# Airways devices are EMT-Basics allowed to use



## MMiz (Apr 13, 2004)

In Michigan an EMT-B can insert an OPA, NPA, and Combitube.  I know in Ohio basics can insert all airways.  I'm wondering what it's like where you are, and if you feel basics should be allowed to insert all airways.

Personally I believe that EMT Basics should be able to insert any type of airway.  Ohio allows this with a 10 hours advanced airway course.  I've never inserted a combitube in the field, but I often see ALS perform Orotracheal Intubation / Endotracheal Tubes and think this would be a nice tool for basic units to have, especially those in rural areas.


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## SafetyPro2 (Apr 23, 2004)

Sorry for not responding sooner...have been busy and was out of town.

The standard around here is OPAs and NPAs. The state allows the Combitube as an "expanded scope" skill, but LA County has not yet added it to their expanded scope. Not sure about the other counties.

Since our department is all BLS, we also have a special approval for advanced airway, so a few (maybe a third or less) of our EMTs are certified for intubation. Our EMS coordinator is scheduling a class to get the rest of us certified as well, he just finished the EMT class for new folks and is doing it as the last part of that.

When California goes to National Registry state-wide in 2006, Combitube will probably become the standard everywhere for EMTs, and we'll most likely lose our advanced airway exemption.


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## MMiz (Apr 30, 2004)

> _Originally posted by SafetyPro_@Apr 23 2004, 01:36 PM
> * Sorry for not responding sooner...have been busy and was out of town.
> 
> The standard around here is OPAs and NPAs. The state allows the Combitube as an "expanded scope" skill, but LA County has not yet added it to their expanded scope. Not sure about the other counties.
> ...


 That's interesting about the use of advanced airways.  In our county Basic units *are allowed* carry a combitube.  Being that my company likes to have more than our competitors, we have them on many of our BLS rigs.  It is my understanding that most in our county dont have combitubes, but call for an ALS intercept and bag while they wait.  

That said, EMT-Basics that work for private companies like myself are in a grey area.  They aren't too keen on private basic units using the combitubes, they'd rather have an ALS unit intubate.  If it came down to it, I'd start bagging with OPA / NPA and wait for ALS, they're usually 1-2 minutes behind us.


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## ffemt8978 (Jun 2, 2004)

> _Originally posted by MMiz_@Apr 13 2004, 08:07 PM
> * In Michigan an EMT-B can insert an OPA, NPA, and Combitube.  I know in Ohio basics can insert all airways.  I'm wondering what it's like where you are, and if you feel basics should be allowed to insert all airways.
> 
> Personally I believe that EMT Basics should be able to insert any type of airway.  Ohio allows this with a 10 hours advanced airway course.  I've never inserted a combitube in the field, but I often see ALS perform Orotracheal Intubation / Endotracheal Tubes and think this would be a nice tool for basic units to have, especially those in rural areas. *


 In Washington, EMTs are allowed to use the OPA and NPA.  In order to use a Combitube, you have to take an additional class and have the Medical Program Director send a letter to the state authorizing you to use the Combitube.  Luckily, since I'm a NREMT, I was able to challenge the test and the MPD signed off on my letter.

For those of you that are wondering, Washington does NOT follow National Registry except at the Paramedic level.  I was previously a NREMT-I/85 but downgraded my certification for ease of reciprocity.  This state has 6 or 7 different levels of Intermediate certification, and is very confusing.


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## Alpha752 (Jun 2, 2004)

As you stated, in Ohio we can use OPA, NPA, Combitube and ET tube on an adult.  We can not tube peds (OPA or NPA only)

I have never used Combi or ET in the field, but from training I can say that Combitubes ROCK!!!  It is 10 times easier then an ET tube.  

Also, for Ohio, Advanced Airway is at Medical Directors discression.  They can decide if they want their Basics to intubate or not.  I have heard its about a 50/50 split.


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## ffemt8978 (Jun 4, 2004)

> _Originally posted by Alpha752_@Jun 2 2004, 06:46 PM
> *
> I have never used Combi or ET in the field, but from training I can say that Combitubes ROCK!!!  It is 10 times easier then an ET tube.
> 
> *


 Combitubes do rock!!!!

My very first call as an EMT, I got to use one on a Code Blue.  Briefly, the call went like this:

Dispatched to a man down.  I was driver, and the Assistant Chief was in the passenger seat.  Upon our arrival, we observed two guys from the local cable company performing CPR on a man laying between his vehicle and a 3 foot snow bank.  I jumped out and grabbed the defib and O2 kit.  I shocked the guy twice and got to insert the Combitube.  We got the guy back in the back of the ambulance, but he died within 24 hours.


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## ResTech (Jun 5, 2004)

In Pennsylvania EMT-B's are only allowed to use OPA's and NPA's. All other airway devices can only be utilized by Paramedic's. Personnally, I would like to see teh Combitube offered as an alternative airway for BLS but just don't see that happening anytime soon.


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## ffemt8978 (Jun 6, 2004)

This is what just baffles me.  Combitubes are so easy to use, pretty-much firefighter proof, and can provide a patent airway in a critical patient that I don't understand why so many jurisdictions don't allow their EMT-B's to use them.

I realize that they're not as good as an ET, especially if you want to push drugs through them.  However, they are more stable than the ET and often times work when an ET can't be inserted for whatever reason.


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## cbdemt (Jun 16, 2004)

Only OPA and NPA in good ole central IL.  I've heard our protocols are under review, hopefully some changes are underway.


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## citizencain20 (Jun 16, 2004)

*Here in northern wisconsin, we are allowed to use oral, nasal as well as combitude as basics.  The current protocals are currently under review to train and allow basics in Wisconsin to also learn Endotrachial Intubation as per National Registry standards.  I could't live without my double lumen!*


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## rescuecpt (Jun 24, 2004)

New York State allows EMT B's to use NPA and OPA.  EMT-I (intermediate) and EMT-CC (critical care) can intubate.  Combi Tube is soon to be rolled out as an advanced (I & CC) protocol and if all goes well, hopefully will be rolled out for basic.

Combitube is pretty much idiot proof, and since you don't need to visualize the chords, almost anyone can be taught to do it.  Intubation should not be included, IMO, at the BLS level due to the amount of time, anatomy & phys, and real life practice (in the field or in an OR or morgue) that should be performed prior to using the technique in the street.  The amount of time necessary to properly learn the skill would add weeks to the BLS course and probably discourage a lot of prospective EMTs.


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## ffemt8978 (Jun 24, 2004)

> _Originally posted by rescuelt_@Jun 24 2004, 10:08 AM
> * Combitube is pretty much idiot proof, and since you don't need to visualize the chords, almost anyone can be taught to do it.  Intubation should not be included, IMO, at the BLS level due to the amount of time, anatomy & phys, and real life practice (in the field or in an OR or morgue) that should be performed prior to using the technique in the street.  The amount of time necessary to properly learn the skill would add weeks to the BLS course and probably discourage a lot of prospective EMTs. *


 I was always taught to say firefighter proof.    

I agree about intubation not being taught at the basic level.  I have some reservations about it being taught at the intermediate level primarily because of RSI, which uses drugs.


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## rescuecpt (Jun 25, 2004)

Another point about intubations: EMT-Intermediates and EMT-Critical Cares can not use paralytics in NY State, I don't even think medics can unless they're certified Flight Medics.  That makes it extra difficult in a lot of cases.  Hey, if I have the choice, it's OPA and bag first.


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## TTLWHKR (Jul 24, 2004)

:blink:  I often speak with people who have been in EMS since the 1950's, before ems really. They say that the biggest change in the EMT scope of practice in Pennsylvania was only that they came up with an EMT course. The change from the "Pennsylvania Ambulance Attendant" To Basic -EMT-Ambulance in the 1970's was the only worthy change they can think of. Of course they added AED's, and some ambulances can carry EPI, some can do EKG's; all on a BLS level. But two of those are just from the past 5 years, and only 1 service per ems region was selected. 

I'd like to see them expand the scope of practice to advaced airway techniques; maybe the combi tube.

Our skills include OPA, NPA... Thats it. It's basic, very, very basic. The scope of practice needs to be expanded so tha people in rural areas have the same chance of living as people in cities. There are many counties that do not have paramedics at all. We attempted to staff two medics 24/7, and they quit b/c of the lack of calls. We only run 750 a year, and that wasn't enough I guess. So that puts us 42 minutes away from the nearest paramedic unit; and we're lucky to get that one. If they aren't available, we don't wait on scene; yet go enoute to the hospital as fast as possible. Often the closest hospital is 35 minutes away at 55-65mph, and the 5th Due ALS service is 50 minutes to an hour away. We can make it to the ER before they can get to the town that has the hospital. So the patient would have to wait a long time before getting advanced care, and by the time it arrived, we could have care far more advanced than them. 

I DIDN'T MEAN THAT I WAIT ON SCENE... Although I've heard some dimwits do that b/c they don't know how to make a decision.  :blink:  < I love this smilie


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## rescuecpt (Jul 24, 2004)

> _Originally posted by Blueeighty8_@Jul 24 2004, 03:01 AM
> * If they aren't available we have to wait for a unit that is 65 miles away.  :blink: *


 What do you mean wait?  Are they closer than the hospital?  Before I became ALS, I never waited for ALS... we did a grab & go and they met us along the route.  EMT-B's can't do advanced airway techniques on Long Island - and we don't even have enough EMT-B's let alone ALS!  There is a huge volunteer drive in effect, but it's not working... there aren't enough of us out there - that's part of why I took ALS.


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## SafetyPro2 (Jul 24, 2004)

Our protocol specifically states that if the response time for an ALS unit is greater than the time it would take BLS to transport, BLS should go ahead and transport and not wait for ALS.


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## TTLWHKR (Jul 24, 2004)

That is NOT what I meant....

If anyone is stupid enough to wait on the scene, they should not be in EMS....

The point was, they aren't readily available... It's still quite a long wait for advanced life support, even heading toward them at 55-65mph...

Many times we are able to get to the nearest hospital 20 some miles away before the 2nd due squad can even get to the town the hospital is in.

We never wait on the scene, our policy is that if you spend more than 10 minutes on scene, and there is no complications, you aren't doing your job. Now that's different if the patient is trapped, or cannot be moved down the stairs. i.e. weight issues. 

  Wait on the scene...  :blink:   YOU THINK I'M NUTZ?


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## MedicMan (Jul 25, 2004)

Hello,

I would like to make a comment.  
First consider what is best for the patient?  A hospital (most anyway) is more advanced than the most ALS capable vehicle, the patient deserves which ever is closer in relation to time.  If your agency insists on calling for additional support -- then call for it, beat them to the hospital without jeapordizing the patient, and document the events clearly in your reporting.  Eventually the policy will reflect true operations.  
Second (actually on the airway issue) -- I would recommend that you speak with your medical director and submit the possibility of the LMA.  I would recommend doing your research before contacting the medical director.  There are some agencies in the US that consider placement of this devise a BLS skill.  The rest is up to you.
Scott


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## rescuecpt (Jul 25, 2004)

I have spoken to our County training supervisor about the LMA, I've used it in the OR and thought it worked pretty well, but the County has decided that Combi-Tubes will be the next BLS airway rollout.


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