# TN First Responders To Receive Combitube Orders



## disassociative (May 21, 2006)

The other day I was speaking with one of my old EMT Instructors, and he was telling me about the new classes they have him teaching. One of these classes is a First Responser(Refresher/CE). It appears that TN has now given First Responders the ability to place combitubes. I find this weird seeing as most counties in TN won't let their responders do Nasal airways(usually by order of the medical director of course.) TN FR's are also to receive authorization for the administration of EPI-Pens. I am wondering if EMT-IV's in TN will get any new abilities. If anyone knows anything about this; I would like to find out.


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## Jon (May 21, 2006)

combi-tubes and eip-pens are supposed to be moderatly idiot-proof.

If only PA would let BLS play with Combitubes


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## disassociative (May 21, 2006)

*...*

I was shocked that they would pass combitube orders before Epi-Pen; after
all epi-pen is preset dose almost impossible to mess up; however combitubes
can have some bad consequences if not done correctly. I wonder what my counties Medical Director will say about it; He will not allow our FR's to do Nasopharyngeal airways because of risks associated with basal skull fractures.


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## Wingnut (May 21, 2006)

As B's we can use the combitube but we have to call for med control for an epi pen. Epi-pen is much simpler to use in my opinion but maybe they're afraid of a mis-diagnosis as where a compromised airway is pretty hard not to see.

Doesn't matter here though we all ride with a medic.


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## MMiz (May 21, 2006)

EMT-Basics in my county have been able to use Combitubes, and for about a year also carry Epi-Pens.

With ALS only a few minutes away, and a Level 1 Trauma Center about 5-10 minutes away, I've never heard of a Basic tubing someone.


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## fm_emt (May 23, 2006)

and in the county I live in, we can't touch an ET tube or a combi-tube... or do a glucose test. Or touch an epi-pen.

Maybe I should move to TN.


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## Guardian (May 23, 2006)

This is an issue i have been thinking a lot about.  I volunteer with a somewhat rural fire department (bls only) and work as a paramedic in a city.  The EMT's with our fire department are allowed to use Combitubes.  I think Combis should be an ALS piece of equipment although nationally there not and I think combis are a "temporary, last resort" for ALS providers who can't intubate for some extraordinary reason.  My question is, why is it so important for EMTs to use Combitubes if us ALS providers are just going to have to pull them out and ETT later at some point? Why are combitubes so much better than OPAs with BVM?  In my opinion, from personal experience, they don't really help to prevent aspiration all that much but if you have research showing they do, i would love to see it.  You can't give meds down combitubes or at least i cant.


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## ffemt8978 (May 23, 2006)

Guardian said:
			
		

> This is an issue i have been thinking a lot about. I volunteer with a somewhat rural fire department (bls only) and work as a paramedic in a city. The EMT's with our fire department are allowed to use Combitubes. I think Combis should be an ALS piece of equipment although nationally there not and I think combis are a "temporary, last resort" for ALS providers who can't intubate for some extraordinary reason. My question is, why is it so important for EMTs to use Combitubes if us ALS providers are just going to have to pull them out and ETT later at some point? Why are combitubes so much better than OPAs with BVM? In my opinion, from personal experience, they don't really help to prevent aspiration all that much but if you have research showing they do, i would love to see it. You can't give meds down combitubes or at least i cant.



Because in areas like mine, the NEAREST ALS unit is 25-35 minutes away.  An OPA/NPA with BVM for that duration is not a viable option.  And you can give meds down a Combitube if you get it in the trachea (not very often, I know.)  Also, our medical director says if the Combitube is working, leave it in place unless you have a good reason for pulling it.  To pull a working Combitube just so you can throw an ET down the patient is not a good thing in his opinion.


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## Guardian (May 23, 2006)

25-35 mins away, wow!


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## Jon (May 23, 2006)

ffemt8978 said:
			
		

> Because in areas like mine, the NEAREST ALS unit is 25-35 minutes away.  An OPA/NPA with BVM for that duration is not a viable option.  And you can give meds down a Combitube if you get it in the trachea (not very often, I know.)  Also, our medical director says if the Combitube is working, leave it in place unless you have a good reason for pulling it.  To pull a working Combitube just so you can throw an ET down the patient is not a good thing in his opinion.


I agree. in my area, we have 2 medic units stationed at the hospital next door to our base... the next due medics are 15+ minutes away. The ONLY reason I would use a combi-tube prehosptal would be if ALS has an extended ETA. Otherwise, I'm going to wait for the medic.

In some parts of my county, ALS can be 20+ minutes away, for the first-due unit.

And I think that a combitube is preferred over an opa/bvm

In PA, Combitube is reserved for ALS providers.


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## RALS504 (May 26, 2006)

Guardian said:
			
		

> I think Combis should be an ALS piece of equipment although nationally there not and I think combis are a "temporary, last resort" for ALS providers who can't intubate for some extraordinary reason.  My question is, why is it so important for EMTs to use Combitubes if us ALS providers are just going to have to pull them out and ETT later at some point? Why are combitubes so much better than OPAs with BVM?  In my opinion, from personal experience, they don't really help to prevent aspiration all that much but if you have research showing they do, i would love to see it.  You can't give meds down combitubes or at least i cant.


 
The reason is it gives us rural responders waiting for ALS intercepts of 15-60 minutes (code 3) a more secure airway. It also prevents gastric distension. Oh yeah, on my rig I run with a paramedic and that if that medic can not get a ET tube after three tries, move out of the way because I am dropping a combi-tube. And I think Jon has a valid piont if you are dropping a combi-tube as ALS is hitting the scene maybe you should have waited to place it. I am just thinking of the medication route aspect in a code. Combi-tube and LMAs have a place in EMS and why not with BLS crews after all there are a lot more bls providers than ILS or ALS.


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## ma2va92 (May 26, 2006)

Well .. combitube is a item we are tested on that is a must pass.. along with the normal ET tube.. for state level.. "BUT" when in the field.. first it's the ET tube.. if that don't work it's the LMA.. yup LMA ... a item we are not tested on... and we are not allowed to use the combitube.... but thats the states rules..... virginia is so smart it just wants to make me puke.... 
from my point of view it's a good thing for FR to be able to use combitube.. and it maybe great in there area... but were i am it's very rare that a FR will get to the pt. before EMS will...... and most of the time if we call in for FR to head to the pt. because of time for our responce.. then send a Fire/Rescue vec that is staffed by emt-p...


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