Rsi?

[fcfiremedic]

just wondering if this is a standard in other parts of the country. Here in kentucky, only two ground service throughout the whole state have it written in their protocols. of course we can always call for it, and its pretty much a standard on the flight services, but i was wondering if its more used in other parts of the country.

 

[Lisa]

Rsi

My service has a protocol for it and it gets used! Most services around my area also have protocol for it. Very rural area.... sometimes 25 min to the closest hospital and even then it is not a Level 1 Trauma center. Closest trauma center is about a 12-18 min flight. The service I work for probably averages 20 a year and that is guessing on the high side.

 

[Epi-do]

We don't have it, but I am only about 12-15 minutes from 3 Level 1 trauma centers (2 adult, 1 peds). I do know that counties farther out from Indy do have it in their protocols though.

RSI is a scary thing. Most medics don't intubate enough as it is, and it shows in study after study. That is why as a whole, we have such dismal statistics. If you are going to RSI someone, you had better be darn sure you are going to be able to adequately maintain their airway or they don't stand a chance. I am not saying that it doesn't have it's place, but looking at it with the perspective of someone working in a urban system, it isn't something that would typically/routinely need done in my area.

 

[Ridryder911]

Just to add, RSI is great but has to be used with extreme caution and only to those with in-depth education and QI.

R/r911

 

[Ridryder911]

I too agree if one would just search a little one will find out this as well many topics have been talked about way in-depth. Although, I have to admit at least I find it more interesting than what pair of boots, pants or even what number your NREMT test stopped at (like that really matters, since it has no base value the way the test is graded).

I do wish there were more emphasis on searching before posting. Again, there are much information that maybe given and answered, and the post may not even be needed.

Although, there is always new research it is really a mute point. It has been out for over nearly three decades and so many act like it is a brand new procedure. What many still fail to recognize is that it is not a bad procedure, nor do most Paramedics perform it poorly. It is the circumstances that is associated with the procedure.

The problems identified is poor skill retention (along with intubation in the field) due to the number of Paramedics that are able to intubate. I find this ironic, since there is such a shortage of Paramedics yet.. we have too many to perform skills? ... Yes, confusing unless one is too identify most of those studies were conducted at ... Yep, large FD's. Again, one needs to really look at the number of Paramedic or even ALS providers per rescuers. Is it really necessary for everyone to be a Paramedic or even half or maybe just two per responding companies.

What type of Paramedic training or education was conducted as a base level before introducing more advanced airway? Was it an in-depth program or a trade school 10 month program? Was there additional clinical requirements as well as detailed quality assurance program to monitor the development... good and bad? Was there actions taken? Is the Medical Director active in participation of such protocols?

Those are the points that one need to address even before implementing RSI. Not that it is not needed, or even the medications used, rather the whole process of utilizing and implementing a dangerous procedure.

R/r 911

 

[VentMedic]

What type of Paramedic training or education was conducted as a base level before introducing more advanced airway? Was it an in-depth program or a trade school 10 month program? Was there additional clinical requirements as well as detailed quality assurance program to monitor the development... good and bad? Was there actions taken? Is the Medical Director active in participation of such protocols?


R/r 911

So let's see if any of the newcomers have something new to offer to your questions.

While the search function is great, there are some new members to the site that may want to talk about their system also. They, too, should be given a chance. And, they may have seen the threads where someone was criticized for reviving a thread from the past.

There are some EMS systems that are acquiring new Medical Directors with new ideas on education and training.

Of course, there are also systems that are considering eliminating ETI all together and just using the King Airway.

just wondering if this is a standard in other parts of the country. Here in kentucky, only two ground service throughout the whole state have it written in their protocols. of course we can always call for it, and its pretty much a standard on the flight services, but i was wondering if its more used in other parts of the country.

The original post inquired about who was using RSI. It didn't ask should or should not. It would be interesting to see what education, training and oversight are being done if the posters wish to include that.

 

[fma08]

No RSI here, we have PAI where we are allowed up to 10mg Versed to assist... the benefits/shortcomings of PAI vs. RSI are already in another thread.

 

[ffemt8978]

Okay,

Now that I've removed 16 posts to get this thread back on topic, I'm only going to say this once and it is directed at all of those that had their posts removed from this thread.

KNOCK OFF THE PERSONAL ATTACKS!

If they continue, both parties will get a short vacation from this forum.

 

[EMT-P633]

hey, I am frm middle TN, and we use RSI, as do 7 other counties in my region. testing / certification required by my service include, ample monthly inservices, in which we normally include atleast 1 mega-code on the maniquine, aside from our inservice topic. Our RSI check-offs are done bi-anually, (every 6 months). Our medical Director is present and is the one to sign off on our skills / knowledge.

Hope this is what you were lookin for.

 

[rmellish]

One of the services Is the 911 provider for a rural area, and do not have a protocol for RSI. Because of this we end up calling for air evacs more frequently than at my other service, primarily due to airway management considerations. Really it comes down to the medical director and the amount of liability they are willing to incur. Most of the neighboring counties have protocols for it.

 

[grumpy1]

State I live/work in does not have RSI for ground services, RSI is for air services only. Don't see that changing anytime soon. Our medical director does not see RSI as a skill that is needed in the field due to the training and proficiency needed to accuratley utilize the skill.

 

[VentMedic]

State I live/work in does not have RSI for ground services, RSI is for air services only. Don't see that changing anytime soon. Our medical director does not see RSI as a skill that is needed in the field due to the training and proficiency needed to accuratley utilize the skill.

You listed yourself as a Critical Care Paramedic. Are you ground or flight? If ground, do you do CCT with paralytics? Can you start and/or maintain them for ventilation? What about the flight service? HEMS and/or interfacility?

 

[rmellish]

Our medical director does not see RSI as a skill that is needed in the field due to the training and proficiency needed to accuratley utilize the skill.

Its really too bad that protocols are written for the lowest common denominator instead of a service simply increasing their training and education requirements.

What's the contraindication for a patent airway?

 

[grumpy1]

You listed yourself as a Critical Care Paramedic. Are you ground or flight? If ground, do you do CCT with paralytics? Can you start and/or maintain them for ventilation? What about the flight service? HEMS and/or interfacility?

Ground - Get the needed drugs (sedatives, paralytics etc) from the sending facility; right now we do interfacility only.

Air - HEMS/interfacility. Full RSI protocols used, hypocritical yes but each flight service uses an extensive process getting filghts crews signed off on RSI and intubations. Each RSI is QA/QI'd by the medical director and its all online medical direction.

 

[VentMedic]

Ground - Get the needed drugs (sedatives, paralytics etc) from the sending facility; right now we do interfacility only.

This is the part I can not understand about some "CCT" teams. They are virtually useless unless the ED or ICU nurses set everything up for them including the pumps and the ventilator. The paramedics can only monitor and not make any changes to the drips. Some probably don't have any idea what they actually have running. Some Paramedics have even been know to ignore or shut off a pump that was beeping "air" because they were not able to do anything else. If meds are hung in the ED on a patient heading for the cath lab in another hospital, many times an RN will have to ride along with the Paramedics. And if the Paramedics have a ventilator, it might be some simplistic piece like an ATV or something that only barely qualifies as a ventilator because it pushes air/O2 into the patient. It is easy to see why many hospitals are now going with RNs as part of their own CCTs.

Excuse the rant, not being critical of you or your service. Just a few observations I've been making over the years. CCT and CCEMT-P are my pet peeves if one doesn't have the education and skills to back up the letters.

 

[marineman]

The service I'm riding with does RSI. I'm not really sure what their protocols are for it so I'll have to ask next time I'm in. I know the stipulation from their medical director when he added it said every medic on the service had to perform 50 successful intubations each year or he'd yank the protocol. Now there's almost always medics in with the anesthesiologist for major surgeries ready to put the tube in.

 

[Flight-LP]

Well said Vent!

My personal pet peeve is when medical directors focus all of the aspect on just a successful intubation (i.e. dictating X number of tubes) instead of focusing on the kinetics and dynamics of RSI. Especially the indications for when to use it vs. just doing it because you can. I always hear medics saying "I RSI patients all the time". That statement scares me as most have no clue what they are really doing to the human body or why it needs to be done.

 

[KEVD18]

The service I'm riding with does RSI. I'm not really sure what their protocols are for it so I'll have to ask next time I'm in. I know the stipulation from their medical director when he added it said every medic on the service had to perform 50 successful intubations each year or he'd yank the protocol. Now there's almost always medics in with the anesthesiologist for major surgeries ready to put the tube in.

wow, 50 tubes. it probably should be up that high, but thats the highest ive ever heard.

in mass the bare minimum is 20 tubes per medic per year

 

[marineman]

Yeah our med director was trained in the Army, became a flight surgeon through them so he is very open and willing to give the guys a long leash but he also keeps an iron fist on the other end of the leash.

 

[VentMedic]

50 intubations in nothing compared to what members (RNs, RRTs) of some specialty transport teams do in addition to their other advanced skills along with a few hundred hours of continuing education/training each year. Once you know that is what is required, you just do it as it becomes part of your routine.

That is why those teams have incredibly good protocols.