scott_EMT

Not a nurse, but have been an EMT-intermediate for 4 years and am a paramedic student. Do lots of difficult IVs throughout the hospital when im doing clinical rotations. My tips.... 1: prepare.... get everything you need organized, do it the same way every time, develop your own routine and rhythm for it. 2: take a deep breath before going into the room when you are new. calm yourself. if you find your heartrate high or are jittery take a deep breath, hold for 4 seconds, exhale, hold for four, and repeat. 3: confidence.... dont say you are going to try to start the IV. you ARE going to start the IV. calm yourself and the patient. 4: pick a site and a catheter size you think will work. It is better to stick once and get it than trying to get a big iv and having to do it 2 or 3 times. 5: usually you want to go right on top of the vein and 'land the airplane'. The angles in most EMS texts and I'm going to assume most nursing books are way too steep. try like a 25 or 30 degree angle, sometimes even shallower. 6: for those really tough wiggly ones try hooking the vein. puncture the skin beside the vein and the twist so you are bevel away from the vein and go in from the side. (easier to have someone show you than describe) 7: relax.... sometimes you get it, sometimes you dont, ask for help when you need it. if you miss and feel upset or frustrated let someone else help you as you will not be doing yourself or the patient much service. 8: lots and lots of practice.

"EMS does not need to be called to bring you to the hospital because your sig other is at the bar, out with his other girlfriend, etc. You call EMS, only to have half of your family and friends arrive before you do." yeah, because I can do a whole lot other than crap my pants and drop everything in the OB kit all over the floor. Give me trauma or complex medical but OB is something we are so not ready for. though please call before you walk to the car with the baby crowning... My guess is L&D doesnt like it when you waddle in with the baby sticking out. I think "wash it" applies universally to every patient and every body part.

One thing that seems to be lacking mention is the operational aspect. Anyone who wants to get into EMS should, especially those with previous medical training such as RNs and PAs. I work with a couple of RNs on the truck, they are great and we learn from eachother. However I would caution anyone to take steps in this profession. Be an EMT-Basic for a little bit, if nothing more than to get use to operating an emergency vehicle and some of the scene management stuff. As a medic you will often not be driving, however you are still expected to be able to safely operate an emergency vehicle. Also there are decisions that you will learn to make in the field that you would never have to make as an RN, like is the longer transport to a higher level hospital/specialty center worth it, or do you need to stop in any ED now. Those decisions are some of the most important that an EMT at any level can make. Learning how to talk patients into going to the right hospital, or actually just to go to the hospital. Also experience will teach you a bit about scene safety. How to look for exits when entering a house, how to avoid conflicts, and getting a bit of a gut sense of when you just need to get out of dodge. Just think its worth mentioning the non medical side as well, since that is really what is going to decide if you make it home at the end of your shift. Just dont short change yourselves into thinking its all medical, its mostly medical and being an advanced provider in the back with an unstable patient in a radio dead zone really will teach you to be confident in your decisions. We need more good EMTs and paramedics, but if you do it, make sure you learn how to be safe out on the streets.

I would like to suggest that an ER 'tech' be utilized in a smaller hospital in addition to the ICU/ER RN. I know in my area the hospitals use nationally registered paramedics as their techs. If that is the case with you then it might also be helpful to find out what they are allowed to do vs what they are trained to do. I know here we become IV techs, we loose the authorization to intubate, use surgical airway techniques, and many other things that might be useful.

It appears to me that having patients be able to access the RRT is an important fail safe(ideally by dispatching the floor sup. to make the actual decision). It is impossible for a a nurse burdened with so many patients on a floor to catch subtle signs in every patient every time they happen. This really is no different than family members/patients calling 911 from a nursing home, bypassing the staff. I have experienced these responses and normally they are non emergent and do not need an ALS ambulance, but sometimes the nurses do miss things and they really do need paramedic assessment and intervention. Much in the same way that things can be missed on the floor. Preventing the abuse of such a system also shows great skill in the nurses ability to educate the patient and family. Really the healthcare team is not complete without the involvement of the patient and their family.

If you just came in by ambulance, the medics are still outside your room writing their report, and are warmed up after carrying you down those stairs. so... Don't threaten the nurses or docs, we like the nurses and will kick the **** out of you if you touch the nurses. if you give them a hard time they know we are less gentle with restraining someone, and we are thrilled by the idea of doing our work someplace with a roof and lighting. "the ambulance driver already asked me that" is not an acceptable answer to a question. answer it, they already know that EMS asked it, and know the answer you gave EMS. when EMS says 'no, you can't have something to eat until the doc sees you', don't bother the nurse with the same question. yes, that 'ambulance driver' also works in the ED, don't complain about not having a nurse start your IV, they are busy with the patients who can't complain (thanks to all the ER nurses and staff for the great job you do with the problems I have to bring you)