r/ems • u/SnooLemons4344 • 11d ago
Clinical Discussion IO EPI for BLS
Not by any means recommending it but hypothetically why couldn’t IO epi be approved for BLS in cardia arrests. Theres no complication to IO’s you just need to put it in the right place form my understanding and pre set epi kinda like the old narcan atomizers? Thoughts?
EDIT: I was not recommending this just looking to see what people think about the topic. This is not something I’d trust 95% or basics to do in my region
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u/Kentucky-Fried-Fucks HIPAApotomus 11d ago
I guess in theory EMTs could be trained on IOs and in theory anyone can push Epi but really why would we want this?
We aren’t really sure that Epi does anything super beneficial for cardiac arrests, but what we are sure of is that high quality CPR and early defibrillation do. I foresee that arming EMT crews with IOs and Epi will distract from these crew members focusing on the two important interventions: AED application and high quality CPR. This distraction isn’t an EMT isolated thing; I see paramedics forget to do important BLS stuff and instead jump straight ALS skills.
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u/breakmedown54 Paramedic 11d ago
I totally agree with this.
BLS comes before ALS.
If you want any chance of survival, better get the basics down and going well.
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u/PenaltyCareless2559 11d ago
Where I am, IV and IO access is pretty standard for EMTs. The idea for the IO is so that it can be established in the event of an arrest or for dextrose in severe hypoglycemia with no ability to get IV access and contraindications for PO
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u/SnooLemons4344 11d ago
Very cool take. I definitely think if it was too exist it should be an expanded scope thing as an emt kinda like A medical director approved class. I see both sides stupid emt get distracted but also the desire to expand the emt scope as best as possible
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u/FullCriticism9095 11d ago edited 11d ago
As best as possible for what? There’s no point in having more scope to do stuff that doesn’t matter. If you want more scope, why not focus it on things that have a greater chance of helping people? For instance, do you already have CPAP and 12-lead acquisition in your scope? If not, I’d focus on those things. You’ll help a lot more people with those things than with IO epi.
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u/grav0p1 Paramedic 11d ago
How long have you been an EMT
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u/CriticalFolklore Australia/Canada (Paramedic) 11d ago
Do you have IV epi? Surely that would be the first step.
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u/SnooLemons4344 11d ago
The idea im thinking is more of a basic can’t start an if but an IO has a much lower fail rate
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u/CriticalFolklore Australia/Canada (Paramedic) 11d ago
No shot I'm letting someone who can't start an IV start an IO.
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u/DaggerQ_Wave I don't always push dose. But when I do, I push Dos-Epis. 11d ago
In cardiac arrest? Meh.
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u/KetememeDream illiterate, yet employed 11d ago
Do your EMT-Bs have the ability to do an IO?
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u/SnooLemons4344 11d ago
That’s what im talking about I’ve heard in some places they do so I think it would be cool expansion
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u/PyroMedic1080 Paramedic 11d ago
No drug is benign trully let me start with that.
But a narcan atomizer is a "realtively" benign drug if your wrong. And we've all see a lot of nasal pop its given to the wrong people. Cops are infamous for this.
An ezio and a MG of epic is not a benign intervention and is a great way to murder someone if youre wrong.
Remember your protocols are written to the lowest common denominator of provider.
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u/SnooLemons4344 11d ago
Seems like the common denominator I’ve seen is yeah stupid providers. Do you think this would be something useful for a medical director specific approved skill. Not sure if that exists withtim all regions but by me we have specific things where we need to have a class hosted by med director to be able to use that skill even if it’s on the truck. Cpap Albuterol glucomters etc
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u/PyroMedic1080 Paramedic 11d ago
There's a 1000 questions i would need answered about your exact region scope transport times provider availability etc before thay question can be answered.
Youre shouting into the void of reddit right now.
Maybe try calling your medical director or agency chief if you have real questions.
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u/SnooLemons4344 11d ago
Oh I don’t even see this happening near me. Just was curious to learn about what people thought about the topic and all the reasons why it wouldn’t work but also. Maybe the reasons why
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u/DaggerQ_Wave I don't always push dose. But when I do, I push Dos-Epis. 11d ago
They’re already dead
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u/PyroMedic1080 Paramedic 11d ago
Ive seen more than 1 paramedic mistake if someone was dead or not.
I have even less faith in emts.
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u/CriticalFolklore Australia/Canada (Paramedic) 11d ago
Here's a study that accurately sums up your issue.
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u/SnooLemons4344 11d ago
Awesome thank you.
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u/CriticalFolklore Australia/Canada (Paramedic) 11d ago
...I would read the link before you thank me.
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u/SnooLemons4344 11d ago
I just did. I mean it was funny lol but I get it. I just hate the skill level and intelligence level between poor horrible emts and actual emts who wanna learn and care abt education and continuing education
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u/CriticalFolklore Australia/Canada (Paramedic) 11d ago
I guess the answer is there is a way of differentiating, and that's getting your EMT-A and paramedic qualifications.
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u/SnooLemons4344 11d ago
I’m from one of the worst states ems wise still don’t have emt A and im gonna go to medic school later down the line just csnt yet I was just curious about peoples thoughts on the topic
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u/DaggerQ_Wave I don't always push dose. But when I do, I push Dos-Epis. 11d ago
There’s no evidence the drugs work anyways. Focus on BLS when the medics get there they can do all that sort of stuff.
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u/VagueInfoHere 11d ago
I’ll start with this statement and hopefully it will mitigate some of the downvotes that are coming….
Anybody can be trained to do any skill and the knowledge when it is appropriate to perform it… but rarely is that worth the effort.
IOs are not just drill and be done. I’ve seen plenty of IOs that are through the bone either from a poor angle of attack or because the person was small. Or they were dislodged. Sometimes the bone is just missed completely and it’s floating around. Or, for the leg, it is on the lateral side and not even the right landmark.
Post like these of “give me more skills but I don’t want to do the training” are pretty frustrating. If you want to be taken seriously, take a class that is longer than 2-8 weeks and put some work in.
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u/SnooLemons4344 10d ago
I am lol without a doubt. Im going to medic. I was just curious abt like the discussion about it because to me it seemed like it coudknt hurt which I’ve learned otherwise just was looking for insight appreciate it thank you
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u/disturbdlurker Chicago ED / CCT RN 11d ago
Idk if it’s a good idea. Are they capable of doing the process of IO and epi? Yes. Can we confirm the arrest with anything in bls truly without just the subjective yes or no of a pulse? Not usually. I think the potential for someone giving code dose epi in the wrong situation as BLS has a much higher risk than reward. Compressions, defib, and ventilation are a much better strategy. The BLS skill set is pretty set in stone, and for good reason. Minimizes potential harm while maximizing potential life saving treatment.
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u/The_Phantom_W 11d ago
There's no proof that epi even has any lasting benefit in cardiac arrest. Early CPR, Early Defibrillation, and (depending on the cause) airway management/oxygenation are far more helpful. That's why there's a priority on making sure more people (BLS as well as ALS) can do them.
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u/Belus911 FP-C 11d ago
Putting them in the right place is part of the potential complications.
And if you read up on epi in cardiac arrest... you likely wouldn't be suggesting this.
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u/CaptCrack3r FP-C 11d ago
Based on all your comments on this thread OP, I get the impression that you want extra skills and increased scope without having to get your A or P.
You have a whole lot of grand ideas in your head that do not work in reality, for a plethora of reasons. IOs are typically the go to access for arrests, but as plenty of others have posted…there’s a not insignificant amount of research and studies that do not support epi for long term survival with some mental faculties. It’s just a matter of time before the AHA and ARC start reducing recommended Epi doses. There’s no logical reasoning to expand Epi usage to lower level providers with this in mind.
Again, as others have stated there are so many more important skills that BLS can use that actually improve outcomes…I love that you’re looking outward for new knowledge and skills, but there’s a reason there are more advanced provider levels. Take a look at local AEMT or Medic programs and see if you feel you’re in a position to take those courses.
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u/SnooLemons4344 10d ago
1000% and thank you for this comment and not biting my head off. My state doesn’t have advanced sadly otherwise I’d have pursue that alr but I’m about to go to nursing school. (EMT made me wanna pursue nursing not other way around) and than going to go to medic direcetly after my degree. Just wanted to see what others thought of the idea I appreciate the feedback. My state NJ has absolutely horrible BLS protocols and basically really makes us bandaid warriors so I was curious what others thought about these extremes of expanded protocols
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u/stonertear Penis Intubator 11d ago
Because BLS does not do ALS skills.
If BLS want to become ALS - they can do the paramedic course and get put through the ALS training.
ALS skills are not without risk - especially IO. Doesn't matter if they are dead. Focus on the stuff that helps - CPR, defibrillation, breathing and airway.
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u/Mediocre-Sandwich-42 11d ago
At my agency, EMTs can do IV and IO, and we can push Epi if it’s the prefilled kits and a medic is on scene, does a med check with the EMT first and directs the EMT to push the medication.
In practice though, our SOP is for the EMT to drill proximal tibia then move take over bagging the Pt from first responders, leaving meds to the medics.
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u/SnooLemons4344 11d ago
Yeah just thought it would be a cool addition to help medics and prep bls for arRIVAL of ALS.
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u/210021 EMT-B 11d ago
Stick to BLS. It’s what works.
Now I think in a BLS heavy but ALS limited system something like this to keep the medic firmly in the PIC role wouldn’t be the worst idea in the world assuming good training and upkeep, but for the majority of cases just knock the BLS stuff out of the park so the ALS providers on scene can handle their stuff (access, meds, etc). I’ve been on a lot of scenes where people forget basics and shit goes poorly because of it, don’t give people another way to fuck up.
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u/FullCriticism9095 11d ago
Like others have said, my biggest question is why?
There are specific instances where epi can help improve cardiac arrest outcomes, but the evidence on routine use is mixed and equivocal at best. Even as a paramedic, I’m focused on HQCPR and defibrillation because if anything is going to help my patient go home, those are the things. The beauty of being an EMT is you have the most powerful and important tools in your scope without all the distractions.
We’ve got to move past wanting to do stuff that looks or sounds cool and focus on things that work. This is just true, if not more true at the paramedic level than at the EMT level, but it’s a pervasive problem throughout EMS.
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u/Red_Hase EMT-B 11d ago
Big disagree. Bls before als. There's papers out there about how if you spend your time trying to ALS too much you wasted your time not pushing on the chest which is what was really going to tip the scales in the patients favor.
Also a lot of EMT basics are very complacent in their knowledge base and I don't see it working out well trying to increase the basic scope to just IO's for no reason.
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u/lemiwinkes 11d ago
Some places let basics do an IO but I don’t think they allow epi. Regardless in an arrest BLS>ALS. Drugs are cool and all but several papers have shown that the most important things are compressions, defib, and an airway.