Question: ALS paramedics have directives as to when they must attend/start IV's to give meds in various situations/bolus etc. The directive for starting an IV is for the "potential need" for an IV, administering meds or bolus. Are there specific times we should always attempt an IV if time permits? (pre arrest, post-ictal, chest pain with past nitro use etc?)
Thanks for the question. When establishing an IV, one should always consider the indication. Meaning, the IV itself is literally just a port for a medication or fluid to be administered for a clinical situation described in the directives. It serves no therapeutic benefit by itself. Thus, while functioning in the PCP role, there is currently not a seizure directive (though there is a proposal for one), and fluid boluses and IV meds in cardiac arrest are not covered by a directive.
So, to answer your question, the IV directive has been left deliberately vague to allow paramedics to interpret the myriad if individual scenarios they are confronted with to determine if an IV would be beneficial or not. To list all of these scenarios in your directives is unfortunately just not practical. Specific incidences however (such as hypovolemia with hypotension) are specified, and paramedics need to be familiar with these directives.