Field lab draws by ALS

[Ridryder 911]

Although, infection should and is a concern in the prehospital arena, I have yet seen any major studies showing an increase of infection rates of those initiated out-of-hospital setting versus those in-hospital setting. I am concerned that this might be a "concern" or be based upon anecdotal theories. Even the evil thoughts of poor recognition of this profession (EMS) and increasing financial means comes to mind.

I know it is not unusual in some settings for the I.V. to be re-initiated from one department to another. Even though, medicine has came a long way, it has a long way to go in barbaric thoughts. Because the site was not "cleansed" (if one really could do such) as in a prescribed manner..and to re-institute another opening and pain to patient as well as costs, should be weighed heavy. Unfortunately, it is not us in EMS that makes such decision(s).

Again, I would like to see specific studies, citing microbial infection rates of those from EMS to in-house hospital initiation. Our hospital did an informal one several years ago, to emphasize to us "medics" the need to place betadine ointment on top of the puncture site.. Ironically, we had a 28% less infection rate of those in-hospital rate... and they quit using the ointment as well. ...........

Be safe,

R/r 911

[paramedicmike]

Looking back at my initial post questioning infection rates, I didn't intend for it to sound like I was badmouthing RNs. I can see how it would come across that way. I hope, despite my poor language skills at this late hour, noone took it that way.

I understand that hospitals have policies regarding certain things. I was just wondering if they had info I hadn't come across yet.

Thanks for the info!

-be safe.

[Spock]

There is no doubt our hospital policy is anecdotal but it is the policy. Like I mentioned, we have no control or input over local EMS which is very fragmented and ranges from excellent to very bad. The good get lumped in with the bad.

Live long and prosper.

Spock

[BlueLifeSaver]

Our service allows blood draws in the field, and, as far as I know, the lab accepts tubes that are filled with enough blood. As long as a service holds a Labratory License issued by the state, everything is fine. 9 times out of 10, every time we start an IV in the field, we draw the rainbow as well. It's very rare that we don't draw blood when we start an IV. Also, I think it's far better to draw blood in the field then to have the patient be "stuck" again in the hospital. It's less trauma for the patient, and a better use of resources.

[Dustdevil]

Our service allows blood draws in the field...

And I suspect that most of you draw blood simply because it's "allowed," and not because it is actually needed.

The question was, do your receiving hospitals actually use the blood, not do you draw it.

[Nate]

Our primary hospital supplies us with the materials to draw blood, however they have asked us to only draw blood for the following:

Cardiac Pain, Cardiac Arrest (if we have time), or Observed Cardiac Dysrythmia

CVA, TIA, or Stroke Like Presentation

AMS

Suspected Drug Use or Overdose

Other hospitals is a different story, I don't generally draw blood unless the doctor/nurse I'm giving report to requests it (I do offer) because I see no point in wasting materials and the risk (most people don't believe that there is a risk with blood draws, but there is).

As far as gray tubes (thats the color of PD's alki tubes), we don't draw blood for PD. If they want blood then can ask the hospital to do it (which they usually do).

[ffpm41]

Our hospitals keep our IV's unless there is a question on how clean the start was. As for blood, for the most part they only use the green for the I-Stat for suspected cardiac calls.

[Leon]

Here in SA we don't draw blood prehospital. It might be to much work?????? :?:

[Medic26]

Our local facility does not accept, but all of the others will accept pre-hospital labs. We generally don't draw them here at all.

As far as pre-hospital IV's........they use ours here. I don't know of any local facilities that pull them.

[fiznat]

In Hartford we have 2 major hospitals we transport to (a lvl 1 and a lvl 2)- the lvl 1 hospital does not accept EMS blood draws, but the lvl 2 hospital does.

As far as techinquie and "accurate" blood draws or whatever, I'm in medic school right now and we do clinicals at the same level 2 facility I mentioned above. We do blood draws in the ER all the time as part of IV practice, and the instruction/technique is exactly the same as that performed in the field. I see no reason why EMS blood draws should be treated any differently than an ER blood draw as the technique (and equipment!) is exactly the same. Also, even in the ER I was never taught any specific order to fill the tubes, so I dont know how much that really matters...

Like I said, I'm just a medic student right now but I really dont see any good reason to deny EMS blood draws other than as an attempt to control who gets to charge for the service.