DZ first aid kits and IV's

[jclalor 12]

I was reading in the safety section that it's recommended to have an IV starter kit along with fluids in the first aid kit.
As a nurse I was wondering about the legalitys of starting an IV without an order.
I mean if it was a very apparent life or death situation I would have no problem.
Does anyone know the legal stuff on this?

[mamajumps 0]

As an EMT, I know that nearly everyone that goes for a ride with us (unless it is just a pure BS call, I have a paper cut, need to go to the ER person) they get an IV. If the situation warrants it, it would only be a time saver, in my opinion... granted there was someone on scene who knew how to start a line....

[kkeenan 13]

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...if it was a very apparent life or deaf situation

I think that hearing-impaired people deserve first aid too.

_____________________________________
Dude, you are so awesome...
Can I be on your ash jump ?

[tombuch 0]

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I was reading in the safety section that it's recommended to have an IV starter kit along with fluids in the first aid kit.
As a nurse I was wondering about the legalitys of starting an IV without an order.
I mean if it was a very apparent life or death situation I would have no problem.
Does anyone know the legal stuff on this?

As a former EMT and Safety and Training Adviser I agree with your concern. An IV should only be started with an order from a physician, by a person who is trained to do so, and performing under a QI program. If a drop zone has a physician who frequents the DZ then it might be reasonable to have the equipment he needs available, but I'd rather see him/her take charge of that and not leave IV's and other medical equipment around. The exception would be if an agreement has been reached with the local rescue squad/company, and they would like to have the equipment staged on site for first responders who arrive before the rig.

And of course if a skydiving-physician is going to give orders on site, then he needs to be willing and able to do the work needed, and not just use his license to authorize somebody else to take action...I'm thinking of a podiatrist or another medical professional who doesn't deal with trauma on a regular basis trying to one-up the experienced emergency responders. I've seen that happen, and damn does it create a bunch of bad-will that takes years to recover from.

Tom Buchanan
Instructor Emeritus
Comm Pilot MSEL,G
Author: JUMP! Skydiving Made Fun and Easy

[slingerapie 0]

I don't really understand why these things are recommended on a DZ? These stuff are sterile. If not used prior to the date, you can throw it away. Not sure if an IV starter kit is different, because I am not from the states and maybe you have other stuff there.

And, what are the chances that if an accident happens and a person should need an IV, that there is actually someone around who knows how to use it? I am an ER nurse here in the Netherlands, and am authorized to give a person an IV acces. But I am not at the DZ all day every weekend! I do keep the emergency kit up to date so in case of minor injuries (scratches, small cuts, distorsions etc) that person can be helped at the DZ.

But then again, maybe you americans have different rules about this. I think, if someone needs an IV, just let the paramedic (ambulance) do it, it is his/her job, and I think they would be happy if the person needing the IV isn't already been poked a few times....

But this is just my opinion, as said, haven't been on an american DZ (yet) so not sure if the rules are very different....
Illona

Don't try to live forever, you will not succeed!

[Broke 0]

You know I don't think that in the United States that an IV kit and fluids should be available on the drop zone.
Even if you have a medic on scene. It may creat some bad feelings with the locals if he starts an IV, and they don't get to play.

And anyway it is more important to stop bleeding then it is to start fluids. Remember Normal Saline can't carry oxygen.

Divot your source for all things Hillbilly.
Anvil Brother 84
SCR 14192

[JohnnyD 0]

If you are already a nurse, you should know better.

[grimmie 176]

Each county in the US has an entire different EMS protocol to be followed by trained responders.
In some locations only a paramedic can start an IV and in others an EMT with special training can start one. Some places only allow RN's to start IV's. Doctors sort of get to do anything they want in any jurisdiction, if their malpractice insurance is paid up(just kidding).

The only thing an IV will do is replace fluids if someone is bleeding out internally. An external bleed can be stopped.

I have used more IV bags for a sterile flush on road rash, open fractures than fluid replacement.

IMHO I think the ABC's of first aid, proper gear removal/packaging and a rapid transport saves most severe cases at the DZ.

[slingerapie 0]

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If you are already a nurse, you should know better.

Not sure what you mean by this reply?

Don't try to live forever, you will not succeed!

[riggerrob 558]

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If you are already a nurse, you should know better.

Not sure what you mean by this reply?

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If you are already a nurse, you should understand local laws concerning IVs in your state.

Laws vary so widely from province to state to nation that generic advice on this forum is worse than useless.

[Andy9o8 0]

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Laws vary so widely from province to state to nation that generic advice on this forum is worse than useless.

...and yet, we read it on here almost daily. It's a losing battle.

[slingerapie 0]

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Quote

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If you are already a nurse, you should know better.

Not sure what you mean by this reply?

.........................................................................

If you are already a nurse, you should understand local laws concerning IVs in your state.

Laws vary so widely from province to state to nation that generic advice on this forum is worse than useless.

Guess you didn't read my post very good than. I am not even from the united states. And yes I know the laws in my own country about IV's. That is why I said that I don't know how things are handled over in your states. Just wanted to say that in my opinion there shouldn't be IV's in a DZ first aid kit.

So I agree that if laws in every state of the US vary so much, it is useless to say something about it. But one can always give an opinion....

Don't try to live forever, you will not succeed!

[JohnnyD 0]

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If you are already a nurse, you should know better.

Not sure what you mean by this reply?

In the US, nurses are licensed by the state they work in. Lose your license, lose your job. Many states have reciprocal licensing, which means that your license will be recognized in another state. California and New York are exceptions to this rule, where the requirements are more stringent.

To the point, most nurses would never do something knowing that they are putting their license at risk.

Example (true story): very hard landing close to manifest and packing area. Jumper is down with obviously broken arm, scraped up, and has hit his head, but not very hard. Some well meaning guys who are not medical professionals start an IV while waiting for the ambulance. I am standing next to a registered nurse and she informs me not to even let anyone know she is a nurse. Wants absolutely nothing to do with the situation. Paramedics arrive to find the jumper in the landing area with an IV. They refuse to even touch him before radioing in and documenting that he already had an IV started because they don't want to be responsible if anything happens. They also refused to take the IV out. They made the guys that started it do it.

Summary - I don't think IVs have any place in a dz first aid kit.

[tetra316 0]

Your post almost makes it sound like that nurse would rather stand by and do nothing just to protect her job instead of helping someone who may be seriously injured. I hope that's not the case as it sounds like this guy was just badly shaken up

[JohnnyD 0]

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Your post almost makes it sound like that nurse would rather stand by and do nothing just to protect her job instead of helping someone who may be seriously injured. I hope that's not the case as it sounds like this guy was just badly shaken up

In a way, you are right. She was not protecting her job, but her license and career. The paramedics had the same response and fortunately, the kid wasn't badly hurt.
Interestingly enough, the very same nurse has given minor first aid such as cleaning and bandaging wounds before the person went for stitches, taking temps, watching for dehydration in instructors that had 14 too many, cactus needle removal, etc.
It speaks to the reluctance of qualified people to get involved in situations where they can ultimately do more harm to themselves than good for others.

[fred 0]

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Some well meaning guys who are not medical professionals start an IV while waiting for the ambulance. I am standing next to a registered nurse and she informs me not to even let anyone know she is a nurse.

She should talk to her hospital's counsel about Good Samaritan laws, and possibly "Duty to rescue".

Most states would protect her from liability if she attempted to help, and a couple states would punish her since she refused to help, despite her training.

[grimmie 176]

http://www.medi-smart.com/gslaw.htm

[riggerrob 558]

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Your post almost makes it sound like that nurse would rather stand by and do nothing just to protect her job instead of helping someone who may be seriously injured. I hope that's not the case as it sounds like this guy was just badly shaken up

.......................................................................

Welcome to the American legal system.

[kkeenan 13]

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Welcome to the American legal system.

Yeah. In Canada, there's a paid EMT crew standing by at each DZ 24 hours a day...

_____________________________________
Dude, you are so awesome...
Can I be on your ash jump ?

[ladydyver 0]

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Your post almost makes it sound like that nurse would rather stand by and do nothing just to protect her job instead of helping someone who may be seriously injured. I hope that's not the case as it sounds like this guy was just badly shaken up

.......................................................................

Welcome to the American legal system.

yep....it can be a sticky situation. I would have no problem starting a line if it needed to be done.....but I was an er nurse for 8 years and work as a nurse practitioner in the er. of course it probably helps as I almost always have my favorite er doc around where ever I go. As far as making the locals angry because they didn't get to play....don't think that is really an issue - we are all here to help people..and if they have a fit, well in my opinion they should reflect about their behavior.

As for our Dz we are very spoiled....we have several flight nurses, a couple of ER docs, a cardiologist, a couple of EMS people and me (np). We have the supplies there but it is locked up and only certain people have access. Our DZ is in a rural area and it takes time for any response to occur so for us to have those things around is a good idea.

DPH # 2
"I am not sure what you are suppose to do with that, but I don't think it is suppose to flop around like that." ~Skootz~
I have a strong regard for the rules.......doc!

[jdthomas 0]

Protocols for starting IV's can not only very from state to state but county to city.
Starting a line is not a life saving medical intervention and as stated is only fluid replacement. IV's no not carry oxygen which cells need to survive.
Starting a line and not being trained to do so can be dangerous to the patient, embolis from cath shear are serious issues as well as infection.
Good samartin laws are a joke, they will not stop you from being sued and even if you win, you loose because it's expensieve and stressful to fight that stuff.
Duty to act is a big deal, does your stae, county, city requier you to act even if off duty? most cases not and if you are like me I travel to DZ's that are out of my state and i am not licesend in those states. I have no duty to act at an emergency and if I do then I assume the liability..
IV's, if your dz can even get one have no place in the wrong hands and people.. i can't stress this enough. if you are not medically trained do not rush out to take off someones rig so the emts don't get cut happy on it.. this is a foolish mistake that could cost your friend spinal damage that may not already be there, simply get some first aid trainging, hold there c-spine and maintain an airway until the ems people arrive on scene.
soap box rant over!
Joe

www.greenboxphotography.com

[Broke 0]

I would take an ER nurse over a NH nurse any day

Divot your source for all things Hillbilly.
Anvil Brother 84
SCR 14192

[skydiver30960 0]

The idea of exactly what was necessary in a DZ medical kit was a topic of past (and future) discussion after an incident at my DZ. We'll all get our heads together and restock our gear bag, but as a medic and RN my gut feeling in the matter is K.I.S.S.

We need the gloves and masks (and maybe a BVM)necessary to safely administer CPR;

We need some gauze, wraps, and tape to control life-threatening bleeds;

We need a small supply of splints or SAM splints (good for a kit) for splinting injured limbs;

I would LOVE to see an AED at the DZ although it probably won't happen because of $$$;

...and that's about it, IMO. All of this should EASILY fit in a very small duffel bag, or "tick bag" to use the vernacular.

DZ's don't need IV supplies, for all the reasons mentioned above;

DZ's don't need immobilization gear; the EMT's will bring their own, and will DEFINITELY want to immobilize the patient themselves;

DZ's don't need oxygen, it's another "Rx only" supply that would be difficult to maintain even if you could legally get it.

DZ regulars who want to "do good" when a friend gets hurt don't need to know how to start IV's or administer heavy duty medications. Instead, they should get CPR certified (definitely), get basic First Aid (if you want to), and learn the few hotpoints that come with managing someone who may have head/spinal injury (i.e. anyone who has been in a skydiving accident), such as maintaining c-spine stability, turning in unison, and maintaining a patent airway.

Elvisio "dazit" Rodriguez

[Broke 0]

YOu know AEDs have come down in price drasticaly. If you really shop around you can get a really good price on them too. I bought 5 AEDs for the company I work for with all the accessories needed for it to work and I got it all for less than Half of the MSRP

Divot your source for all things Hillbilly.
Anvil Brother 84
SCR 14192

[skydiver30960 0]

Totally with you on that one, except in addition to the price I'm worried about the upkeep. If somebody doesn't stay on top of it, and keep shelling out the bucks for the preventative maintenance, then it's useless.

We'll see...

Elvisio "clear the patient" Rodriguez