jeepmedic
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Where you think I learned it from?
intubation as a basic skill
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Where you think I learned it from?
depending on the day and time, about right
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The biggest issue with intubation is that providers are taught it once, practice it a few times on dummys and "Easy" OR patients, and then they are cut loose.
You need a good QA/QI program with intubation, and the ability to have staff spend some time in the OR as an on-going thing so that they can KEEP their skill up.
You need a good QA/QI program with intubation, and the ability to have staff spend some time in the OR as an on-going thing so that they can KEEP their skill up.
KEVD18
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the most important fact about intubation as it relates to this discussion is that it is a skill. a mechanical skill. being such, it can be taught to anybody that posses the physical ability to perform it. its not terrifically complicated.
the only argument against bls intubation would be medication. basics cant carry the meds commonly associated with intubation(versed, etomidate, succinylcholine, vecuronium et al). to counter that, essestially the only time a basic should be tubing is in the worst possible situation. a code comes to mind. for the medics out there: wouldnt it be nice to get the call for the intercept, show up on scene with iv access and ett in place. now all you have to do is hook up your monitor and push your drugs. better for you. better for the pt. better all around.
to have the attitude that a person cant be taught to intubate because they're "just a basic" is pigheaded, rude and smacks of the over inflated egos commonly associated with the paragod.
the only argument against bls intubation would be medication. basics cant carry the meds commonly associated with intubation(versed, etomidate, succinylcholine, vecuronium et al). to counter that, essestially the only time a basic should be tubing is in the worst possible situation. a code comes to mind. for the medics out there: wouldnt it be nice to get the call for the intercept, show up on scene with iv access and ett in place. now all you have to do is hook up your monitor and push your drugs. better for you. better for the pt. better all around.
to have the attitude that a person cant be taught to intubate because they're "just a basic" is pigheaded, rude and smacks of the over inflated egos commonly associated with the paragod.
Fedmedic
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F' en ey, that's what I have been saying all along. Thanks for the reinforcement.
If they are pulseless and apneic and you intubate them and screw it all up, what have you lost; they were dead to start with.
Ridryder911
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Because that would be "gross incompetence and negligence". Just because the patient is in cardiac arrest, does not exempt competency and performance. Why not crack the chest? Their dead right, what could it hurt?
Actually, it is the ignorance of realizing that intubation is much more than a "skill". Should basics be allowed to place NG tubes as well, or maybe foleys' as well? Since all skills are really only mechanical. Heck, even crich's, chest tubes are just skills?
It always amazes me it is always those without the education and knowledge to attempt to justify their existence, and as well add procedures to which they have not a clue or have an in depth knowledge of this process.
Intubation will not be added into the new curriculum, in fact discussion is being made of even potentially removing from the Paramedic curriculum. Since the new advances of alternative airways, recent studies of inadequacy of even Paramedics' not being able to maintain proficiency.
There is a reason most states do not allow basics to intubate.... they are not educated enough. This is not demeaning, just the truth, the same reason they are not able to administer medication (even though you may assist in administering nebulizers', and yes some of the non-harmful medications such as ASA.) I should highly recommend those that are "bragging" about administering Ipecac and Activated Charcoal to obtain and read the new suggested national guidelines. Ipecac has not been recommended for several years, as well as now most poison centers do not recommend Activated Charcoal in most poisons as well. Since new research is showing more harmful effects to no difference in outcomes without administering of those two medications.
One can argue on this forum and attempt to justify anything, but it will only fall on deaf ears for those that make decisions. Those that have formally been educated in advanced airway techniques, realize it is far more than a "mechanical" procedure.
Again, when one wants to perform an advanced level procedure then one go to school and learn appropiately.
R/r 911
The only reason I don't see EMTs or EMT-Is in Connecticut intubating with Et tubes is the lack of availability for OR time. They want paramedic students to get a minimum of 10 ET tubes to graduate. Some students have had to have extended semisters due to use of LMAs and other students (Docs, med students and paramedics). One school petitioned to use maniquins for 5 of the 10 to get their students through. They were denied.
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jakobsmommy2004
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THis is actually her husband writing now. I work primary response in Lincoln Park, MI as a paramedic. And be it a full code for a patient in asystole, or any other situation, I alway skeep it simple to start with. An OPA or an NPA, the idea is to maintain an airway, and ensure proper ventalation of the patient. Even the most current ACLS guidelines no longer push intubation as mandatory or the big necessity as it once did and our protocols effective the beginning of the year 07 will intoduce IO access even for the adult patients especially for the administration of cardiac meds being the preferred route when IV access is unobtainable in the field setting. With any piece of knoweledge you learn in your EMS career, keep in mind that just because you CAN do something, doesn't always mean you SHOULD do that particular intervention, if something less invasive can be performed and give you the same results. I have intubated three patients in the last 7 months, (and have been a medic for only 7 months) with 100 % success, but never without utilizing other methods first, continuing then with my ABC's then utilizing my intubation skills, not only verifying placement with auscultaion, colormetric changes on an ETCO2 detector, but also with capnography (not available on all LP12's) - we are just fortunate to have that luxury. In all cases I have found it best to be basic first in the field, then utilizing meds, advaced airway management etc, when absolutely neccessary, always with an "atta boy" from the receiving facility. So as you go on in your career, remember these three things: 1 - Just becasue you can, doesnt always mean you should. 2 - Doing whats right and doing the right thing arent always the same. 3 - Use your knowedge, clinical judgement, protocols, and On-line Medical direction R. Barron, NREMT-P
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jakobsmommy2004
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Of course it is more than a mechanical procedure... so it oxygen administration, or any other EMS skill. One should know much more than just the mechanical procedure before being allowed to do any medical procedure. This goes equally for medics as well as basics.
Basics could learn how to intubate just as easily as medics do. I learned how to do it in a continuing education class several months ago. It wasn't that hard, nor was the anatomy/physiology/etc behind it. Same for venipuncture. However, there is no reason to add it to the basic curriculum. We have a separation of skill levels, and adding intubation and IV access, etc to the basic curriculum only begs the question "why don't they just take the paramedic course?" We apparently have judged there to be a need for all three skill levels, and there are only a finite number of differences between what medics can do and what basics can do.
trauma1534
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To add to Fed's post... Virginia is a very VERY aggresive state.. esp in the parts we come from. We have standing orders for everything at every level of training. Each level is trained to the max of what they can legally get by with. Now, in Virigina, in this area, EMT-B's can and do intubate in code situations. Many times, they don't have any hope for a Paramedic to show up. Everything is done for the very best outcome in the patient. Unless you live here are are familure with the way we do things and have been in the situation as a Basic with no help on the way in a code, you don't have an arguement. Now... if you are an intermediate and you don't intubate your patient when it is needed... let's just say, I'd hate to be you standing in front of our Medical Director, or worse being in front of that patient's family in court. We are aggresive for a reason. Like I said before, why play around when you can have your airway secured. If you have been in EMS for any length of time as an ALS provider, then you would know that you have to stay ahead of the game and not behind it. If you waste time by fooling around with an OPA or NPA, then you are already loosing your battle with that grim reaper! Now... Meagan, again... I will ask you... how long have you been in EMS, and how many true ALS calls have you been on? Till you have been around and paid your dues and learned the tricks of the trade, you have no leg to stand on... with me... the courts and the office of EMS! YOU MUST KNOW YOUR AGUEMENT BEFORE YOU CAN PRESENT IT!!! Now, you are loosing your arguement with those of us who have been around and know our ****! Stay in EMS for a few years and come back and talk to us after you have had all that BS to fail on you and you have learned that what we are talking about is true! You sound like a true book-head rookie!!!
trauma1534
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I want everyone to take a wild guess... excluding Fedmedic, Jeepmedic and Prizenmedic who know me, what level of training am I?
Celtictigeress
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Alright.. .Meagan Im going to make this known to you and others that dont think emt bs can intubate.....or should not be taught...
Before we moved to Texas....I lived in SC in a rather rural Part....Basics are taught Intubation and it is permitted...We had a call in BFE SC the closest als was 15/20 minutes out it was raining and I as a basic Intubated Plain and simple had I not the Patient would not be living today it is something that SHOULD BE and NEEDS TO BE taught....and honestly if you are taught right.... then there are very few complications Im sorry a pt cant live without air if a patients airway closes off for whatever reason and the only way to salvage them is a tube and you go through protocol and training then there is nothing wrong with it...
just because you dont feel comfortable or perhaps secure in your skills doesnt mean others dont.....I feel rather damn secure in my skills.... and many others taught to practice do as well....its all about your mentality if the person is willing to learn then let them.... If a person isnt comfortable then they will tell you, I have NO issue with my practice...
Before we moved to Texas....I lived in SC in a rather rural Part....Basics are taught Intubation and it is permitted...We had a call in BFE SC the closest als was 15/20 minutes out it was raining and I as a basic Intubated Plain and simple had I not the Patient would not be living today it is something that SHOULD BE and NEEDS TO BE taught....and honestly if you are taught right.... then there are very few complications Im sorry a pt cant live without air if a patients airway closes off for whatever reason and the only way to salvage them is a tube and you go through protocol and training then there is nothing wrong with it...
just because you dont feel comfortable or perhaps secure in your skills doesnt mean others dont.....I feel rather damn secure in my skills.... and many others taught to practice do as well....its all about your mentality if the person is willing to learn then let them.... If a person isnt comfortable then they will tell you, I have NO issue with my practice...
Fedmedic
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I think SC, NC and VA as are a lot of other southeastern states when it comes to EMS. We have so many very rural settings without the luxury of ALS at a moments notice that we become very secure in our skills as BLS or ALS providers. And our OMD's and state governing bodies also recognize the need to have providers that can provide the best care possible, regardless of certification. Sometime that means letting EMT-B's intubate and do other procedures often reserved for more advanced providers. After all, we aren't in it for ourselves or our egos. We are in it to take care of the patients.
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Ridryder911
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Before you all "strut" your feathers too much I would not be comparing Virginia or the other 49 other states to Canada's EMS system. For as being "aggressive as the law allows"... that's total B.S. !
Compare Canada's Basic level with U.S. ... Hmmm don't think I would be doing this since theirs is about 4 times longer (1 year long) Now you want to compare? Their advanced level is 2 1/2 years long (collegiate level) and their Advanced Paramedic level is 4 yrs long with several hundreds of hours clinical time, including cath lab, multiple ICU/Trauma and Flight Services.. so before we start our "bragging rights" we might want to evaluate our own back door.
U.S. EMS education sucks! Period. We make multiple levels for excuses not advancement. Please, if a town really wanted Paramedics they would educate and hire them, not placing placebo ones on their place. One cannot tell me since the EMT/I is so close to Paramedic level in some states this is not a management technique to get cheap medics.
Basics have no need to perform advanced level procedures.. If the patient needs advanced level care then they need advanced level practitioners. Please don't tell how aggressive your state is then do not provide "true" ALS providers in >95% of your state. Compare this with Missouri that only has 2 levels.. Basic & Paramedic. They will get "true" ALS when there is an emergency.
R/r 911
Compare Canada's Basic level with U.S. ... Hmmm don't think I would be doing this since theirs is about 4 times longer (1 year long) Now you want to compare? Their advanced level is 2 1/2 years long (collegiate level) and their Advanced Paramedic level is 4 yrs long with several hundreds of hours clinical time, including cath lab, multiple ICU/Trauma and Flight Services.. so before we start our "bragging rights" we might want to evaluate our own back door.
U.S. EMS education sucks! Period. We make multiple levels for excuses not advancement. Please, if a town really wanted Paramedics they would educate and hire them, not placing placebo ones on their place. One cannot tell me since the EMT/I is so close to Paramedic level in some states this is not a management technique to get cheap medics.
Basics have no need to perform advanced level procedures.. If the patient needs advanced level care then they need advanced level practitioners. Please don't tell how aggressive your state is then do not provide "true" ALS providers in >95% of your state. Compare this with Missouri that only has 2 levels.. Basic & Paramedic. They will get "true" ALS when there is an emergency.
R/r 911
Fedmedic
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When we talk aggresiveness, we're not talking about how long you've been to school. We're talking about "on the street saving lives." Agressive protocols and aggressive providers. From my 15+ years experience, the worst medics I have ever worked with in my life are the over-educated ones, no common sense and just plain out dumber than dirt when it comes to taking care of patients. If was in trouble, I would just as soon they stay in the ambulance and hold the steering wheel. We used to call them "cookbook medics", I would rather work with "street smart, savvy, common sense medics." They are the ones who will save your life. The others just read about how to save lives. If its about years of education, just put lawyers on ambulances, what do they have 8 years+.
advanced level paramedic is 4 years long! wow, I take back anything bad I ever said about Canada's ems. Canadians know their stuff...what textbooks do Canadians use for basic paramedic as well as advanced paramedic curriculum? The reason I ask, I don't see it taking anymore than two years at the most to get through a standard brady or mosby paramedic book so the question becomes, what do they study after that. Do they study critical care textbooks or what?
Ridryder911
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Amazes me when discussing education it is always the ones that don't have it argue against it. Sure street education is wise, but it is NOT education. Sure, it is essential.. but again if one has the education and then the experience with street wise, look one would have. Anyone can get the experience, not vice versa.
I am not going to argue this anymore. Obviously physicians and 99.9% of the other health care industry see the need of in-depth education. Only EMS takes short cuts and lowers their standards, thus causing harm and inadequate care to patients. EMS much rather do things half as*, than ever do it the right way. And one wonders why, there is no professionalism ?
R/r 911
I am not going to argue this anymore. Obviously physicians and 99.9% of the other health care industry see the need of in-depth education. Only EMS takes short cuts and lowers their standards, thus causing harm and inadequate care to patients. EMS much rather do things half as*, than ever do it the right way. And one wonders why, there is no professionalism ?
R/r 911
Fedmedic
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Let's put it this way, if I spend 2 years in a paramedic program learning to take care of patients and that is all I am doing is learning patient care. Vs. spending 2 more years getting my Bachelors which incorporates 2 more years of learning english, math, history, basket weaving, etc. etc., I will now be a better paramedic...that's BS. Because that is all a bachelors or even a masters in EMS gets you. Basketweaving 101. That may be fine if you want to get into EMS management, but if your happy just being a street medic, then who cares if you can even spell "paremadik."
Prime example of education at its finest; there is a paramedic here who has a bachelors from a major four year state university and a MBA from another highly accredited state university. He was in the back with a patient when I heard the defibrilator charging. I asked what he was doing, he said "getting ready to shock, she is in v-fib, I quickly stopped the ambulance and got in back, pt. was A/O x 4, sitting on stretcher, he had paddles in hand, getting ready to defibrilate; a lead had come off and it appeared to be v-fib, even though the patient was A/O x 4, the book said the squiggly little line was v-fib and to shock it. Needless to say, I didn't let him shock her.
What does common sense have to do with your level of education? Are you telling me that people who have been through long, extensive, college level paramedic programs are lacking in common sense? I don't see it, in fact, I see the exact opposite most of the time. "Cookbook" medics are ones who don't understand why they are treating a pt a certain way, they are just following a set of instructions. The ones who do this are lacking in formal education and are dangerous if released to practice on the street too early. I hate to use Rid as an example but here goes...rid has had a lot of "classroom education." Would you say this has hindered his ability? Is he lacking in common sense? Of course not. Hmmm, I wonder who I would rather have treat a family member during an emergency, a rid or a fedmedic?
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