Magil Forceps's

[Gbro]

Are there any BLS agencies that carry Magil Forceps's,
1 on board in jump kit?
2 on their person?

Link to forcep's
http://www.dealmed.com/index.asp?PageAction=VIEWPROD&ProdID=44

We had them in our jump kit, but the State Compliance inspector pulled them, He stated they are for ALS licensed services only.

I was the one who ordered them for use when we look into an airway and see a foreign object/obstruction. Why not have a tool made for the job. I do agree a finger sweep is a great technique, but its just a nice tool that works well with a pen light.

 

[Onceamedic]

In Wisconsin, they are within the scope of practice for a Basic. I have only ever run with paramedic services and we all have them. I just assumed that they were part of the Basic service as well. Hmmmmmm...

 

[Ridryder911]

One cannot use Magill forcep's correctly without using a Laryngoscope, for direct visualization of the glottic opening, thus it is an advanced procedure.

As well, it is not part of the EMT curriculum and is considered advanced level.

R/r 911

 

[Onceamedic]

One cannot use Magill forcep's correctly without using a Laryngoscope, for direct visualization of the glottic opening, thus it is an advanced procedure.

As well, it is not part of the EMT curriculum and is considered advanced level.

R/r 911

It is part of the cirriculum in Wisconsin and we were taught it with the use of the laryngoscope in EMT-Basic.

 

[MMiz]

One cannot use Magill forcep's correctly without using a Laryngoscope, for direct visualization of the glottic opening, thus it is an advanced procedure.

As well, it is not part of the EMT curriculum and is considered advanced level.

R/r 911

That's what Michigan thinks, and I agree.

 

[KEVD18]

+1 on the als level thinking. bls does not teach enough of the anatomy of the airway to allow futzing about with instruments. if theres an airway obstruction, follow bls fbao protocols. if their moving air, hall buttox to the H and leave em be.

 

[Ridryder911]

There is a reason the Magill's is commonly called "tonsil pullers" for a reason.


R/r 911

 

[Gbro]

Captain KEVD18 said;
if theres an airway obstruction, follow bls fbao protocols. if their moving air, hall buttox to the H and leave em be.

That is exactly why i would like to have a tool like the magil.
The FBAO protocol for a child/Infant is to look into the airway for a FBAO, and if one is present then remove it. No blind finger sweeps "Ayee".
Now we have a directive here to remove an object blocking the airway, and a tool that is shaped to do such a basic thing is forbidden to use unless....

Now Rid said this tool is designed to be used with a scope, but it will also work with a penlight.
I am not advocating deep probing, all i am saying is we, by protocol are to remove an obstruction from an complete airway obstruction, where "my" fingers would block out any possibility of being able to see what i saw, therefore i may make matters worse.
That is not acceptable to me. I do carry a leatherman tool, but that is no way comparable to the Magil.

 

[SwissEMT]

Now wanting to have more tools to do our job is fine, but problem is that many of these require further training in order to understand the implications of employing more advanced devices..oh wait, that's what Paramedic school is for...

The McGill foreceps require direct visualization in order to use without running the risk of causing extensive damage to all the little parts down there that are oh-so fragile.
Direct visualization requires a Laryngoscope and blade. Which requires proper technique in order to avoid breaking teeth or trauma to the pharynx.
Probing around with any other tool down there runs the risk of obstructing the airway even more, where BLS FBAO procedures will be even less effective. You say that you'll use the McGills just to grab anything which may be in the posterior wall of the oropharynx but you KNOW that won't last more than 10 seconds out there.

To be honest, we have so many yo-yos in our field, the more we give, the more damage.

Just my two cents.

 

[Flight-LP]

but problem is that many of these require further training in order to understand the implications of employing more advanced devices..oh wait, that's what Paramedic school is for...

The McGill foreceps require direct visualization in order to use without running the risk of causing extensive damage to all the little parts down there that are oh-so fragile.
Direct visualization requires a Laryngoscope and blade. Which requires proper technique in order to avoid breaking teeth or trauma to the pharynx.
Probing around with any other tool down there runs the risk of obstructing the airway even more, where BLS FBAO procedures will be even less effective. You say that you'll use the McGills just to grab anything which may be in the posterior wall of the oropharynx but you KNOW that won't last more than 10 seconds out there.

To be honest, we have so many yo-yos in our field, the more we give, the more damage.

Agreed......................But for some reason there are those out there that see a justification for these yo-yo's to play ALS without having a clue as to what they are, or more importantly, are not doing...........................

 

[Gbro]

LP says;
Agreed......................But for some reason there are those out there that see a justification for these yo-yo's to play ALS without having a clue as to what they are, or more importantly, are not doing........................

...

1. Airway obstructions are a BLS procedure, I don't care what your training level is it's still BLS, Sure you have tool's for intervention, Great! but calling someone a "YO-YO that is trying to save a life is a very arrogant statement.

Maybe you didn't call me a yo-yo personally, but we in the BLS field have every right to advance our level of care.

We (in the rural arena) are not BLS by choice, Our services don't have the ability to employ full time staff.
Years ago i took the Intermediate course. I couldn't maintain that level of certification because of our run volume. I would have had to spend what free time i just didn't have and go to the city and do calls there. Then i put the burden on our service, who is going to fill in for me?,
Oh yes I could have had someone put some marks on the paper, and maybe that would work. Not me, there is no way! (and if you don't think that is done on some services, your head is in the sand).

Remember only 30-35 years ago, most services were stuffing pt. into the box and that was all.
30 years ago our neighboring ALS service was then run by one of the funeral homes, when the call came in, the mortician would swing by the fire hall and the "junior" Fireman on shift got to go.

 

[Flight-LP]

...

Maybe you didn't call me a yo-yo personally, but we in the BLS field have every right to advance our level of care.

You are absolutely correct. You do have every right to advance your level of care. It is called going to Paramedic school and becoming a Paramedic.

We (in the rural arena) are not BLS by choice, Our services don't have the ability to employ full time staff.
Years ago i took the Intermediate course. I couldn't maintain that level of certification because of our run volume. I would have had to spend what free time i just didn't have and go to the city and do calls there. Then i put the burden on our service, who is going to fill in for me?

Sorry, calling BS on that one (this has been previously discussed to some length). Your local community chooses to have a BLS provider. Do you bill for your services? Do you have any tax income? Does your agency receive funds from your town, munincipality, or county? If not, then your future is restricted by your own community.

Why couldn't you maintain a certification as an ALS provider? You can hold C.E. locally, you can practice your skills, you could ride say one shift every month at a local ALS service. It can be done, even in a low volume rural environment. I'll save this one for another thread down the line, but it is possible and in most cases feasible to have ALS everywhere. It's just not followed through on or contested by the general public who are in most cases ignorant on the true need for ALS (and thus have the belief that an EMT-B can start lines and intubate with only 40 extra hours of training).

Oh yes I could have had someone put some marks on the paper, and maybe that would work. Not me, there is no way! (and if you don't think that is done on some services, your head is in the sand).

Remember only 30-35 years ago, most services were stuffing pt. into the box and that was all.

Trust me, my head is not in the sand. I don't doubt that "pencil whipping" occurs, fortunately I am in a professional environment with a supportive community and a quality budget. Thus it is not needed.......
I actually envision a better future for EMS. Your last comment is indicitive of what many think. "Well xxx years ago we did this, so what we have now is acceptable". This couldn't be further from the truth. American EMS is WAY behind the rest of civilized society. don't believe me, take a look at our neighbors to the north and the one's east of us across the pond. Canada and Britain both can teach us a lot!

 

[BossyCow]

Airway obstruction is a BLS skill. But using forceps to dislodge something from an airway is not.

I'm also an EMT-B in an extremely rural area. There are some things we just can't provide. This is a condition of that 'fine, country living'. While I can see there may possibly be an occasion where the forceps would be used to safely and effectively clear an airway, that hypothetical maybe is overshadowed by the threat of that tool in the hands of a 'Yo-Yo'. Risk vs Gain. by that criteria, this tool needs to remain ALS

 

[SwissEMT]

Gbro,

I'm not directing that remark towards you. I am well aware of the needs and implications of rural response services. You say that we (BLS providers) have the right to advance their level of care but we MUST respect the limits of our current training coverage and training standards. Let's face it, we're a huge joke.
Do you, as an EMT-B feel that you are given adequate training to comprehend and provide care for complex patient care presentations? None of us are. You can toot the horn of "well I'm damn good at my job" but that will never compensate for the utter failure which our "education" is. The education which you receive is a small scratch on the surface of the Advanced Life Support field you're wanting to have access to.
More skills and tools will NOT replace a good understanding of human anatomy, physiology, and pathophysiology.
I work in a state which grants EMT-Bs with Glucagon IM, blood glucose meters and even intubation (16 hr course) and we've got providers KILLING people. Both the state AND the providers should be held responsible for this. Though I'm sure you'll say "well that's just your state" you have to realize our ENTIRE field is plagued with incompetence. I, personally may be able to help my patients more but is that worth the risk of death or harm of 1.1 million others? No. Period. Unless you can guarantee that every other provider in your state will be able to have your competency and understanding, all you'll be doing is putting more patients at risk of malpractice.
We're all SURROUNDED by idiots and yo-yos. The Rescue Ricks and Whacker-Ones who don't know what and why the hell they're doing what they are. I would bet that literally 99% of EMT-Bs in this country are absolute idiots.
Instead of wanting to put more of our citizens at risk with more advanced protocols, let's increase educational standards instead!

-SwissEMT
Fellow EMT-Basic

 

[VentMedic]

...

Remember only 30-35 years ago, most services were stuffing pt. into the box and that was all.

Ouch! EMS in many areas were actually in a better position 30 years ago than it is now in many ways. Yes, there were a few areas slower to change than others but not all of us old timers ran calls with a mortician. I could even do intracardiac epinephrine back then.

The Magill Forcep should only be used with direct visualization. This is true even for doctors and RTs in the hospital. A pen light may not give you an adequate view of what other objects or tissue might be involved. If the patient can still move some air, removing an object may not always be the best answer. The standard Magill Forcep is a little large for a pediatric mouth and may cause more damage. Follow your BLS protocols to the letter. This may not be an easy answer but it could also prevent a bad situation from becoming worse, if not for the patient but for you.

It's great that you want to advance your skills. But, for the sake of safety for your patient, acquire proper education and not just learning bits and pieces of the process. It is always good to know a plan B, C or D if A fails as long as they are within your scope of practice for your certification and according to your local protocols.

 

[Ridryder911]

Short and simple, the use of Magill forceps is an advanced procedure! I will gladly testify against any basic that uses one. It is simply described as such in the NHTSA curriculum, AHA BLS and ACLS guidelines (what you will be judged from).

So, from one from the "good ole days" .. you want to play paramedic, go to school and become one. Until then, perform your level and deal with it. Quit trying to live in the past when there were no formal guidelines, license, and "cowboy medicine/EMS" was the norm, as well not very many litigations against EMT's as well. Things have changed.. from those of us that wanted a thing called "progression".

R/r 911

 

[triemal04]

Gbro,

I'm not directing that remark towards you. I am well aware of the needs and implications of rural response services. You say that we (BLS providers) have the right to advance their level of care but we MUST respect the limits of our current training coverage and training standards. Let's face it, we're a huge joke.
Do you, as an EMT-B feel that you are given adequate training to comprehend and provide care for complex patient care presentations? None of us are. You can toot the horn of "well I'm damn good at my job" but that will never compensate for the utter failure which our "education" is. The education which you receive is a small scratch on the surface of the Advanced Life Support field you're wanting to have access to.
More skills and tools will NOT replace a good understanding of human anatomy, physiology, and pathophysiology.
I work in a state which grants EMT-Bs with Glucagon IM, blood glucose meters and even intubation (16 hr course) and we've got providers KILLING people. Both the state AND the providers should be held responsible for this. Though I'm sure you'll say "well that's just your state" you have to realize our ENTIRE field is plagued with incompetence. I, personally may be able to help my patients more but is that worth the risk of death or harm of 1.1 million others? No. Period. Unless you can guarantee that every other provider in your state will be able to have your competency and understanding, all you'll be doing is putting more patients at risk of malpractice.
We're all SURROUNDED by idiots and yo-yos. The Rescue Ricks and Whacker-Ones who don't know what and why the hell they're doing what they are. I would bet that literally 99% of EMT-Bs in this country are absolute idiots.
Instead of wanting to put more of our citizens at risk with more advanced protocols, let's increase educational standards instead!

-SwissEMT
Fellow EMT-Basic

Off topic, but I wouldn't go so far as to call BLS training a huge joke. At least not allways. (I will call some of the BLS care that I've seen a joke, but that's another story.) Basic's were never intended to have the same knowledge as medics, or the ability to understand what was going on. The point is that they should be able to recognize major problems, ie trauma, classic MI's, diff breathing (while not always figuring out the cause) codes and childbirth and start the initial treatment, which, aside from O2 and maybe asa and ntg, is going to be vitals and maybe spinal precautions. The problem is that some states have forgotten this and are giving basics more skills without adequate training on how to do them, or education on how to recognize situations when those skills should be used. Where I live, an EMT-Basic can assist with ntg or an inhaler, give oral glucose, subq epi, activated charcoal, and if an extra class is taken, give asa. Medical directors now have the option to allow some basics to use combi-tubes in codes, but generally that's only being done if an ALS responce is going to take a long time. I don't have any problem with any of that really. Good BLS care can make a big difference in some situations, especially codes, it's nothing to look down on. There's not a problem with a competant BLS provider saying, "yeah, I'm good at what I do." A lot are. It's just that they need to go back to school if they want to get better at what they do; it's the only way. Unfortunately not everyone get's that, and there's plenty of people out there who are way to eager to get a new shiny toy that will let them do something they've only got to watch before with only a couple of hours of training. You're right, that's the way to kill people.

Back on topic, if nobody in the service that's being talked about is trained at the medic level, then magills shouldn't even be on the rig. If none of the providers have been trained how to use them, they really shouldn't be thinking about it. If they have...little different. But otherwise...nothing like seeing someone use a laryngoscope for the first time and bust some teeth, or pick up the magills the wrong way. All that'll do is make a bad situation worse.

 

[Gbro]

Swiss,
you are an Paramedic Student, and list your training level as EMT-Basic,
And you say;

I would bet that literally 99% of EMT-Bs in this country are absolute idiots.

99%, at that, where do you place yourself ?

We have had those that would fit that ?% in the past, but they have been flushed.
You do EMS wrong to state that.
I think an apology is in order.


I was going to do a new thread on emergency tracheotomy's, but here goes.

20+years ago, while attending an EMS conference one of the speakers, an ER Doc from a large medical center was doing a presentation on airway management (most of the audience was BLS) knowing what our rural services were dealing with, he told us that when the FBAO protocols are used and there is no change, death is going to happen, you are just to far from the ER. But all it takes is a small pen knife to open an airway. the alternative is the pt. goes to the morgue. What would you want for your family? He had all of us find the trach, and explained what we should do.

Well one of my fellow EMT's sitting next to me used to argue with me about just this, and looked at me and said,

"You know what he said, "

 

[Flight-LP]

20+years ago, while attending an EMS conference one of the speakers, an ER Doc from a large medical center was doing a presentation on airway management (most of the audience was BLS) knowing what our rural services were dealing with, he told us that when the FBAO protocols are used and there is no change, death is going to happen, you are just to far from the ER. But all it takes is a small pen knife to open an airway. the alternative is the pt. goes to the morgue. What would you want for your family? He had all of us find the trach, and explained what we should do.

O.k. last thread from me about this, obviously there is a deaf ear from our friend in Minnesota, and I'll probably get spanked by admin, but...........

Your patient will probably go to the morgue anyways because once you start slicing open the patients neck, you will more than likely lacerate the tracheal arteries and have the pt. drown in his own blood. Mcgyver went off the air about 15 or so years ago, stop watching the repeats.


As warped as it sounds, the patient's death would probably be a wake up call to the community. do you honestly believe that after losing a loved one because of inadequate EMS, a community wouldn't want that Paramedic level service???????

Think it over, keep it safe and please don't stick magill's in anyones mouth or a knife in their throat...............

 

[Gbro]

So you say;

Your patient will probably go to the morgue anyways because once you start slicing open the patients neck,

Why would you be so adamant that only a Medic can? I just don't understand these thought processes.

My Wife was sitting in on that EMS conference, as she was also an EMT and an RN. When in the EMT-B jacket was unable to use any RN skills because some intellectual somewhere ruled that the brain stayed in the hat they received upon graduation(humor).

But throughout all of this she stated the she could never cut open the airway on one of our children. no matter what the circumstances.

I just cannot identify with this, and she knows and supports me. Its just that she cannot, not that she wouldn't want to. Somewhere in some people there is a I can't do it until someone tells me i can mentality.
-humor to follow-
Its a good thing Rubbers didn't get included in Advanced care, cause we'eus of the lesser knowledge wouldn't know how to use em!