Starting a Line
By Michael Morse
Firefighters are far more comfortable charging, advancing, or flaking a line than they are starting one, but gaining intravenous (IV) access has equal importance in today’s firefighter toolbox. Our EMS engine companies are staffed with EMTs and paramedics and equipped with everything the ALS ambulances carry, so it is reasonable that we do everything we can to treat a patient prior to the ambulance’s arrival. A patient with chest pain, weakness, hypotension, bradycardia, slow respirations, abnormal skin color, or any symptoms that lead us to believe a cardiac event is likely benefits from IV access and any medications we are authorized by protocol to administer. Trauma patients need IV access, as do people suffering from life-threatening or potentially disabling conditions.
Considering infection rate is 0.18 percent (nearly two infections per 1,000 IVs)1 for hospital-placed peripheral IVs and with little data to suggest prehospital lines differ, there is no good reason to wait for the ambulance to start a line on a patient who you believe needs one. Common sense dictates much in the fire service; the decision to start a line depends on any number of unpredictable circumstances. A crew returning from a dumpster fire may want to consider the need for invasive procedures. If the patient’s condition merits IV access, and that access is imperative, then by all means clean up and get to it. If not, a little extra time before treatment may not be such a bad thing.
Proficiency at “starting a line” comes from practice and the only way to get that practice is by starting lines. The better we are at what we do, the better chance we have of making a difference for our patients. EMS is no different than firefighting when it comes to experience. The more experienced, the better the firefighter, and the better the firefighter, the better the outcome of the job.