# Advanced Airways for Basics



## TraumaJunkie (Jun 3, 2007)

Are there any agencies that train EMT-B's to uses Advanced airways such as a Combitube? I know this is a ALS skill but i was just curious to see if anyone was recieving training to do it as a basic. Thanks


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## Alexakat (Jun 3, 2007)

In Florida, the Combitube was one of the stations we were tested on for practicals...my sister (who was here in Virginia practicing as an Intermediate when I was going through my Basic class), kept saying that I was learning a more advanced skill than the B's here in Virginia do...


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## Onceamedic (Jun 3, 2007)

In Wisconsin, EMT-Bs are taught to use a combitube...  as well as administer, in addition to oxygen, epi, glucogon, aspirin, nitro and albuterol.


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## Raf (Jun 3, 2007)

In MA anything other than an NPA or OPA is advanced and basics cannot do afaik.

You might be able to do combitube, ET, King LT airway at the intermediate level.


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## Rattletrap (Jun 3, 2007)

Ohio, has them in state scope of practice


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## Guardian (Jun 3, 2007)

Plenty of OMDs allow their emt-basics to use the combitube (ETC) and some even intubate.  Since the ETC is not completely idiot proof, many are now moving to the King airway. In my opinion, this is all half *** ALS.  In my experience, you just can't trust emt-basics with ALS airways and they're better off just bagging with an OPA and suction if needed.  Lately this opinion seems to be the opposite of where we are going (at least in my area) and many OMDs seem to be more than willing to let basics use ETC or King airway.  Maybe they know more than I do.  I haven't actually looked at any data to make an educated decision either way.


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## Canoeman (Jun 3, 2007)

Guardian,

We have been teaching Combitubes in the New York Sate cirriculum for some time --yet they are not in the protocols for the Basics. I am like yourself, give me a good EMT that can suction and bag with confidence and the outcomes are always pretty good. If it aint broke--------

Canoeman


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## Summit (Jun 4, 2007)

I think combitubes are a great idea especially in areas with limited or delayed ALS (wilderness rescues and rural services).

Some services around here have them on a waiver.


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## BossyCow (Jun 4, 2007)

Washington State has Combi-tube as an EMT-B skill but after one year of practice as an EMT-B. Also has to have quarterly updates.


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## emtjaysen (Jun 5, 2007)

Oregon EMS has added the combitube to the EMT-Basic scope as well.  I've been trained to use it but have never used it since we always have paramedics on scene to intubate.  It's entirely up to your agency to train you on this skill and your medical director to approve of it's use in your area.


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## Easy (Jun 5, 2007)

We've been taught and tested on the Combitube in our Basic program.  The ALS guys that teach the class would like to see them used more often, if protocol allows.


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## BossyCow (Jun 5, 2007)

I have used Combi-tubes in the field multiple times.  They really do the job!


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## Guardian (Jun 6, 2007)

Easy said:


> We've been taught and tested on the Combitube in our Basic program.  The ALS guys that teach the class would like to see them used more often, if protocol allows.



I can't imagine for the life of me why.  I've brought a couple of patients in with combitubes and it's a bad feeling.  I failed, I couldn't intubate those patients.  When ED staff sees a combitube, they immediately think "we have someone here who couldn't intubate and protect the airway properly and now we have to pull this stupid thing and intubate ourselves."  The combitube is better than nothing, but not much.


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## VentMedic (Jun 6, 2007)

Guardian said:


> I can't imagine for the life of me why.  I've brought a couple of patients in with combitubes and it's a bad feeling.  I failed, I couldn't intubate those patients.  When ED staff sees a combitube, they immediately think "we have someone here who couldn't intubate and protect the airway properly and now we have to pull this stupid thing and intubate ourselves."  The combitube is better than nothing, but not much.



You've pretty much summed up what we do think in the hospital.  As a Respiratory Therapist in the ER, my personal ETT intubation numbers have more than tripled since the Combitube. We actually are not supposed to hook up to our ventilator until we put a regular ETT in place.


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## Ridryder911 (Jun 6, 2007)

Combitubes are a nice airway, because it is simple to use and is a "blind insertion". They are however; not the optimum airway and personally would not consider them an advanced airway, since most of the time they have only occluded the esophagus. 

Yes, I agree it is better than nothing, thus the reason they are used by those not able to intubate or in a failed intubation attempt. 

R/r 911


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## BossyCow (Jun 6, 2007)

Our frequency of combi-tube use has to do with our location and ALS being at least 20 minutes away.  A combi-tube secures the airway as we scoop and scoot towards our ALS intercept.


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## Guardian (Jun 7, 2007)

BossyCow said:


> Our frequency of combi-tube use has to do with our location and ALS being at least 20 minutes away.  A combi-tube secures the airway as we scoop and scoot towards our ALS intercept.



I'm no expert on very rural ems.  Maybe the combitube does have a place here.  Regardless, you are not securing an airway with the combitube.


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## VentMedic (Jun 13, 2007)

Training video for the Combitube

http://www.youtube.com/watch?v=4kAtsfH-LbE


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## Onceamedic (Jun 13, 2007)

*** shakes head ****

overcoming the gag reflex has a lot more interesting applications than that...B)


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## BossyCow (Jun 13, 2007)

Guardian said:


> I'm no expert on very rural ems.  Maybe the combitube does have a place here.  Regardless, you are not securing an airway with the combitube.



We're improving the pt's chances of being viable when we rendezvous with ALS. We reduce the incidence of gastric inflation and improve the delivery of O2.  Without the combi-tube we have an airway adjunct but no real airway either.  While there may be better options, of the options available to us, Combi-tube is the best.


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## drg (Jun 13, 2007)

My EMT class is using Brady's 10 Edition and one of the last chapters goes over combitubes.  From what I can tell, EMT-Basics are allowed to use combitubes in Illinois but most agencies do not let them.


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## Rattletrap (Jun 13, 2007)

I also forgot to mention that in Ohio EMT-B's are allowed to intubate


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## Guardian (Jun 13, 2007)

BossyCow said:


> We're improving the pt's chances of being viable when we rendezvous with ALS. We reduce the incidence of gastric inflation and improve the delivery of O2.  Without the combi-tube we have an airway adjunct but no real airway either.  While there may be better options, of the options available to us, Combi-tube is the best.




This sounds like nothing but excuses to me, and I'm tired of them.  Why aren't you a paramedic?  I'm sorry, but if you're truly smart enough to use a combitube, then there is no reason why you shouldn't be striving for the gold standard of care.  The esophagus is a smooth  elastic muscle and gastric contents and air pressure can easily overcome the combitube and because of that big cuff in the middle, you might be pumping crap down someone’s airway and not even know it.  This is just my opinion, don't take offense, take it for what it's worth.  Your "best" might be good enough for you, but it's not good enough for me.


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## VentMedic (Jun 13, 2007)

Guardian,

The Combitube looks easy enough on this video clip.
In case you missed it;

http://www.youtube.com/watch?v=4kAtsfH-LbE


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## Guardian (Jun 13, 2007)

VentMedic said:


> Guardian,
> 
> The Combitube looks easy enough on this video clip.
> In case you missed it;
> ...



i know it's easy, the problem is it doesn't work and that guy is dumb.


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## VentMedic (Jun 13, 2007)

Guardian,
You have no sense of humor!  Lighten up! 

I don't like the Combitube either especially if used by a Paramedic who should have access to other devices if he/she can't intubate for whatever reason.

If this is what the EMT-B has and they have a lengthy transport, so be it.  I survived and so did some of my patients with the EOA on BLS and backup on ALS trucks in my early years.

The guy is probably an Intern (1st year medical resident) learning his ABCs.


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## Guardian (Jun 14, 2007)

VentMedic said:


> Guardian,
> You have no sense of humor!  Lighten up!
> 
> I don't like the Combitube either especially if used by a Paramedic who should have access to other devices if he/she can't intubate for whatever reason.
> ...





well, it's all fun and games until he gags and vomits.  Since the esophagus stretches, the vomit will pass right into the lower airway and promptly be aspirated.  He would then panic and probably rip out the ETC without deflating the cuffs.  And that's when I would probably hit the floor from laughing so hard.  Yes, i do have a sense of humor.


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## VentMedic (Jun 14, 2007)

Hopefully all of those things are covered in training very thoroughly.

My last court depo a couple years ago was on a patient brought into the ED by paramedics with the largynx relocated and fractured.  It was a very young patient who the paramedics didn't think "needed an ETT". "The patient was only drunk". Go figure.  Costly binge for the college kid. 

But, there are horror stories about all medical devices even with the most highly of skilled people using them.

Good education and advancing education is still key at any level. There is no reason an EMT-B can't continue learning even if they don't advance their certifications. Yes, I agree being a Paramedic would be helpful in many situations. But, if you're working in a BLS system, it's BLS. I wish this country would be able to advance services everywhere in every area of healthcare. It ain't going to happen anytime soon. 

You've made some good points GUARDIAN. Hopefully you're half my age and will be able to make changes in the System for the future.


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## bstone (Jun 14, 2007)

About 2 years ago I was at a BLS ConEd run by a nurse for Chicago North EMS. Dozens of BLS firefighters and EMT-Bs from the city were there.

The nurse asked, "How many of you have used CombiTubes?" There were maybe 200 EMTs in the room.

Not a single hand went up. All of the ambulances have them. We carry them on my private service's BLS ambulances. I have only ever used them on mannequins.


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## bstone (Jun 14, 2007)

drg said:


> My EMT class is using Brady's 10 Edition and one of the last chapters goes over combitubes.  From what I can tell, EMT-Basics are allowed to use combitubes in Illinois but most agencies do not let them.




Basics in IL are trained to use endotrachael intubation. Most PMDs don't let us and instead give us CombiTubes.


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## BossyCow (Jun 14, 2007)

Guardian said:


> This sounds like nothing but excuses to me, and I'm tired of them.  Why aren't you a paramedic?  I'm sorry, but if you're truly smart enough to use a combitube, then there is no reason why you shouldn't be striving for the gold standard of care.



I'm 'smart enough' to be a paramedic and I'm not making excuses.  I am a volunteer with a small rural agency.  I personally cannot afford to pay the tuitiion and give up a year of my life to attend paramedic school so that I can volunteer that skill for free.  

I am in the process of getting my EMT-I which will allow me to intubate.  The problem with that is there is no local access to EMT-I OTEPS which will allow me to maintain my training and skills.  This means I will have to challenge the test every 3 years and the local MPD is balking at allowing me to get a skill that I may not be able to maintain.

I understand the 'Gold Standard' but where I live, it's not a reasonable expectation under the current system of health care.  We are a tiny rural logging community. We often are not able to get airlift due to the geography, our ALS support is spotty and 20 minutes away.  There have been major calls where it's been one EMT-B and a couple of kid firefighters handling a trauma code. 

It's nice for those in more urban environments to toss 'Shoulds' at the rest of the world.  But we are not all operating under the same conditions or resources.  Some of us are doing what we can and what we can afford, to improve things as much as we can.  Nice to hear that this is considered not quite good enough!


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## Guardian (Jun 14, 2007)

No matter what I write, I’m sure you could come up with more excuses.  I’m sure you have an endless supply of them.  The thing is, I don’t care.  The fact remains the ETC by itself is not good enough, in any setting, under any set of circumstances (maybe not combat but that’s another discussion).  The fact your system has some problems doesn’t suddenly make the ETC an effective airway.  We are talking about two different things.  I’m talking about ems airway devices and you’re talking about geography, financial problems, compromising, etc. etc. etc.  I don’t care about any of that.  Those are your problems and it’s your responsibility to work them out.  Judging by your previous posts on this thread, what worries me is that you seem to think the ETC is good enough given your circumstances.  I don’t think so.  If you lived in a small village in the himalayan mountains, I’d feel the same way.  In fact, it’s even more important to have a proper airway in your setting!  All of those problems you mentioned can be solved and have been solved before.  The problem with the ETC cannot be solved.  So scrap that damn thing and find a way to implement ETTs.  If you think it would help, I’d be glad to post 20 or so, truly rural ems agency websites from around the country that have found a way to implement ETTs.  If that’s not enough, I can show you where medical officers (paramedics) are using ETTs in some of the most remote places in Africa.


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## maconEMS219 (Jun 14, 2007)

Here in NC  the EMT-B class covers advanced airway, which includes combitube and ET tube. and in class we learned and practiced these skills. However i havent heard of a service in NC whos protocol allows basics to use advanced airway.


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## BossyCow (Jun 14, 2007)

Guardian said:


> The fact remains the ETC by itself is not good enough, in any setting, under any set of circumstances (maybe not combat but that’s another discussion).   Judging by your previous posts on this thread, what worries me is that you seem to think the ETC is good enough given your circumstances.  I don’t think so.  If you lived in a small village in the himalayan mountains, I’d feel the same way.  In fact, it’s even more important to have a proper airway in your setting!  All of those problems you mentioned can be solved and have been solved before.  The problem with the ETC cannot be solved.  So scrap that damn thing and find a way to implement ETTs.  If you think it would help, I’d be glad to post 20 or so, truly rural ems agency websites from around the country that have found a way to implement ETTs.  If that’s not enough, I can show you where medical officers (paramedics) are using ETTs in some of the most remote places in Africa.




I can't get permission to use an ETT in my system.  The best tool I am allowed to use is a combi-tube. It's not a matter of Combi-tube being better than an ETT... it's a matter of Combi-tube or nothing.  These are my options.  In that case, Combi-tube is better than the alternative.  

African Paramedics are going to be allowed to practice paramedicine.  I am a member of a BLS agency.  There is no ALS here.  ETT is an ALS skill and is practiced by ALS providers.  

I think what you are saying is that we should all be ALS.  That is a Should and when you rule the world, you can make that your first act of office.  In the meantime, I will continue to try to convince my agency to allow me to have the ETT.  Until I am granted that right, I will continue to use my combi-tube, whether you approve or not.


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## VentMedic (Jun 14, 2007)

Guardian said:


> The fact remains the ETC by itself is not good enough, in any setting, under any set of circumstances (maybe not combat but that’s another discussion).  The fact your system has some problems doesn’t suddenly make the ETC an effective airway.
> 
> The problem with the ETC cannot be solved.  So scrap that damn thing and find a way to implement ETTs.
> 
> If that’s not enough, I can show you where medical officers (paramedics) are using ETTs in some of the most remote places in Africa.



Whoa Guardian,
As much as I don't personally care for the Combitube, some big corperate types have put up some serious money for research and some big name docs and hospitals have endorsed it. There have been a serious amount of literature written on the Combitube. Just recently have I seen more about the complications. However, the marketing machine for this device is big. ETI is now controversial even for the paramedics in some areas. Some areas have eliminated ETI for pediatrics by paramedics. I now find it ironic that some services/states are endorsing EMT-Bs to do ETI.  But that is for another day.

You or I as paramedics could not practice our ALS skills on a BLS unit. Period. You work within the scope of that agency and under the P&P of their Medical director. But, I suppose you carry your own scope and ETTs also.

EMT-Bs have the literature to back up their use of Combitubes. 

Now, according to the literature, even more paramedics are using the Combitube as a first line instead of ETI. Can you tell me why? They have the training for ETI. Have they lost they confidence or ability to intubate? Lazy? That too can be discussed on another thread and time. 

http://search.medscape.com/all-search?queryText=combitube

*Negativity and unfounded criticism against someone because of the system their area uses is just poor professionalism and manners.*

I can not find fault with a region that utilizes the resources they have available and if it is the Combitube, then it's the Combitube. I would rather have an EMT-B that is proficient with what they have than an EMT-P who is a perfect world idealist.  I hope you never have to work under a disaster situtation like a hurricane or earthquake. Your resources will be limited and you may have to use what you got. Are you going to spend more time complaining or just get the job done?  

If you do become ruler of the world:
Stop the war, fix the deficit, improve spending on education and healthcare. After that, solve world hunger and AIDS.  I'll get a couple people together to take care of global warming.


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## Ridryder911 (Jun 14, 2007)

I agree to a point Vent, but as an experienced and educated medic, you have seen the multiple excuses in EMS. 

Do you promote complaisance in your own profession in R.T. You would not promote having technicians in lieu of therapist, as well as of providing antiquated care and use of inferior equipment, such as MA1 vents, etc. 

The reasons many medics are no longer have adequate ETI skill is being studied and some results are from poor education to begin with as well as no quality control to maintain skill adequacy. Some have even suggested because of laziness and the ease of placing more simplistic devices such as Combitube in.  Personally, I do not think of them as an advanced airway, since majority of the time it only occludes the esophagus, not much better than a BVM or EOA. 

Again, you are quite aware of the promotion of any device. You and I have both seen multiple promotions and even changes in patient care from this carelessness. (i.e. Bretylium, EOA, McSwain Dart's, MAST) Unfortunately, EMS is gullible and will purchase and promote anything that might appear to increase care. Intentions are admirable, but sometimes that is not always the best. This is where my personal problems lie. Misleading or leading that these devices are comparable to ETI, when even ECC and AHA describes that risks of aspiration can still occur, thus the whole purpose of the device.  

I believe to many EMS communities much rather seek easy alternatives than to do the right way the first time. Yes, I agree there maybe remote areas that will never be able to provide the "gold standard; yet even that needs to be explored. Remote areas in Australia, Africa, Canada appear to address some of those problems, something again that should be addressed instead of immediately taking the being satisfied with taking the easy route.

We in EMS are way too eager to accept anything we can get. We need to evaluate why and what can be done to provide the best traditional method before seeking alternative routes. 

R/r 911


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## VentMedic (Jun 14, 2007)

Ridryder911 said:


> Do you promote complaisance in your own profession in R.T. You would not promote having technicians in lieu of therapist, as well as of providing antiquated care and use of inferior equipment, such as MA1 vents, etc.
> 
> Again, you are quite aware of the promotion of any device. You and I have both seen multiple promotions and even changes in patient care from this carelessness. (i.e. Bretylium, EOA, McSwain Dart's, MAST) Unfortunately, EMS is gullible and will purchase and promote anything that might appear to increase care.
> 
> R/r 911



I agree whole heartedly about education. As long as someone wants to improve their knowledge and skills. However, one must also have a place to utilize the skills. Use it or lose it. One can not run around intubating if it is not in their protocols on a BLS truck. 

As far as RT, we no longer have "technicians" (except those grandfathered for now). The A.S. is now standard entry for testing, B.S. preferred for employment in many areas.  The title is Therapist. We gave people 5 years to get upgraded. The end of 2007 will determine the weakest links. The herd has spoken. 

And yes, when I was a traveler, I found hospitals that still utilized some of the "oldies but goodies". Not all hospital systems are created equal either. I have used therapies 15 years out of date in places thought to be progressive like parts of California and other states.  

I won't even bother commenting on California's individual county EMS certification system.  That I find more difficult to tolerate than BLS systems  in many areas of the country which still provide a vital service. 

Guess what I preferred during Hurricane Andrew - MA1 and BEAR 1 and 3. Less electronics for the electrical flucts on generator power. Even put a few on the old MARKs. We still keep them in the warehouse for the next storm.  I still admire the McSwain Dart. Yeah there's better stuff than all of these things I've mentioned, but sometimes you gotta use it. 

I guess you've seen my posts in other places on CPAP. This is the latest "gadget" that EMS companies are getting suckered into buying some CR** and not CPAP. Demand Valves are another high ticket item that should only be in the hands of experienced providers. I loved my Elder Valve in 1979 as a new medic and used it for almost everybody. Then I got educated... 

A limited education about the way things work or the body functions can lead to some very bad purchases. 

ETI in itself is a leader in aspiration just by the nature of doing it. People also think that the cuff below the cords prevents aspiration...NOT. The cords will still allow stomach material unless very chunky to pass. That's why tubes in some hospitals now have subglottic suction ports.  These are too expensive for paramedic units at this time.  However, ETI is a secured airway and forced ventilation will not be going to the stomach. 

I wish everything was equal. I wish the Freedom House Ambulance service had its accepted place in EMS history. I wish Nancy Caroline M.D. would have been more recognized for her work both in and out of EMS.  I wish our educational system had more money. I wish every county in this country had a trauma system. Every hospital should be like Jackson Memorial's Ryder Trauma Center or UCLA.  There should be a brilliant paramedic like Guardian on every EMS truck. I wish everybody got the respect they deserve.  

And as educators, we've allowed minimally educated people to continue teaching minimally educated. 

Life and healthcare is just too full of inequalities. If all was equal, we probably would have nothing to post.


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## MizRizQuick (Jun 14, 2007)

Here in Louisiana, Basics are allowed to use the CombiTube as well. Just thought I'd throw my 2 cents in.


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## TraumaJunkie (Jun 14, 2007)

Guardian said:


> Your "best" might be good enough for you, but it's not good enough for me.



When your best is all the patient has at that time thats is what the patient should get. When i started this discussion i was interested whether or not agencies are allowing EMT - _BASIC_  were being allowed to use the combi tube. I think i speak for all of the Basics out there when i say that we know that ET intubation is the best airway for the patient. We know this and it does not have to be made anymore crystal clear then it already is. But my point is that our scope of practice is limited to for most of us a OPA and for a few the Combi Tube.  I know its not as good as ETT, but its the best we can offer the patient. When that patient is in the back of my bus im going to give him the best care i know how to. Once ALS or some one with better training then i have i will gladly step aside and turn my patient care over to them. But until then i dont see anything wrong with attempting to "secure" { i know its not actually securing the airway so im using the term loosely} to the best of our abilities.
 :excl: Guardian please don't take this as a direct attack its just my feelings on it.


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## Guardian (Jun 15, 2007)

BossyCow said:


> I think what you are saying is that we should all be ALS.  That is a Should and when you rule the world, you can make that your first act of office.  In the meantime, I will continue to try to convince my agency to allow me to have the ETT.




I don't think we should all be als providers, but I do think we should strive to offer als to everyone, no matter how rural, poor, rich, urban, etc.  In your previous posts, you came across as a naively proud emt who was satisfied with the level of care provided in your system.  In this one, it appears that you are not satisfied and you're at least trying to convince someone to provide better care.  That's all I ask.  I understand logic and I know there is no such thing as perfection.  But I do know that people who strive for perfection usually get much closer to it than people who make excuses or generally don't care.  So good for you and keep up the good work.


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## knxemt1983 (Jun 15, 2007)

we can use them, but only if no als available, or greater than 5-10 away and the pt is running out of steam very rapidly


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## BossyCow (Jun 15, 2007)

Guardian said:


> In your previous posts, you came across as a naively proud emt who was satisfied with the level of care provided in your system.  In this one, it appears that you are not satisfied and you're at least trying to convince someone to provide better care.  That's all I ask.  I understand logic and I know there is no such thing as perfection.  But I do know that people who strive for perfection usually get much closer to it than people who make excuses or generally don't care.  So good for you and keep up the good work.




Do you have any idea how arrogant that post reads?  You assumed things about me based on a bias that you have.  Now you post that I have achieved your grudging acceptance and my dissatisfaction is now worthy of your approval?  Wow.. gee.. thanks!


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## PinkEmtGurl (Jun 17, 2007)

I was taught use of the Combitube in EMT Class several years ago in Colorado Springs, the services i've been with since do not allow Basics to use the combitube, however, if you think about it, they are stupid proof!  You don't have to use a laryngiscope and you don't have to know what the vocal cords or any of the airway looks like, you just shove the tube down, inflate a bubble and it's there...  Not much thought involved!


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## Onceamedic (Jun 17, 2007)

PinkEmtGurl said:


> Not much thought involved!




well.. it would be nice if you listened for breath sounds to see if its in the treachea or the esophogeus...   not good to start bagging the patient's stomach...


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## PinkEmtGurl (Jun 17, 2007)

I do understand the concept of listening for breath sounds but it really isn't that difficult to shove a tube down someones throat!  Either way it's in the right place one way or another.  The point that I was getting at here is that it's not that difficult of a skill...and there's no reason why Basics shouldn't be able to do it.


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## VentMedic (Jun 17, 2007)

PinkEmtGurl said:


> however, if you think about it, they are stupid proof!  You don't have to use a laryngiscope and you don't have to know what the vocal cords or any of the airway looks like, you just shove the tube down, inflate a bubble and it's there...  Not much thought involved!



I am going to try to type this without it sounding condescending. 

*Don't ever take anything that is AIRWAY that lightly!!  *The vocal cords and larynx are very easily damaged. The esophagus is very easily torn. Any of these complications may make any further rescue attempts nearly impossible. If the patient wasn't dead before, they just might be now.


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## Guardian (Jun 17, 2007)

PinkEmtGurl said:


> I was taught use of the Combitube in EMT Class several years ago in Colorado Springs, the services i've been with since do not allow Basics to use the combitube, however, if you think about it, they are stupid proof!  You don't have to use a laryngiscope and you don't have to know what the vocal cords or any of the airway looks like, you just shove the tube down, inflate a bubble and it's there...  Not much thought involved!





Thank you so much.  You have done what I have been unable to do.  You have proved, beyond any reasonable doubt, that emt-b should never be allowed to use an ETC.


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## PinkEmtGurl (Jun 17, 2007)

Guardian said:


> Thank you so much.  You have done what I have been unable to do.  You have proved, beyond any reasonable doubt, that emt-b should never be allowed to use an ETC.




I'm really sorry that your gold patch went to your head but there really isn't that much thought required in placing a combitube and if Basic's are taught it in school, there's no reason they shouldn't be able to place one if needed when an ET Tube can not be placed or ALS intervention is not available...


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## ffemt8978 (Jun 17, 2007)

Play nice, boys and girls.


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## beckoncall62 (Jul 9, 2007)

*Arrogance*



BossyCow said:


> Do you have any idea how arrogant that post reads?  You assumed things about me based on a bias that you have.  Now you post that I have achieved your grudging acceptance and my dissatisfaction is now worthy of your approval?  Wow.. gee.. thanks!



Thank you-well said.


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## Ridryder911 (Jul 9, 2007)

PinkEmtGurl said:


> I was taught use of the Combitube in EMT Class several years ago in Colorado Springs, the services i've been with since do not allow Basics to use the combitube, however, if you think about it, they are stupid proof!  You don't have to use a laryngiscope and you don't have to know what the vocal cords or any of the airway looks like, you just shove the tube down, inflate a bubble and it's there...  Not much thought involved!



Do you realize that you and your ideas, are a prime example of why most states do NOT allow Basics to use advanced airway. 

First it is a laryngoscope.. if you are to claim it, at least spell it right, second you should NEVER shove anything down a throat and as well it is NOT a bubble it is called a cuff! 

Geez, it is quite obvious that you were not even taught the proper names, and now you expect me to trust you on insertion of the device that you don't even the name of the parts of it? So you took a a little more than an advanced first-aid class, and now you believe that you can properly insert and utilize an advanced airway? 

*Again,* it is not the technique or skill!! A monkey could be taught that! It is the knowledge of risks, what to do in case of failure, complications, and yes... being able to control the airway other than that device. 

If you do not understand why most basics are not taught and cannot.... then instead of *attempting* to just stating your opinion, educate yourself on airway techniques, ventilation and oxygenation of patients. Then afterwards, see how much education you really had prior to that statement instead of shooting from the hip. 

R/r 911


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## emtkelley (Jul 9, 2007)

Thanks Pink. This is why basics are constantly bashed in public forums. Ugh....


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## VentMedic (Jul 9, 2007)

Ridryder911 said:


> First it is a laryngoscope.. if you are to claim it, at least spell it right, second you should NEVER shove anything down a throat and as well it is NOT a bubble it is called a cuff!



Who cares about spelling anymore when the schools don't?

There's a new PDQ factory in Florida that has a major typo on their website. Even after 2 weeks of courtesy emails and a phone call, it's still there. 

Or, could it be Endotracheal incubation is a new _skill_?

http://www.floridacareerinstitute.edu/emergency_medical.htm

The PATIENT CARE TECHNICIAN program sounds longer and better structured.


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## Rattletrap (Jul 9, 2007)

Ridryder911 said:


> Do you realize that you and your ideas, are a prime example of why most states do NOT allow Basics to use advanced airway.
> 
> First it is a laryngoscope.. if you are to claim it, at least spell it right, second you should NEVER shove anything down a throat and as well it is NOT a bubble it is called a cuff!
> 
> ...




You know I always thought that the layyngoscope was the "thingy with the light, and the cuff was the "thingy you blew up on the tube".

:huh::blush:


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## Jay114 (Jul 10, 2007)

Obviously all Basics cannot be judged by the words of one...
although her words did make me wince...


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## IrishMedic (Jul 11, 2007)

i'm an EMT-B, i trained in ~Indiana and we were trained in combitude, and it was a stage in our practicals for NREMT. i cant comment on whether or not they are allowed use this skill on the local BLS units. but i have also done a course on ADV. Airways, to better my knowledge and skill, i can understand where all the ALS and BLS providers are coming from in this thread....but the point is, although the majority of us strive to improve standard of care for our patients, either by training as ALS providers, or pushing for Better training or getting more training hours to keep up skills we dont regularly use, right down to nearly every EMT at all levels trying to educate themselves as much as they can, we all have to follow scope of practice that exists today, and if the best your scope of practice allows you to do is combitude, well then it's the EMT's duty to the patients, to train and educate themsleves so they know the complications, indications, anatomy and procedure to almost perfection...there have been some comments on how "easy" and i use the term loosely, it is to insert combitude, yes i agree it is a relatively "easy" procedure, but it still doesnt excuse the fact the we *NEED* to  know the anatomy, contraindications, indications, and how fragile the airway just is, our job is to keep the pt. alive and to do nothing that causes our pt. further injury or harm...so we dont just ram or jam or whatever you wanna call it, a combitude down someones airway....and in all cases i would of thought, listening for lung sounds after placement was a given....EMT-B's in my opinion are well capable of performing these procedures, but it is each EMT-B's responsibility to ensure they* KNOW* exactly what they are doing....I hope all ALS providers would not generalise against EMT-B's, or EMT-I's just because of a few comments from a small number of EMT's they come across. in all fairness ive come aross paramedics at times when their actions could be questioned. but i dont generalise against all medics, everyone should be judged on their own merit....i'm sure if you rode some shifts with most of the EMT's here *MOST* of the medics would be happy with our patient care and treatment...instead or griping about what someone elses scope of practice is in their county or service, we should be sticking together and helping each other to overcome the obstacles that face improving the gold standard of care that *WE* all strive to achieve.

final point is...if your in this job and you feel like there is nothing more you can do to achieve a better standard of care for your patients and your complacent with the current standards, then maybe you need to reconsider your career choice, cos in every level of training from first aider right up to paramedic, there is always going to be something we all can do personally to improve our pt's "*GOLD*" standard of care.


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