Paramedics rely heavily on their equipment to provide the best care. Among the many tools in their arsenal, IV infusion pumps play a pivotal role. They provide the ability to administer medications and IV fluids with defined dosing, flow rates, and controlled target volumes directly to patients with speed, accuracy, and confidence. But while many other key EMS tools and technologies have advanced and progressed over the years, the IV infusion pump has yet to undergo a true mobile renaissance.
Today most paramedics use gravity-powered manual infusion therapy methods. This requires them to calculate medication doses by hand and then hang infusion bags high enough that gravity can play its role. In the meantime they need to count the individual drops in a drip chamber controlled by a roller clamp or with intravenous IV flow regulators (IIFRs) that correlate to the correct dosage.
Outside the hospital care is provided in nonideal settings. This can be problematic, as the transportation of patients can interfere with gravity-powered infusion’s drip rates. Additionally, many clinicians struggle with performing the manual calculations required during stressful situations. In fact, in a study analyzing medics’ medication calculations, researchers found their performance was poor, with IV flow rate and medication bolus problems found in 69% of cases.1 These miscalculations can lead to additional patient deterioration.
Additionally, according to a more recent article, significant variation in IIFR volume was observed across all devices even in static laboratory environments. These findings add caution to the use of IIFRs overall, as they could lead to inaccurate medication dosing.2
The few paramedics who currently have access to advanced infusion pumps often use multichannel hospital pumps, which are large, expensive, and not built for rigors of the prehospital environment. The motion and turbulence of transport can also set off false alerts, which I have experienced innumerable times.
This is one area where our less-than-ideal approach could benefit from new innovations.
EMS-Ready Infusion Pumps
To address the needs of EMS teams, infusion pumps used in these settings must be capable of performing during a multitude of unpredictable scenarios.
When we arrive at an emergency, we assess the scene, gain access to the patient(s), make a field diagnosis and treatment plan, begin treatment, and then navigate transporting the patient(s) to the hospital. During that time the nature of the environment and the patient’s underlying disease process can contribute to a rapid decline in their status. In training with EMS teams for these types of scenarios, I’ve found it’s crucial that equipped infusion pumps are easy to use and have a small footprint so our teams can easily transport them where they’re required and quickly begin administering care when we recognize the need. In these challenging situations, the traditional hospital pumps some use cannot be operated in their usual mounted configuration—they simply aren’t designed for the prehospital setting.
That’s why pumps need to be outfitted with the proper infusion sets and accessories to negate all possible errors, including air-in-line alarms, to ensure optimal performance no matter the surroundings. Drops and spills are far more common during EMS situations than they are in hospital settings, and pumps need to be reliable despite these obstacles. To that end pumps also must be transport-rated, indicating they can withstand the temperatures, motion, and electrical interference of out-of-hospital environments.
Long-lasting batteries are essential to ensure we can provide care at all times. Further, the more these systems can be automated with presets and preprogrammed drug libraries, the more we can prevent errors in fast-paced response scenarios.
Every Second Counts
In an ever-changing world, it is important our emergency care providers be equipped with essential infusion devices that allow them to provide the best care possible. Medical device manufacturers need to learn from the pain points field providers have endured and develop devices that meet our specific needs, rather than simply expecting a pump designed for the hospital to function optimally in a prehospital setting.
1. Hubble MW, Paschal KR, Sanders TA. Medication Calculation Skills of Practicing Paramedics. Prehosp Emerg Care, 2000; 4(3): 253–60.
2. Loner C, Acquisto NM, Lenhardt H, et al. Accuracy of Intravenous Infusion Flow Regulators in the Prehospital Environment. Prehosp Emerg Care, 2018; 22(5): 645–9.
L.J. Relle, BBA, NRP, FP-C, CCP-C, is a career firefighter and paramedic who has served the greater New Orleans area for more than 15 years. He has performed various roles in high-volume fire/EMS/critical care agencies and is a veteran of Hurricane Katrina and many other industrial and natural disasters. He also serves as a consultant to Eitan Group, a global leader in advanced infusion therapy solutions across the care continuum, developing EMS-optimized infusion solutions.