by abuse of the system. until our governing officials grow some balls and put and end to this we can expect to be 'pimped out' even more.

[spenac]

I have seen and I am sure you have to seen an infected IV site, an infected injection site and the like. So don't lecture me on the fact that it won't happen. It does.

We do very little to our patients in the ambulance that a physician already has not ordered or has not approved via standing orders.

Actually the only infected injection sites ive ever seen were due to IV drug use. maybe you guys need to revamp your stick procedures if this is a rampant problem in your service. I got 'all snippy' with you because we can what if this thing into the ground along with every other procedure we do. You also said a doctor had to order a blood draw. you have since clarified your comment. My protocols are meant to be thought through as all patients are different to a degree. Few to none of my protocols are 'orders'. your arguments border on the ridiculous. your only ALS truck could be tied up on a runny nose when the 'big one' comes in. does that mean you arent going to respond to the runny nose because the world might end in the next 5 minutes? we cant be everywhere at once and unfortunatley EMS has degenerated into taxi rides for the poor and/or lazy. The true reason for EMS has long since been trampled by abuse of the system. until our governing officials grow some balls and put and end to this we can expect to be 'pimped out' even more.

You have protocols or guidelines so you are still following doctors orders. Yes you have to decide which approved medicine/procedure to perform but all are approved by your medical director prior to your performing them either online or offline. So yes you are following orders no matter how you word it.

I agree more services need to implement patient transport denial protocols. Educate people by telling them no.

[VentMedic]

As far as complications go, I've seen plenty of thrombophlebitis from IV starts, but never from phlebotomy. I wonder what the true incidence is. Couldn't find anything in a quick Pubmed search.

Try this link. Medicare is also keeping their tally very closely and should be publishing their data.

http://www.ahrq.gov/

[Just Plain Ruff]

I have seen and I am sure you have to seen an infected IV site, an infected injection site and the like. So don't lecture me on the fact that it won't happen. It does.

We do very little to our patients in the ambulance that a physician already has not ordered or has not approved via standing orders.

Actually the only infected injection sites ive ever seen were due to IV drug use. maybe you guys need to revamp your stick procedures if this is a rampant problem in your service. I got 'all snippy' with you because we can what if this thing into the ground along with every other procedure we do. You also said a doctor had to order a blood draw. you have since clarified your comment. My protocols are meant to be thought through as all patients are different to a degree. Few to none of my protocols are 'orders'. your arguments border on the ridiculous. your only ALS truck could be tied up on a runny nose when the 'big one' comes in. does that mean you arent going to respond to the runny nose because the world might end in the next 5 minutes? we cant be everywhere at once and unfortunatley EMS has degenerated into taxi rides for the poor and/or lazy. The true reason for EMS has long since been trampled by abuse of the system. until our governing officials grow some balls and put and end to this we can expect to be 'pimped out' even more.

CTX, thank you very much but our service has not seen a infected iv site or injection site or blood draw site in nearly 3 years so our stick procedures and policies I don't believe need to be revamped. I can say that I've seen several infected sites that were done by other services.

But I do see where you are coming from and what iffing is just counterproductive.

Peace out.

[VentMedic]

CTX, thank you very much but our service has not seen a infected iv site or injection site or blood draw site in nearly 3 years so our stick procedures and policies I don't believe need to be revamped. I can say that I've seen several infected sites that were done by other services.

How long are your hospitals leaving your field IVs in?

Our hospital had allowed for 24 hours but now the IVs must be changed either in the ED or upon arrival to the floor or unit. So, no, we have had few if any incidences of infectiion with our IVs now. Due to the number of IVs we see daily, we are not going to assume we are perfect and must constantly monitor every procedure. We also started changing our field tubes in the ED or ICU and have seen a drop in VAP. That study should be published in the near future.

[CTXMEDIC]

Our IV's are also in for 24hrs. ER checks patency and will establish more access if they feel the need to.