# Magil Forceps's



## Gbro (Sep 9, 2007)

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 (Sep 9, 2007)

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 (Sep 9, 2007)

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 (Sep 9, 2007)

ridryder 911 said:


> 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 (Sep 9, 2007)

ridryder 911 said:


> 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 (Sep 9, 2007)

+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 (Sep 9, 2007)

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


R/r 911


----------



## Gbro (Sep 10, 2007)

> 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 (Sep 10, 2007)

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 (Sep 10, 2007)

SwissEMT said:


> 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.
> ...



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 (Sep 10, 2007)

> 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 (Sep 10, 2007)

Gbro said:


> ...
> 
> 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.



			
				Gbro said:
			
		

> 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).



			
				Gbro said:
			
		

> 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 (Sep 10, 2007)

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 (Sep 10, 2007)

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 (Sep 10, 2007)

Gbro said:


> ...
> 
> 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 (Sep 10, 2007)

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 (Sep 10, 2007)

SwissEMT said:


> 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.
> ...


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 (Sep 10, 2007)

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 (Sep 10, 2007)

Gbro said:


> 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 (Sep 10, 2007)

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!


----------



## ffemt8978 (Sep 10, 2007)

That's enough of this thread until everyone cools off a bit.


----------



## ffemt8978 (Sep 12, 2007)

Okay, this thread is reopened provided everyone can abide by the forum rules.


----------



## BossyCow (Sep 13, 2007)

Okay, I'll bite.  

I don't understand why a thread that is asking about a piece of equipment and what level of skill and training is required to support its use turns into an argument of "Do you think I'm an idiot" answered by "You're all idiots".  

I think we are all frustrated when the skill sits on the border between certifications.  Paramedics unable to use their ALS skills in a BLS agency response.  EMT-B's who see the need for a particular skill or tool in order to provide for our patients, but can't due to SOG's or protocols.  

Maybe its because I know for certain that I'm not an idiot.  But when a medic says "I don't want a yo-yo using this, I assume he doesn't mean me. But then, part of not being a yo-yo is I don't want to use a tool I haven't been trained in or in-serviced on.  

I'm fortunate to have a medical control who is incredibly lenient when it comes to allowing us to use those borderline tools.  But, I better call in first, I better have a plan for what I'm going to do if it doesn't work, and I better know what I'm talking about.  And you know what?  If I don't meet the above criteria, I don't want my MPD allowing me to do something that going to leave me with a drano pt. no ALS support and a 30 minute transport.  

The truth is we can't all work in ALS services.  God I wish we could, but we don't.  There are those times, places and systems that are not going to fund them.  This is the flip side of rural living.  When you move way out into the toolie-berries, you better do so with the understanding that there will be inconveniences.  You will not have immediate access to state of the art medical care.  You will not have police and fire at your beck and call.  You will have to occasionally live without power (even to your Oxygen, or C-pap)
The road between you and your doctor may be out and the satellite that your cell phone needs to transmit may or may not be functioning when you need it most.  

Now, in those places, there are people, often volunteers who will do whatever they can to pitch in and help when things go south.  They train, they practice and they will do whatever they can to help mitigate an emergency.  They are held to a standard of training and skill by the state.  They are often top notch, professional healthcare providers.  

They are not as well trained and do not have the skills of paramedics.  paramedics don't have the skills of nurses and nurses don't have the skills of physicians and physicians don't all have the skills of surgeons.  While there may be an EMT who can do better CPR than a 30 year floor nurse who has never seen a pt code on her shift, that doesn't mean that nurses are stupider or less skilled than EMT's.  Nor does the fact that a paramedic has more tools in his arsenal and the training and skills to use them mean that all EMT's are morons.  

I think the bottom line here is that we are all trying to do the best we can with the tools we have.  We're on the same team and we need to work together.  There is enough ego on both sides of every fence to keep the battles and bashing going for eons.  But the mature among us know how to keep that under control, or at least preserve that illusion.


----------



## Ridryder911 (Sep 13, 2007)

First, I do not personally think all basics are morons myself, I have seen moron at all levels including physician level. 

I believe what most people are loosing sight on is the whole picture. Anyone, can perform procedures if guided or talked through, and even if allowed a simple in service could be taught sufficient... even an appendectomy and hernia repair is simplistic...again what most basic level does not understand is the "whole picture". 

It is hard to understand the whole picture, when you have not been taught it.  One of the reasons such procedures as using the "Magill" forceps is what happens if that fails? Remember, there are steps and the next step after the use of Magills is surgical airway. 

As well, as one that had to recently use Magills, I can attest visual landmarks, and having an extreme knowledge in anatomy is crucial. I had a pediatric choking (8 weeks) (the father shoved a baby wipe into the trachea). Upon arrival, there was a large aount of blood, as well as laryngeal edema. Again after BLS, procedures we immediately visualized, and please remember the glottic opening of a pediatric is approximately the size of a dime. Try visualizing and placing pediatric laryngoscope blade and magills into that area. The chords appeared to be torn or was it .... a foreign body? Remember we did not know what exactly had occurred at the time. I attempted to pull on the portion of the chord that appeared to be strange... (remember, pulling a chord out, totally removes the ability of that person to ever speak again!) 

Now, please place yourself into that responsibility. 

When I pulled on the "supposed" object it did not move, I even asked a new Paramedic to visualize and her self was confused, exactly if it was the chord or an object. I declined to "yank" on it due to again that it could be the vocal chords. I was able to ventilate with some chest rise, although the child heart rate was declining rapidly, and CPR was performed when it went below 60. We rapidly transported to the ER, fortunately it was <  1 minute away. 

Upon arrival, the ER physician agreed it was difficult to differentiate. With the CPR a smaller portion of the wipe had dislodged a little enough for him to grasp it with the Magills. I can attest as he did, it was a tough pull and finally removed the object, while doing so the child went into cardiac arrest. We were fortunate enough, that resuscitation was successful. 

This was approximately 10 months ago, and about 3 months ago, I had testify against the father. 

I can assure you it was h*ll, against the defense attorney, even though the father admitted he forced the wipe into the child's mouth. Acquisitions was made that we forced the wipe down using the Magill forceps, and exactly what education and training did I receive to use such specialize equipment. I was even quizzed on the anatomy. Even though, I hold instructor levels in the Neonatal Resuscitation, PALS, PEPP, etc.. Why, didn't I just transport while doing BLS? Could I be 100% certain, I did not force the object further, or cause more damage?

I can assure you something, I would never want to go through again. 

I wished I could say the outcome was good. Even after the ER physician testimony, and the blunt admission of guilt, the jury only awarded him a few months in jail, and worse, the time he had spent was allowed to be entered. 

So, I feel my emotional response is valid. From one that has been cross examined and questioned using magill forceps, even though I have used them several times successfully, and have had been extensively trained and educated in using them still was placed on the hot seat. I can just imagine what would occur from those that did not have such education, training, experience  as myself. 

Here is a link to the story.. http://news-star.com/stories/051707/new_47824.shtml

R/r 911


----------



## Airwaygoddess (Sep 13, 2007)

Rid, all I have to say that that was one hell of a call from start to the end.  You and the others that were there give that baby a fighting chance, I thank the heavens that she won.  -_-


----------



## Gbro (Sep 13, 2007)

Thank you for sharing that story.
Now if you will pause for a moment and think/look back to the original post, your story and my post were not fully relevant.
What i was posting about is when we look into an airway, i always would verbalize "peek" when looking for a foreign object in the airway of a child. The protocol is to "Not Sweep" "Look" and "remove what we see". 
What a splendid procedure, Now with "my fingers", I might just as well be doing a blind sweep, as i wouldn't see past my fingers in most instances., and that is why we do not do blind sweeps, we could just make matters worse. 
Now maybe i should use a fish hook remover, Because there is such a strong consensus that a Magill is married to a laryngoscope . 
Rid in your story you related that you went searching deep in the airway, as you didn't see an obstruction prior to pulling out the scope. There is a difference. I never intended that.


----------



## Flight-LP (Sep 13, 2007)

***bangs head on wall***

A fish hook wouldn't be recommended.............

Why not just do what your level of certification and training allows you to do and leave it at that? Despite RELEVANT depictions of how and why things WILL go wrong, you still insist that everyone else is incorrect in your search for self justification. This thread is going no where and is falling on deaf non believing ears. Lets just move on..............................


----------



## triemal04 (Sep 14, 2007)

Even in a little kid...a newborn...if you don't need a laryngoscope to see the obstruction, then it's most likely going to be plenty high up enough in the airway that you can get to it with your fingers.  Think about how the human body is put together and it starts to make sense, doesn't it?

If you need a laryngoscope...then you are almost gaurenteed to need magil's...which means that as a basic with no knowledge of the human anatomy, you are out of luck.


----------



## Gbro (Sep 14, 2007)

Flight-LP said:


> ***bangs head on wall***
> 
> A fish hook wouldn't be recommended.............
> 
> Why not just do what your level of certification and training allows you to do and leave it at that? ..............................



What part of my training am I not following? "If i can see it, Remove it"
Please, where did you loose the "remover" part of my post?



> "fish hook remover"





Maybe you should refrain from getting your head so close to that wall?

Now I am not a beliver in  evolution, from ape to man, but isin't using tools to preform simple task kind of where .....................................


----------



## Grady_emt (Sep 14, 2007)

I like to take some 4x4s and ball them up, pinch them in the Magill's and preform a self administered nostril cleaning.


----------



## BossyCow (Sep 14, 2007)

I'm big on analogies, and the one that comes to mind here is a kid, used to driving on Dad's lap down the driveway assuming he can drive a car.  There are times he can drive, there are times when it works just fine, but that doesn't mean you buy him his own set of keys.  

Just because there *may* be an instance where the forceps could be used instead of fingers to pull something out of an airway without negative consequence to the pt. doesn't negate the risk of causing a problem to a pt with the same tool.  The risk outweighs the gain.

Bottom line, if you want to be trusted with an ALS tool, get an ALS certification.


----------



## KEVD18 (Sep 14, 2007)

BossyCow said:


> Bottom line, if you want to be trusted with an ALS tool, get an ALS certification.




and rtight there is the central theme of every thread regarding als tools at the bls level.

i've been told that many times myself and i got mighty tired of it. so you know
what i did? well, check my "current level" under my name....


----------



## Ridryder911 (Sep 14, 2007)

Great analogy Bossy! 

This is part of the problem with some lower level medical providers. Not all by any means; but it tends to be greater on those with lower training, because the lack of understanding of the risks, potential dangers, and litigation of using and playing with medical equipment that has to be authorized by a licensed physician. 

Unfortunately, EMS suppliers are just too happy to sell oxygen cylinders, medications, IV supplies to about anyone. If not suppliers, medics carry such things off duty. Amazing, most EMT's and medics carry much more medical equipment than I have ever seen a licensed physician (that actual has authority to use it ) carry. Compare their little black bag to a jump kit of off duty EMT. 

The difference between ignorance and stupidity is not being aware or unintentional action versus repeat offense or have been educated and refuse to change. All medical equipment has a label that reads..._ Federal Law prohibits the distribution and use of this device without proper prescription or orders of a licensed physician"...._. With this said, cervical collars, IV's, etc..legally can only be carried by a physician order or one is technically is violating a Federal Law, with consequences of fine or prison. Oxygen * is a medication in a gas form*... period and unless you have a prescription to carry it or administer it, you are providing medication and practicing medicine without a license. The only way Rescue and EMS is able to do such is through licensing agencies, and qualified personal under protocols, while either representing the agency or on duty. 

Remember, litigation can be based upon "standard of care". This means, what you were taught, certified or licensed in, as well as compared to those with the same license or certification would had done under protocols or direct medical control. Deviating away from such, is risky business, and one better be able to justify one's action well enough to do so without further harm to the patient. Even then, one can still be prosecuted for acting upon themselves and endangering the patient. i.e. defibrillating a patient in v-fib without license or certification, intubating a apneic patient without a cert to do so.. IV or any medication or tools, that one has not been taught or certified in. Just because there are surgical tools in the ER; does not allow me to use them... even though, I might do so sucessfully. I * must* know my limitations....

R/r 911


----------

