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I feel good.... . . .
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Well, Navigator, you asked for it.... .. . . .

What situation would a non-licensed person be justified in initiating IV therapy? What medicines would one deliver, what fluids would one give, how much, why, what problems would one be treating?
 

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You’re right, Woody Creature, I asked for it. And knowing this group, they’ll probably let me have it, too.

Two ground rules, to start with...

First, everyone needs to understand that it's not our purpose to establish Standards of Practice or ethical guidelines. Some of our members have raised the question of adding IV treatment to their survival medical capabilities, and they deserve well-reasoned and courteous answers, without the chair-throwing that seems endemic to the site.

Second, we’re talking about an End-Of-The-World-As-We-Know-It scenario, without any professional help available. Nothing. Nichts. Nada.

Having said that, are there any situations where non-licensed personnel would be justified in attempting IV treatment after the Fall of Civilization?

With one or two possible exceptions, probably not. Here are some reasons why:

Setting and maintaining an IV line is the relatively easy part of IV therapy. The hard part is deciding upon the correct diagnosis, the correct medications to use and their correct concentrations. Much has been said about the dangers of a bungled IV insertion attempt; actually, I’m more concerned about the successful ones that start delivering fluids and medications into a patient when they’re not called for. Infusing extra fluid volume and improper medications when they’re not indicated is almost guaranteed to make a bad situation worse. Most of us can easily handle the lesser sequelae of a botched IV attempt, but who wants to take on a case of pulmonary edema brought on by fluid overload?

On top of that, there are considerable risks involved in just setting an IV line. Site infection, hematoma, infiltration and peripheral nerve damage are things that even licensed professionals have unintentionally inflicted on their patients. (Not to mention septicemia from contaminated IV fluids, which will be a very real danger after the Fall of Western Civilization.)

Weighing the risks involved against the probability of delivering actual benefits, most survival groups probably would be better off investing their resources and training in learning how to provide less invasive modes of treatment, and leaving the possibility of IV therapies to the really advanced groups who have the qualified personnel.

Now, could there be any exceptions to that conclusion? Well, consider this situation:

It’s a year after the Fall, and one of your group members has been brought back from the field unconscious, showing all of the classic signs and symptoms of hypovolemic shock brought on by severe dehydration. Would a person with basic medical skills be justified in trying to administer IV fluids in this case?

I dunno. This is outside the range of my experience. I’ve assisted in resuscitation efforts during life-or-death situations, but only with an M.D. right at my elbow, calling the shots. I’ve never handled one on my own. But we do have members who have handled similar (and far worse) situations on their own without a physician available, and it’s their knowledge and experience that we need to draw on here.

So guys, what are your thoughts on the matter? I'm turning this patient over to you.

(And remember, we’re all kindred here. Be civil.)
 

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Scarred for life...
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A non licensed person would very likely not be able to recognize many of the signs that someone would need IV fluids or medications, unless those signs were very obvious.

With that said, starting and running an IV is not easy, especially if you've never done it and not been trained at all.

I would be willing to bet that if 100 inexperienced people were asked to start an IV 99 of them would either kill or injure their patient without having provided any help whatsoever.
 

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I have done numerous IV's in the Army, and for some reason, I was always able to stick perfectly, every time. I checked for signs of dehydration(if not administering fluid for GSW, ect) and would determine the right amount of fluid, which was a pretty general guesstimate, honestly.
 

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viam inveniam aut faciam
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I have done numerous IV's in the Army, and for some reason, I was always able to stick perfectly, every time. I checked for signs of dehydration(if not administering fluid for GSW, ect) and would determine the right amount of fluid, which was a pretty general guesstimate, honestly.
And the likes of you have more training than the average Joe. Hopefully in the next few months I'll have very similar training too, so I would probably agree with you in the sense that those with training could do it with a relative degree of success.

If you have no training, and have never administered a IV before, I would have to say that you should NEVER administer one....Period. Other routes of entry exist, and should be strongly considered.

That's not to say that you cannot educate yourself to the point of administering an IV though. If you're able to get your hands on a good reference book, or have another who has had training, your chances go up dramatically imo.

Regardless, the prognosis for anyone who's on the receiving end of such medical interventions in a SHTF or EOTWAWKI would be quite poor because you would not have the resources to combat the typical complications (ie. infections).

Just my $0.02 (CDN funds) :D:
 

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I would say if the need post SHTF then anyone with at least emt but times right now... only licensed professionals should adminster advanced medical care. There are times that you need lactated ringers, other times you need normal saline, others you need dex... you need to know what each is used for or you can make a bad situation much worse. If you are that interested I would look into taking emt-i course at least to learn emergency medical care.
 

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-It’s a year after the Fall, and one of your group members has been brought back from the field unconscious, showing all of the classic signs and symptoms of hypovolemic shock brought on by severe dehydration. Would a person with basic medical skills be justified in trying to administer IV fluids in this case?
Sorry I missed this scenario in my above post.

The objective of prehospital fluid resuscitation is not the return of normal vital signs but the stabilization of vital signs until the patient reaches the trauma center.
-Essentials of Paramedic Care ISBN: 0-13-098792-1


I take that as a grain of salt, given the rules of this scenario. However, I keep in mind the purpose of a 'fluid resuscitation'.

Unless I had supplemental O2 I would be very reluctant to increase the volume of de-oxygenated fluids into the casualties system, unless I could monitor the causalties sats and they were normal (in which case I would be curious as to the level of consciousness and other vital signs).

Hypovolemic shock is, shock caused by a lack of fluids profusing into the tissues of the body supplying them with nutrients (generally blood loss). The last thing I want to do, is treat the initial problem - in this unlikely case, dehydration - and have my patient's issues cascade into something worse. And my thinking atm would have me question whether or not I want to risk oxygen saturation to increase fluid volume.
 

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I can not over emphasize the value of training in wilderness medicine. Wilderness medicine courses teach you how to treat patients for a the long term when 911 is not an option. The problem with all "regular" emergency medical training is that the answer is always the same: stabilize and call 911/ medevac. This will not be an option in a SHTF scenario. There are three organizations that offer exceptional training in wilderness medicine: Wilderness Medical Institute (WMI) of NOLS http://www.nols.edu/wmi/, Stoehearth Open Learning Opportunities (SOLO) http://www.soloschools.com/index.html, and Wilderness Medical Associates (WMA) http://www.wildmed.com/. The Red Cross even offers a pretty good intro course called Wilderness First Aid- Basic ( of which I am an instructor)

I got my Wilderness EMT through SOLO. The value of this training was priceless.
 

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Woody to put it plain and simple if you have never been trained, yes I said trained not licensed, to administer an IV you need to get it out of your mind. The others have posted correct information but I must stress that it is just like any other medical procedure if done at the wrong time, for the wrong reason it might prove fatal.
 

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"Dolt"
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Training on IV insertion does not give you the hows and whys of IV therapy.

There is a very indepth science that goes way beyond the insertion. If you can not, with educated decision making, give justification of what your giving and why then you should not be doing it.

There is much more to it then just saying "he's hurt, give him an IV".

Example, dehydration is a great reason to give IV fluids (at a no more then 1ltr per hour rate), GSW not so great (other then for venous access for advanced meds and additional blood if needed).
 

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WB edited to specific:
Example, dehydration is a great reason to give IV fluids (at a no more then 1ltr per hour rate), GSW not so great (other then for venous access for advanced meds and additional blood if needed).
One of the changes in TCCC (Tactical Combat Casuality Care) that came out of the Blackhawk Down episode (and all the experience gained since) was a change in IV policy for GSW's and other similar wounds.

For such wounded people.
Awake, alert, oriented - saline lock
Other - IV TKO and if necessary to help alleviate hypovolemic shock. Generally not more than a couple of bags of Ringers. (They have newer better stuff but Ringers Lactate is a standby.) More than that, you wind up with watered down blood and and start causing problems.

So - one good answer to the untrained person question is a definte maybe.
 
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Never never never never. You need to find a friend who's a doc, nurse, or medic.

Dehydration or ANYTHING other than hypovolemic shock does not always need IV treatment. The absorption rate in the colon is 90% more than drinking. If you've got a dehydration Pt. take a Camelback and cut the bite valve off, lube the tip, shove it up the chuff, and hang it like you would an IV bag.

Also, remember any medication that can be given orally can also be administered rectally. If you've got someone who can't swallow or is repeatedly vomiting keep that in mind.

I still encourage each and every one of you to take AT LEAST an EMT-B course. It's well worth the effort.
 

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Well, I learned something new in school today...

Actually, I didn't know that the colonic absorption rate was 90% greater than the oral rate. MountainMan sent me a PM just a few hours before Kuting's post, containing exactly the same information. Our troopers know their stuff.

And the fact that I didn't know is a little embarrassing. The replies to this thread and to the one about suturing training have made it pretty clear that I've got two choices: either get some kind of EMT certificate from the local community college, or else go to the kitchen and pour myself a nice big cup of Shut The %@&! Up.

Navigator has seen the Light. He's found True Religion.
 

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Well, I learned something new in school today...

Actually, I didn't know that the colonic absorption rate was 90% greater than the oral rate. MountainMan sent me a PM just a few hours before Kuting's post, containing exactly the same information. Our troopers know their stuff.

And the fact that I didn't know is a little embarrassing. The replies to this thread and to the one about suturing training have made it pretty clear that I've got two choices: either get some kind of EMT certificate from the local community college, or else go to the kitchen and pour myself a nice big cup of Shut The %@&! Up.

Navigator has seen the Light. He's found True Religion.
Community college is going to ream you with price, pump a bunch of classroom crap in your head and tell you you're ready to "Do work son!"

I would advise going to a hospital and getting training from them. Most of them base their class schedules around working folks so it's not nearly as bad as working and trying to go back to school. Get on with a volley Fire Dept or an ambulance service. Sure it may suck being a taxi driver, but when you don't use those skills you lose them. The market here for EMT-B's with no experience is non-existent, so I usually flip through a lot of notes, books, and go through scenarios at work to occupy myself on my forklift and to remember what to do.
 

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Well, I learned something new in school today...

Actually, I didn't know that the colonic absorption rate was 90% greater than the oral rate. MountainMan sent me a PM just a few hours before Kuting's post, containing exactly the same information. Our troopers know their stuff.

And the fact that I didn't know is a little embarrassing. The replies to this thread and to the one about suturing training have made it pretty clear that I've got two choices: either get some kind of EMT certificate from the local community college, or else go to the kitchen and pour myself a nice big cup of Shut The %@&! Up.

Navigator has seen the Light. He's found True Religion.
Nope - keep learning. Here are a list of books you might want to have in a TEOTWAWKI.

Survival and Austere Medicine: An introduction
by BCE/RR/GM/GL/TG/SG/RQD
www.aussurvivalist.com/downloads/AM%20Final%202.pdf

Where There is No Doctor
Where There is No Dentist
http://www.hesperian.org/publications_download.php

Ditch Medicine
http://www.scribd.com/doc/2205119/Ditch-Medicine-Advanced-Field-Procedures-For-Emergencies-1993

The Ship Captain's Medical Guide
http://www.mcga.gov.uk/c4mca/mcga07.../mcga-dqs_st_shs_ships_capt_medical_guide.htm

Special Operations Forces Medical Handbook (Book Only Edition) (Ring-bound)
Amazon dot Com
Try to get the companion CD - the videos and pictures are worth the effort.
If you have a PDA:
www.findmysoft.com/pda_mobile/Special-Operations-Forces-Medical-Handbook-download.html

HOWEVER, the original Special Force's medical guide was completely supplanted by the SOF medical handbook noted above. The following are some quotes about the original SF manual:
“That manual is a relic of sentimental and historical interest only, advocating treatments that, if used by today’s medics, would result in disciplinary measures,” wrote Dr. Warner Anderson, a U.S. Army Colonel (ret.) and former associate dean of the Special Warfare Medical Group.

“The manual you reference is of great historical importance in illustrating the advances made in SOF medicine in the past 25 years. But it no more reflects current SOF practice than a 25 year-old Merck Manual reflects current Family Practice. In 2007, it is merely a curiosity.”

“Readers who use some of the tips and remedies could potentially cause harm to themselves or their patients.”
There are others who have posted in this discussion that can point out the best EMT etc manuals.
 
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"Dolt"
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Reading a PDR does not a physician make.


Book/manuals/guides are great to have on hand but they can not and should not be considered a substitution for hands on training.

They are and should be considered a supplement to training received where hands on has been taught and is understood.
 

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Reading a PDR does not a physician make.


Book/manuals/guides are great to have on hand but they can not and should not be considered a substitution for hands on training.

They are and should be considered a supplement to training received where hands on has been taught and is understood.
Doc Young,
You're right on all 3 sentences above.


What I'm trying to accomplish with the above listings is to provide another source of information for those who - for whatever reason - will not be able to attend the training.

In a TEOTWAWKI or long term SHTF, I strongly suspect a large part of the US will drop back to Post-Civil War/Pre WWar One levels of medicine.

In that world, the EMT-P's, Nurses, Combat Medics etc who will, will have to step up and take up the slack.

In the spirit of the original question "What situation would a non-licensed person be justified in initiating IV Therapy" I'm trying to do two things:
1 - give the person an idea of just how much knowledge is needed to determine the WHEN it should be done.
2 - give the person a base knowledge to work from if such a bad situation should arise.
 
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Hello all,
I am just a lowly emt-b in iowa, but what I know about iv therapy from those that practice everyday, is that without the proper training ie: signs,sypmtoms, and proper diagnosis is that i am not even planning on having ivs with me. i am on 2 volunteer ambulance services and have seen enough to know when i shouldnt touch something. btw emt-i is not going to be valid as of sometime in 2010 in ia anyway. emt-p or emt-ps are the only emt levels to offer much in the way of iv instruction. also, speaking from iowa statutes, to gain your emt certificate, you need a sponsoring agency, class time, clinical time and ride time on an ambulance service that is full time and not the one sponsoring you. hopefully i didnt just take up space with this.
 

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I saw untrained medics in 'nam do some amazing sh*t, you would be surprised at what you can do when the situation calls for it. IMO, during a shtf situation, no doc's available it would be better to do something than nothing.
 
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