# pre-action IV line



## kaja (Apr 25, 2011)

Well, it's me again with my stupid questions... you are welcome.

From time to time, I stumbled over mentions of soldiers/ officers/ guys answering phones starting IV's on themselves before some kind of Direct Action. From some nearly fantasy "tactical magazines" to some novels, but never found any article in some serious medical journal (I suck at Google BTW...).

I am really curious, if that's sound procedure in some setting, and if it's really used. I can see benefit on case when IO is not available (like few years earlier) or may not be effective (I remember some study that showed, that quite large percentage of battlefield placed FASTs was outside sternum). And of course two on different limbs would be better-Murphy is an asshole 
I discussed this issue with one of our medical directors, and he saw that in use by Norwegians IIRC during operations over sea (vasoconstriction due to cold water).

I also wanted to know, if that IV catether won't get dislocated/ clogged during some activity. I started line on myself (right forehand)  before military adventure race, secured it with some extra tape and after flushing it i went to start. Event lasted for 5 hours, and involved swimming with drowning victim, transport of wounded in NBC environment, shooting on flat range, paintball match, climbing, rafting and lots of running. It stayed in place and was working without issues after finish. Of course that's not relevant study/ experiment for combat use, but at least something...

So, can some of you guys share some knowledge here?

Thanks!


----------



## Muppet (Apr 25, 2011)

Huh?

F.M.


----------



## surgicalcric (Apr 25, 2011)

The British have had luck, of varying degrees, with starting lines on guys before DA hits.  They use Heparin to reduce the chances of the access clotting off.

Crip


----------



## Muppet (Apr 25, 2011)

kaja said:


> Well, it's me again with my stupid questions... you are welcome.
> 
> From time to time, I stumbled over mentions of soldiers/ officers/ guys answering phones starting IV's on themselves before some kind of Direct Action. From some nearly fantasy "tactical magazines" to some novels, but never found any article in some serious medical journal (I suck at Google BTW...).
> 
> ...


 
So, I reread your post. I have not heard (been out for a while now) of pre-starting I.V.'s but I can imagine them becoming dislodged when you become diaphoretic, even with massive amounts of tape. Like Crip, said, Heparin would be needed to prevent clots in the line but I suppose if diaylisis patients can walk around with ports, it could be possible.

F.M.


----------



## Diamondback 2/2 (Apr 25, 2011)

Not a medic or anything but I would not let a medic start one on me before mission.......too many issue I would have with that from an operational stand point. It only takes a 2-3 minutes to start one anyway, what's the benefit? 

Infection 
Possible tearing
Irritating 
Breaks and starts spitting your blood out while in a gunfight.....nope note me...


----------



## QC (Apr 25, 2011)

I've heard the IDF do/have done it, but that's only anecdotal.


----------



## Headshot (Apr 25, 2011)

If you were so bad off as to need an IV pre combat, I would imagine there would be bigger issues to worry about when the need for the IV came about.  I could see this being a huge benefit on very dry overland movements where contact is unlikely however, and time is an issue.  I usually just piss in my mouth after I take my foot out.


----------



## AWP (Apr 25, 2011)

I've heard of it being done, but never seen it myself. I'll have to ask the guy who told me but I want to say some 10th Group guys were doing it in Iraq.


----------



## policemedic (Apr 25, 2011)

Meh. I can see pros and cons, but the truth is that people usually don't die from a lack of plastic in their arm. It's not something I've ever done, and I think pre-mission medical planning time is best spent on other things. 

Concur re heparin flushes if you're going to do it. 

YMMV based on mission profile, skill set, options available, and AO.


----------



## Red Flag 1 (Apr 25, 2011)

RF 1


----------



## pardus (Apr 26, 2011)

QC said:


> I've heard the IDF do/have done it, but that's only anecdotal.



I recall that, I think I read that in a book written by a top Israeli Commando.



Red Flag 1 said:


> Your serious thoughts gents?? Is it of value? Where would you put the line? How would you suggest maintaining and cleaning the site daily? And no, I'm not as rabid as I used to be.........the meds help a lot...........
> 
> RF 1



If I were to do this, I would imagine it would be for a high risk mission which probably wouldnt last too long. I'm thinking a raid etc... Anything longer would suck.
If the risk were that big and lasting so long, why not prophylactic anti-biotics?


----------



## kaja (Apr 26, 2011)

Thanks for reply guys

First- maybe I should named the thread differently- I meant just preparing IV site/ saline lock, no actual administration of fluids (more than flushes).

From what I've read it applies only to DA, having actual running IV for days is different story. But regarding this, I'm not sure about that "behind armor" placement. I would like to be able to check it visually, and also armor may rub on it and dislodge it.. And I'm not quite sure where behind my plate carrier I'll stick an IV other than central line :)

"It only takes a 2-3 minutes to start one anyway, what's the benefit?" Well, with collapsed veins in shock, it may take forever...

About dislodging when sweating/ diaphoretic- for me tape worked, but something like hydrogel may be better...


----------



## Ranger Psych (Apr 26, 2011)

There's tools to get venous access in hypovolemic patients.  In a hospital? I could see it, and it'd make some sense, but I would argue against giving any more holes than issued to troops unless necessitated.


----------



## policemedic (Apr 26, 2011)

The treatment of hemorrhagic shock does not revolve around the placement of an IV cannula. 

I will grant that volume replacement is important, but not at the expense of raising systolic pressure to a level that encourages further bleeding by popping clots or preventing their formation.  There is also the issue of diluting blood.   If bleeding has been adequately controlled and blood products are available, then it's a different situation. But since odds are that the only fluids available will be colloids or crystalloids, caution is indicated. 

While hypovolemic pts are sometimes difficult to cannulate, IO and EJ lines are perfectly acceptable and rapid options assuming an appropriately trained clinician is directing/performing treatment. 

In any case, IVs are started when time is available. They aren't the be all/end all of medical treatment, though they are important.


----------



## Muppet (Apr 26, 2011)

policemedic said:


> The treatment of hemorrhagic shock does not revolve around the placement of an IV cannula.
> 
> I will grant that volume replacement is important, but not at the expense of raising systolic pressure to a level that encourages further bleeding by popping clots or preventing their formation. There is also the issue of diluting blood. If bleeding has been adequately controlled and blood products are available, then it's a different situation. But since odds are that the only fluids available will be colloids or crystalloids, caution is indicated.
> 
> ...



I was getting ready to write just this when I got that getto 911 call and had to didi out. Thanks D.

F.M.


----------



## amlove21 (Apr 26, 2011)

surgicalcric said:


> The British have had luck, of varying degrees, with starting lines on guys before DA hits. They use Heparin to reduce the chances of the access clotting off.
> 
> Crip



I have worked with some Brits here that have done it prior to DA work. I never talked to anyone that it specifically paid dividends for, e.g. they actually needed it, but one guy thought it was good luck for that reason. The hep lock is the standard, with an op site over top for keeping it clean, with some tape/coban/whatever else over top just to keep it from catching on stuff. Mid anterior forearm. Behind armor? I disagree. What if you need to use the I.V.? I would prefer to leave the armor on my pt. Until he's at the hops or out of harm's way. Personal preference.

As for the need to do so, and the risk/benefit- I see your point on the collapsed veins, and we have all started (read:missed) tough IV's for whatever reason. Which is why I carry an I.O. The FAST is good (although limited to the sternum), the BIG is better, and the hand driven model is great (2 humoral heads, 2 tibial tuberosities, and 2 ankles, Iliac Crest, posterior aspect of the femur are sites for the latter 2) . For a viable patient, you can always find an I.O. site when the veins fail you. No limitations on fluids/drugs passed through I.O.



policemedic said:


> The treatment of hemorrhagic shock does not revolve around the placement of an IV cannula.
> 
> In any case, IVs are started when time is available. They aren't the be all/end all of medical treatment, though they are important.



I agree with this wholeheartedly. You would be surprised how much fluid I carry in my med ruck. It ain't that much. Granted, my typical patient is a barrel chested, steely eyed dealer of death, fighting for freedom- but you get the idea.  :cool:


----------



## pardus (Apr 26, 2011)

amlove21 said:


> You would be surprised how much fluid I carry in my med ruck. It ain't that much.



How much?


----------



## amlove21 (Apr 26, 2011)

I'll typically carry 2, max 3 500cc bags of NS for CSAR. 1.5L. And i don't carry hextend- it's single use and expensive. That's my usual loadout. Obviously, I have more available that's carried close in a resupply or more intensive kit, but when I throw on the ruck that's what it has in it.

Before anyone freaks out, cause I am sure there are people that will, this is for a specific mission set. For burns, mass casualty, extended care, MEDEVAC, etc., I get it- it's not enough. And hextend/hetastarch has it's place, but anything I have seen/read/researched just hasn't proven to me that 100% every single time I need to put it in the bag. Just my .02.


----------



## pardus (Apr 26, 2011)

amlove21 said:


> I'll typically carry 2, max 3 500cc bags of NS for CSAR. 1.5L. And i don't carry hextend- it's single use and expensive. That's my usual loadout. Obviously, I have more available that's carried close in a resupply or more intensive kit, but when I throw on the ruck that's what it has in it.
> 
> Before anyone freaks out, cause I am sure there are people that will, this is for a specific mission set. For burns, mass casualty, extended care, MEDEVAC, etc., I get it- it's not enough. And hextend/hetastarch has it's place, but anything I have seen/read/researched just hasn't proven to me that 100% every single time I need to put it in the bag. Just my .02.



Thanks mate.

FWIW at my level, hextend is now a no go, not authorized.
LRS is on the way out too.


----------



## amlove21 (Apr 26, 2011)

Yea, I'll quote a former TL of mine. "NS works great. You can flush with it too, so if I need to flush a wound or stitch someone, I am going for NS anyway. Can you flush with Hextend? I assume you can, but that's an expensive flush. We don't carry anything that's single use if we can help it."

Those other fluids have their place, I am just not so convinced it's in MY SPECIFIC pre-hospital care environment.

Sorry, I wanted to add emphasis to head off the possible freak out session. Medicine is like politics and sex- best done in private with a chaperone. Wait, I don't think that's the saying. ;)


----------



## Ranger Psych (Apr 27, 2011)

Pfft. I agree with your load, you're there for the 3 gets if it's CSAR... get in, get them, get out... fuck treating on the ground, patch minimally and get the hell out of there. let the exfil platform do the lifting, it's not like you're gonna be maxing the airframe out with a case of saline anyway.  Boeing and Sikorsky lift heavier shit easier than you or I ever will!


----------



## amlove21 (Apr 27, 2011)

Thats what I am talking about. If we start talking about direct support or some of the other mission sets out there, you can flex. and carry more of what you need.

I do love hearing guys carrying like 5 liters of assorted fluids. That and plenty of cardiac meeds always makes me laugh.


----------



## surgicalcric (Apr 27, 2011)

amlove21 said:


> <<SNIP>> I do love hearing guys carrying like 5 liters of assorted fluids. That and plenty of cardiac meeds always makes me laugh.



Me too bro.

I also get a good chuckle out of medics who carry all the sniffle meds in their bag.

Not this 18D...I have a self-aid table next to the door of my Med-Shed which contains NSAIDS, foot powder, zyrtec, bandaids, neosporin, etc, etc... with lil ziplock bags, label tape and sharpies, and instructions for use for everything there.  Thee guys can help themselves 24 hours a day.

I look at it like this, the weapons guys dont carry my CLP; the Engineers my IDC's, flashbangs, and firing devices; the commo guys my spare batteries so I am not carrying the items which every other guy on the ODA has access to and the ability to package and carry.


----------



## kaja (Apr 27, 2011)

Thank you guys.

I was skeptical about mentioned procedure, but clarification is always good. I can really see it originated during some pre-action prep rather than from some medical reasoning. "Hey, it really sucked last time I sticked guy in action, so just let's make my life easyer for this one...". As you guys said, and I can't agree more, fluids may help sometimes, but circulating light pink lemonade is not going to make it. I remember, that Brits were quite aggressive with fluids some time ago, but I hope we moved on... ..and we have IOs now:)

Hey, I actually remember one of these medics... "I have 4litres of fluids in my bag, also with 3 diferent strap cutters and tons of other stuff...". It was during field exercise, where guy get hit by BVP-2. Really nasty hematoma, unstable pelvis and shit, so while waiting for MEDEVAC we wanted to start slow drip IV to KVO. Well, that asshole tossed all of his fluids under his bed that morning, because "It was too heavy"... Luckyly I had my first responder bag.
Moral? Don't carry so much stuff that you'll be tempted to throw something away while it gets heavy...



> I am not carrying the items which every other guy on the ODA has access to and the ability to package and carry.


Great point. This concept also works great with IFAKs (..so you don't have to lug around shitload of bandages and can carry only specialized items). It also slows unit down, when everyone with blister or small cut goes to see medic to just pull out tape and tape it. During last FTX I spent like 3 rolls of tape just for cuts on fingers... If everyone had just small Boo Boo Kit... (It wasn't my organic unit-I was just assigned for FTX).


----------



## Red Flag 1 (Apr 27, 2011)

RF 1


----------



## Muppet (Apr 27, 2011)

I always learn something here and I put it forward to the tactical aspect of my career. Thanks all.

F.M.


----------



## DoctorDoom (Apr 29, 2011)

I'm a badass when it comes to central lines.  So pre-emptive IV seems not worth it... but this is not field prep before a DA mission, so perhaps irrelevant.


----------



## BearW (May 2, 2011)

Great thread, BTW guys.
I've had locks put on me before a trg hit just to see if it would stay in. We used a combo of Hydrogel and what looks like a 3M waterproof band aid. Worked okay. I the value in it if you're trying to mainline a guy with NS who is super dehydrated and in shock, but the rate as which fluid is infused kinda makes it not so worth it- all case by case dependant of course. I never found clotting to be an issue, personally.

I've never been on the business end of the BIG/FAST set ups (thank f*&K), but i've seen them in use and they are more effective, IMO. If ambulatory patients can take an IV. Save the BIG/FAST's for litter guys.

I've carried a bag of either with a starter kit to help out and lighten the Grnd Force medic's loadout.


----------



## TLDR20 (May 3, 2011)

amlove21 said:


> I'll typically carry 2, max 3 500cc bags of NS for CSAR. 1.5L. And i don't carry hextend- it's single use and expensive. That's my usual loadout. Obviously, I have more available that's carried close in a resupply or more intensive kit, but when I throw on the ruck that's what it has in it.
> 
> Before anyone freaks out, cause I am sure there are people that will, this is for a specific mission set. For burns, mass casualty, extended care, MEDEVAC, etc., I get it- it's not enough. And hextend/hetastarch has it's place, but anything I have seen/read/researched just hasn't proven to me that 100% every single time I need to put it in the bag. Just my .02.



I carry less than that in my small aid bag. 2 500cc Hextend. That is it. In the big bag I have more, but that is all I have in my small one.

As for pre cannualating, I don't do it. Was never taught to do it, and it has never been shown to have any real positives that I know of.


----------



## amlove21 (May 3, 2011)

cback0220 said:


> I carry less than that in my small aid bag. 2 500cc Hextend. That is it. In the big bag I have more, but that is all I have in my small one.
> 
> As for pre cannualating, I don't do it. Was never taught to do it, and it has never been shown to have any real positives that I know of.


 
Just a question- why only hextend?


----------



## DoctorDoom (May 3, 2011)

Any of you men ever carry the same volume of saline in 250cc bags instead of 500cc?  Any experience pro or con?


----------



## TLDR20 (May 3, 2011)

amlove21 said:


> Just a question- why only hextend?









 Well what am I really getting out of Saline? We are doing hypovolemic resus nowadays, and Saline to me anyways doesn't do much but cure hangovers. I do have NS in the truck bag/range bag/big bag. But real world I carry Hextend.


----------



## amlove21 (May 3, 2011)

cback0220 said:


> Well what am I really getting out of Saline? We are doing hypovolemic resus nowadays, and Saline to me anyways doesn't do much but cure hangovers. I do have NS in the truck bag/range bag/big bag. But real world I carry Hextend.



With NS you're getting a flush, a comparable amount of increase in blood pressure for an albeit shorter amount of time- the only thing that hextend has going for is is that it takes the body a long time to break it down at a molecular level, increasing intravenous pressure (secondary to volume increase) up to 8 hours. You cant pass Valium through the same line (it precipitates). You can make a case for both sides, but I will go with the multi use piece of gear before the single use. Just me.

Have you seen or read anything lately that singled any hetastarch product out as the preferred pre-hospital fluid? I know the Feb 2009 TCCC guidelines suggest "no more than a 1000cc bolus for hemmorrhagic shock".


----------



## pardus (May 3, 2011)

amlove21 said:


> "no more than a 1000cc bolus for hemmorrhagic shock".



Of hextend in particular or just any fluid?


----------



## amlove21 (May 3, 2011)

pardus said:


> Of hextend in particular or just any fluid?


Hextend and other like hetastarch products. 500cc bolus, wait 10-15 minutes, with no improvement and trended vitals, re-administer the other 50cc to get to your 1000cc total. No further hex after that.

The fluid resus question is more of an art than science- some places it will say get peripheral pulses back then titrate, in between 80-100 in some books, patient presentation in some. Hypo resus is the latest and greatest, no more "2 large bore IVs in different big veins with fluids wide open".


----------



## pardus (May 3, 2011)

Thank you for that.


----------



## TLDR20 (May 3, 2011)

amlove21 said:


> Hextend and other like hetastarch products. 500cc bolus, wait 10-15 minutes, with no improvement and trended vitals, re-administer the other 50cc to get to your 1000cc total. No further hex after that.
> 
> The fluid resus question is more of an art than science- some places it will say get peripheral pulses back then titrate, in between 80-100 in some books, patient presentation in some. Hypo resus is the latest and greatest, no more "2 large bore IVs in different big veins with fluids wide open".



The hypo resus is what I learned last time through SOCMSSC. They were teaching Hextend, so I started carrying it. Haven't had to use it, so really don't have any practical knowledge of it. I do know that we all have different preferences, and as long as no one is getting dead because of them they really are not important.


----------



## amlove21 (May 3, 2011)

cback0220 said:


> The hypo resus is what I learned last time through SOCMSSC. They were teaching Hextend, so I started carrying it. Haven't had to use it, so really don't have any practical knowledge of it. I do know that we all have different preferences, and as long as no one is getting dead because of them they really are not important.


I agree 110%.

Yep, I argued the same point (my NS point) at SOCMSSC when I was there, with mixed results. For full disclosure, Hex most certainly is in the TCCC guidelines for hemorrhagic shock. NS is just my personal preference.

Thanks for the input brother. Just wanted to know if I was missing something.


----------



## jcooper.84 (Jan 16, 2014)

I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean. 
This in itself would stop me from wanting to do this.
Please educate me if i am wrong.


----------



## TLDR20 (Jan 16, 2014)

jcooper.84 said:


> I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
> This in itself would stop me from wanting to do this.
> Please educate me if i am wrong.



Well that would be a concern, as well as many others that were voiced.


----------



## pardus (Jan 16, 2014)

jcooper.84 said:


> I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
> This in itself would stop me from wanting to do this.
> Please educate me if i am wrong.



Please post an intro as per the rules you signed before posting again.


----------



## pardus (Jan 16, 2014)

jcooper.84 said:


> I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
> This in itself would stop me from wanting to do this.
> Please educate me if i am wrong.



I would hope they would sterilize the skin pre IV and I know I would place a tegaderm over the site if it was me. Should be OK short term I would think. 

@TLDR20 ?

The Israelis are pretty good with medicine from what little I have seen. 
I'm interested in knowing if they've continue to do this given time and experience.


----------



## TLDR20 (Jan 16, 2014)

pardus said:


> I would hope they would sterilize the skin pre IV and I know I would place a tegaderm over the site if it was me. Should be OK short term I would think.
> 
> @TLDR20 ?
> 
> ...



Yeah I agree. I just don't think that it is worth it. These days I can drill an IO in someone before you can get your IV flowing, guaranteed. So I'll just do that post injury. 

Also I forgot what was in the beginning of this thread, but giving someone an IV every night for 3 months? Seems excessive.


----------



## TLDR20 (Jan 16, 2014)

amlove21 said:


> Hextend and other like hetastarch products. 500cc bolus, wait 10-15 minutes, with no improvement and trended vitals, re-administer the other 50cc to get to your 1000cc total. No further hex after that.
> 
> The fluid resus question is more of an art than science- some places it will say get peripheral pulses back then titrate, in between 80-100 in some books, patient presentation in some. Hypo resus is the latest and greatest, no more "2 large bore IVs in different big veins with fluids wide open".



This is an old thread but I wanted to point out changes to the fluid resuscitation protocol. The standard for TCCC, and the TMEPs, for a patient in hypovolemia is to administer a 500cc bolus of Hextend. then wait 30 mins, then reassess the patient, if the patient is still not to a strong radial pulse or over 90, they get another 500cc bolus of Hextend, at that point, you do not want to give more fluids as it will likely lead down a road that turns your blood into red water. 

Now I personally taught that if you felt any radial pulse, to titrate the second 500 bag up to a strong radial pulse. I know this thread is old but I wanted to throw out the latest information, as people are obviously still reading these old ass threads.


----------



## pardus (Jan 16, 2014)

TLDR20 said:


> Yeah I agree. I just don't think that it is worth it. These days I can drill an IO in someone before you can get your IV flowing, guaranteed. So I'll just do that post injury.
> 
> Also I forgot what was in the beginning of this thread, but giving someone an IV every night for 3 months? Seems excessive.



Do you use a FAST1 as standard? Does an IO impede you in anyway after the fact? i.e. Ive heard people say it makes you non deployable for a while.



TLDR20 said:


> This is an old thread but I wanted to point out changes to the fluid resuscitation protocol. The standard for TCCC, and the TMEPs, for a patient in hypovolemia is to administer a 500cc bolus of Hextend. then wait 30 mins, then reassess the patient, if the patient is still not to a strong radial pulse or over 90, they get another 500cc bolus of Hextend, at that point, you do not want to give more fluids as it will likely lead down a road that turns your blood into red water.
> 
> Now I personally taught that if you felt any radial pulse, to titrate the second 500 bag up to a strong radial pulse. I know this thread is old but I wanted to throw out the latest information, as people are obviously still reading these old ass threads.



It's important that a thread like this is kept up to date, I certainly appreciated it.


----------



## TLDR20 (Jan 16, 2014)

pardus said:


> Do you use a FAST1 as standard? Does an IO impede you in anyway after the fact? i.e. Ive heard people say it makes you non deployable for a while.
> .



I don't know as to the IO making you non-deployable. But I doubt it changes your status more than a wound requiring fluid resuscitation, know what I mean?


----------



## pardus (Jan 16, 2014)

TLDR20 said:


> I don't know as to the IO making you non-deployable. But I doubt it changes your status more than a wound requiring fluid resuscitation, know what I mean?



Yeah absolutely, sounded weird to me. I mean a serious bone break heals in approx 6 weeks and skin/flesh will close and seal a lot quicker than that so I see no reason to have some out of action past the wound healing. FYI the timeline I was told was (IIRC) 12mths non deployable after an IO.


----------



## Muppet (Jan 17, 2014)

Are anybody using EZ IO's out there (TFC / TACEVAC) or just FAST's? Just wondering. I see North American Rescue Products /  Vida Care are selling sternal sets (manual)...

F.M.


----------



## policemedic (Jan 17, 2014)

I never was much of a fan of sternal IOs.


----------



## Muppet (Jan 17, 2014)

policemedic said:


> I never was much of a fan of sternal IOs.



Did not have any of this in the 90's. I like EZ IO's. Got in trouble about 6 years ago when we (EMS) first got them. Every shitty, unstable pt. got a I.O. Then bosses were all "MONEY, THEY COST MONEY"! Gotta love pt. care governed by billing.

F.M.


----------



## TLDR20 (Jan 17, 2014)

EZ IO's are what are issued to SOCM medics.


----------



## amlove21 (Jan 17, 2014)

Firemedic said:


> Are anybody using EZ IO's out there (TFC / TACEVAC) or just FAST's? Just wondering. I see North American Rescue Products /  Vida Care are selling sternal sets (manual)...
> 
> F.M.


FAST is pretty much done. Hard to get out without the removal tool, easy-ish to mess up, whatever. The Ez IO is way better, we carry both the hand driven and drill IOs on the bird. There is also a sternal needle in the EZ IO, if that's the only site you have.


----------



## policemedic (Jan 17, 2014)

EZ-IO is the tits.


----------



## Ranger Psych (Jan 17, 2014)

amlove21 said:


> FAST is pretty much done. Hard to get out without the removal tool, easy-ish to mess up, whatever. The Ez IO is way better, we carry both the hand driven and drill IOs on the bird. There is also a sternal needle in the EZ IO, if that's the only site you have.



Sounds like a win win, wouldn't have minded trying out/playing with other IO options but the FAST seemed to be the way to go at the time. 

Plus, it was always good for frightening privates with, considering a threatening of a prince albert done with that would cure what ails ya.


----------



## amlove21 (Jan 17, 2014)

Ranger Psych said:


> Sounds like a win win, wouldn't have minded trying out/playing with other IO options but the FAST seemed to be the way to go at the time.
> 
> Plus, it was always good for frightening privates with, considering a threatening of a prince albert done with that would cure what ails ya.


hahah yea. It would really piss the CSH/Role docs off when you dropped a patient but didnt have the removal tool. If they didn't have one either, that guy was getting cut open to remove it. 

The EZ IO is dope, light, and has the hand-driven option if the batteries fail. Pretty great.


----------



## Muppet (Jan 17, 2014)

amlove21 said:


> hahah yea. It would really piss the CSH/Role docs off when you dropped a patient but didnt have the removal tool. If they didn't have one either, that guy was getting cut open to remove it.
> 
> The EZ IO is dope, light, and has the hand-driven option if the batteries fail. Pretty great.



Bro. You just used the word "dope" That's fucking epic awesomeness! It's also pretty dope!

F.M.


----------



## amlove21 (Jan 17, 2014)

Firemedic said:


> Bro. You just used the word "dope" That's fucking epic awesomeness! It's also pretty dope!
> 
> F.M.


I'm VERY hood. I always fit in well in South Philly, believe me. I was not the Bucks County medic.


----------



## Muppet (Jan 17, 2014)

amlove21 said:


> I'm VERY hood. I always fit in well in South Philly, believe me. I was not the Bucks County medic.



What are you trying to say hood rat? I am all Bucks and no Fucks? . I did my Rescue time @ Medic-11, South Fucking Philly yo. I also grew up in the Lindonfield Projects. For real, I did. Not fun. Who was the Bucks medic you knew besides me? Oh, come to my local in Lower Bucks. Some A.O.'s are very similar to North Philly, especially Bloomsdale, Fleetwing, Venice Ashby, Winder Village, yada yada yada....

F.M.


----------



## amlove21 (Jan 17, 2014)

Firemedic said:


> What are you trying to say hood rat? I am all Bucks and no Fucks? . I did my Rescue time @ Medic-11, South Fucking Philly yo. I also grew up in the Lindonfield Projects. For real, I did. Not fun. Who was the Bucks medic you knew besides me? Oh, come to my local in Lower Bucks. Some A.O.'s are very similar to North Philly, especially Bloomsdale, Fleetwing, Venice Ashby, Winder Village, yada yada yada....
> 
> F.M.


hahahah nice! I was at 37s, our local backed up to 11. Two of our guys got Bucks for ride alongs, and we used to mercilessly make fun of them- although truth be told, we had no idea why (nor did we care), we just did it because our preceptors said it would piss off the Bucks medics.


----------



## Muppet (Jan 17, 2014)

amlove21 said:


> hahahah nice! I was at 37s, our local backed up to 11. Two of our guys got Bucks for ride alongs, and we used to mercilessly make fun of them- although truth be told, we had no idea why (nor did we care), we just did it because our preceptors said it would piss off the Bucks medics.



They prolly rode at Medic-168's (Penndel-Middletown EMS), my part time gig. A very busy place, like my place, not far but not alot of penetrating trauma, mostly blunt trauma. I precepted many students but none from the pipeline (that would be fucking rad). I always got the kids going zero to hero. City Rescue always got the pipeine dudes. I saw many down there. If I recall, black BDU pants, grey polo and tan boots and cock deisel attitude. LMAO. Medic-37 was the first medic unit my current boss at Bristol worked at in the city during the early 90's.

F.M.


----------



## policemedic (Jan 17, 2014)

I used to see Medic 37 quite a bit.  Their house was co-located with the 1st Police District and South Detective Division (my second home for a while).

The difference between Bucks medics and city medics is that the Bucks folks are way better at medical calls.  The city guys run rings around Bucks with penetrating trauma because Philly is a knife and gun club, but the Bucks guys do better patient care on medical runs.  They aren't as jaded.  On the other hand, some--not all--of the Bucks guys can be protocol monkeys whereas we in Philly understand the protocols are more like guidelines :).


----------



## Muppet (Jan 18, 2014)

Yep. Because of the statewide protocols, many medics, especically the new ones are scared into thinking if they divert from protocols, they will get fucked. Thank god my 2 medical directors both are pro EMS and were paramedics before doctor. They believe supreme clinical decision making and patho phys education is the way to go and understand that the protocols ARE guidelines and that diversion is a possibility. I have diverted from standard many times for the care of the pt. But you know there are many interpetations to the protocols such as: combative pt. We are requested to contact base for sedation permission but I never do. The protocols also say if it is not safe, do it and contact later for which Doc J. supports.Anyhow, I agree with what Policemedic stated. It seems the medics that trained in the city do understand the knife and gun aspect but the medics that trained out here unless they work in the lower end of the area(like me) wherre we see some of that shit also but not to the extent of Rescue in the city.

F.M.


----------



## 256 (Feb 14, 2018)

Cool to read all of this. I always heard this and wondered the same thing.


----------



## Stretcher Jockey (Feb 14, 2018)

This is a super old thread, but really good stuff. Personally I place "pre-action" IVs in the same category as pre-applied TQs. I have definitely heard of units where thats SOP, but when I started to see TQs fail due to dry rot I leaned very far away from it. Thanks for digging this up @256!


----------



## 256 (Feb 15, 2018)

Paramagician said:


> This is a super old thread, but really good stuff. Personally I place "pre-action" IVs in the same category as pre-applied TQs. I have definitely heard of units where thats SOP, but when I started to see TQs fail due to dry rot I leaned very far away from it. Thanks for digging this up @256!




There’s not a whole bunch of places where you can ask Pararescuemen, 18Ds or a Doctor about their experiences.


----------

