# Combitube removed from EMTB NSTC???



## wildmedicspm (Dec 4, 2007)

We got a memo from our state ems division last week that said that the DOT had not included the combitube as a skill for EMTBs in it's latest National Standard Training Cirriculum.  Has anyone out there heard similiar or read through the NSTC yet?  I haven't had time and was hoping someone would be able to confirm or deny that. Thanks.


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## ffemt8978 (Dec 4, 2007)

I know this was being discussed in the draft proposal of the Scope of Practice, but wasn't aware that it had been adopted yet.


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## triemal04 (Dec 4, 2007)

Can't say for sure, but from what I remember of the last draft I read, that's accurate.  And gotta say:  good call on their part.  And that it doesn't surprise me in the least bit.

Good call in that the basic course is so short and absurdley dumbed down (just like the medic curriculum) that there is no way a basic should be attempting a combitube.

Not shocking in that the standards for EMT's at all levels are far to low and I don't really see a reversal of that trend coming in the near future.  

Not to hijack this or anything, but does anyone who has seen the new standards know if CPAP has been added to the medic curriculum?  Or is it still to new and "unproven" for the DOT?


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## Ridryder911 (Dec 4, 2007)

Combitube was never considered to be a basic skill per NHTSA. It is an advanced airway and should be taught and treated as such. It comes with many complications, risks, and advantages. The reason of my concern on allowing anyone other than an advanced level inserting it.

Each state can add to the level of the Basic, Intermediate, etc.. but cannot reduce the level taught. 

I agree, the curriculum had been diluted, we will see what the current one will be like. I am aware the Paramedic curriculum has been increased intensely. I recommend taking collegiate level anatomy in the future. 

R/r 911


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## triemal04 (Dec 4, 2007)

Ridryder911 said:


> I agree, the curriculum had been diluted, we will see what the current one will be like. I am aware the Paramedic curriculum has been increased intensely. I recommend taking collegiate level anatomy in the future.
> 
> R/r 911


Say what!?  Can you elaborate on that at all?  The last draft I've seen (granted that was over a year ago if not 2) was not really an improvement at all.


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## Ridryder911 (Dec 4, 2007)

triemal04 said:


> Say what!?  Can you elaborate on that at all?  The last draft I've seen (granted that was over a year ago if not 2) was not really an improvement at all.



Those over 2 years ago was scrapped. Please do not confuse the "Scope of Practice" with those of the "NHTSA" education curriculum. They are different. 

http://www.nemses.org/documents.html

Here is a powerpoint, I highly recommend to view that explains the process and proposed ideas. 
http://www.nemses.org/edstandards0907.ppt#1

R/r 911


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## JJR512 (Dec 4, 2007)

I took my EMT-B class in the first half of 2006. The Combitube was never taught to us, nor mentioned, nor shown. I honestly don't even know what one looks like. So the fact that it's been removed from the curriculum makes me feel no sense of loss whatsoever.


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## Capt.Hook (Dec 4, 2007)

Wow.  Eye opener.  I know combitube is still being taught in WI.  One wonders what other skills for all levels are used in some states or areas while not in others and why.  I plan to do more research.


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## Guardian (Dec 4, 2007)

Ridryder911 said:


> Those over 2 years ago was scrapped. Please do not confuse the "Scope of Practice" with those of the "NHTSA" education curriculum. They are different.
> 
> http://www.nemses.org/documents.html
> 
> ...



Looks like someone is finally on the right track!!  I love that they want to do away with all the emt-alphabet and use ems responder as the generic term.  This makes me happy.


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## Jolt (Dec 4, 2007)

We were never taught the combitube either, but I did practice it a few times on the airway manikin whenever I was bored.  That and ETT intubation. 

OPAs got boring after a while...


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## bstone (Dec 5, 2007)

Removing Combitube? While that might be the case, more states are having Basics start IVs and do actual intubation. It seems to be they would want combitube to be part of the cirriculum in order to have proper training and standards.


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## Ridryder911 (Dec 5, 2007)

bstone said:


> Removing Combitube? While that might be the case, more states are having Basics start IVs and do actual intubation. It seems to be they would want combitube to be part of the cirriculum in order to have proper training and standards.



Actually, there are few states that want the basic to intubate. Rather there are those that have encompassed the Intermediate and basic together. Basic EMT is really an intermediate level, without the title and of course pay, recognition. As well, there are still heated debates even to allow intubation at the Paramedic level. I believe they will still allow such, but may be restricted in the future. 

R/r 911


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## firecoins (Dec 5, 2007)

Never saw or heard of a combitube at the EMT-B level.


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## bstone (Dec 5, 2007)

Ridryder911 said:


> Actually, there are few states that want the basic to intubate. Rather there are those that have encompassed the Intermediate and basic together. Basic EMT is really an intermediate level, without the title and of course pay, recognition. As well, there are still heated debates even to allow intubation at the Paramedic level. I believe they will still allow such, but may be restricted in the future.
> 
> R/r 911



I have heard of this. Another reason why EMS needs strong representation.

In Illinois, intubation is a Basic skill.


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## mikie (Dec 5, 2007)

firecoins said:


> Never saw or heard of a combitube at the EMT-B level.



It was part of my EMT-B training in Missouri and now I live in Illinois (as a student) and we can use them.  I'm on an ILS squad but as a BLS provider, can still use the combitube (per protocol: must be apneic/pulseless)

isn't it also taught on the National Reg. 'level?'  Because we were told it could've been one of the 'random' practical skills we were tested on.


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## Ridryder911 (Dec 5, 2007)

mikie333 said:


> isn't it also taught on the National Reg. 'level?'  Because we were told it could've been one of the 'random' practical skills we were tested on.



Again, if you were tested on a "practical" for your basic, it was NOT a NREMT practical. NREMT does NOT have or require Basic EMT practicals. States, can adopt their standards as well as the state may require it on the States practical, and yes the NREMT wants some form of a practical (it can be sponsored by the school). 

Please review NREMT practical and testing procedures: 

www.nremt.org

R/r 911


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## bstone (Dec 5, 2007)

We were tested for Combitube for NREMT-Intermediate and were given the option to do the intubation test. Since the state I train in has Intermediate to intbuation they felt it would be approproiate for us to take that test.


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## VentMedic (Dec 5, 2007)

Welcome to EMT Life *mikie333*.

I see you've already met RidRyder911.


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## Ridryder911 (Dec 5, 2007)

Oops... :blush: sorry.. Welcome ! 

R/r 91


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## mikie (Dec 6, 2007)

VentMedic said:


> Welcome to EMT Life *mikie333*.
> 
> I see you've already met RidRyder911.



Thanks!  Is this a 'bad' (for lack of a better word) thing (meeting RidRyder911) ?


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## VentMedic (Dec 7, 2007)

mikie333 said:


> Thanks!  Is this a 'bad' (for lack of a better word) thing (meeting RidRyder911) ?



No, meeting RidRyder911 on the forums can be good for the majority of the time. 

He does not sugar-coat his posts but will definitely give you a straight forward answer or opinion.  His posts are factually based from 30 years of education, knowledge and experience.  The pride he still has as an EMS professional comes across clearly which is refreshing in a profession that has a high burn out rate. 

I welcome a good debate with him but most of the time I do find myself agreeing with his comments.


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## Guardian (Dec 7, 2007)

VentMedic said:


> I welcome a good debate with him but most of the time I do find myself agreeing with his comments.



I have the same problem.


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## Ridryder911 (Dec 7, 2007)

Thanks for the compliments. :blush:


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## katgrl2003 (Dec 7, 2007)

Aw, Rid!  I think you're blushing!

-Kat


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## disassociative (Dec 7, 2007)

I was watching Trauma: Life in the ER; and they were following Oklahoma Med Flight; I could've sworn I saw Rid, lol.


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## Ridryder911 (Dec 7, 2007)

disassociative said:


> I was watching Trauma: Life in the ER; and they were following Oklahoma Med Flight; I could've sworn I saw Rid, lol.



Actually, I was in one of the episodes of that show. I was not with Medi Flight, but was with a flight crew that brought in a abdominal evisceration. The patient was a prisoner, and while enroute became hostile and I had to paralyze and RSI. 

Ironically, my family and fellow peers have seen the episode, I myself have not yet seen it...lol 

R/r 911


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## disassociative (Dec 7, 2007)

They came to Vandy; not too long ago. I was doing my clinicals with the TICU; and missed them by about a day. They came through and had everyone sign a whole bunch of consent forms along with the legal dept. 

Wow Rid, Super-Nurse, Super-Medic and now Super-Star!

Can I have your autograph(particularly on a blank check made out to "cash")?


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## Airwaygoddess (Dec 7, 2007)

Ah Rid, now I have seen stars in my eyes.......^_^


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## jakobsmommy2004 (Dec 13, 2007)

Capt.Hook said:


> Wow.  Eye opener.  I know combitube is still being taught in WI.  One wonders what other skills for all levels are used in some states or areas while not in others and why.  I plan to do more research.



In  the Detroit area here I work for a Private Ambulance and we have them on our BLS rigs.


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## wolfwyndd (Dec 14, 2007)

When I took my EMT - B class in the spring of 2004 the combitube was never part of what I was taught and I was also never tested on in either in the classes or the NR skills assessment.  

Now when I went to take my local protocol test I WAS tested on it and our training officer had to show me how to use it.  Our local protocol for 2008 will include the combitube again.  And just for reference, I live in the Dayton, OH area.  I have a friend of mine that lives in our neighboring state of Indiana and I'm told that basics are not allowed to intubate at all there.


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## katgrl2003 (Dec 14, 2007)

wolfwyndd said:


> I have a friend of mine that lives in our neighboring state of Indiana and I'm told that basics are not allowed to intubate at all there.



Basics in Indiana aren't allowed to intubate, but we are allowed to use the combitube.  As far as I know, there hasn't been any talk about changing that.

-Kat


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## AntonioEMT (Dec 15, 2007)

*intubation*

here...in italy...combitube doesn't exist...:sad:


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## firecoins (Dec 15, 2007)

wolfwyndd said:


> When I took my EMT - B class in the spring of 2004 the combitube was never part of what I was taught and I was also never tested on in either in the classes or the NR skills assessment.
> 
> Now when I went to take my local protocol test I WAS tested on it and our training officer had to show me how to use it.  Our local protocol for 2008 will include the combitube again.  And just for reference, I live in the Dayton, OH area.  I have a friend of mine that lives in our neighboring state of Indiana and I'm told that basics are not allowed to intubate at all there.



Intubation is an ALS skill in NY and NJ.  Combitubes, King tubes and LMAs are ALS too.


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## mikie (Dec 15, 2007)

In my EMT class we were also taught EOA's, but I've heard that they're not going to be used anymore pretty much...

anyone else have experiance/opinions on those?


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## haneyk (Dec 18, 2007)

I am a new EMT-B here in Minnesota. Our EMT-B class did teach the combitube but as a seperate variance certification. It was not a part of the normal EMT-B certification.  We spent about 3 hours on it including training on annie dolls to practice the procedure.   Our ambulance service is also working on training the EMT-B to do IV's as a seperate variance also. They have state signoff on this along with our medical director.  We are in the rural area of Minnesota so resources and skills our limited to mostly volunteer EMT and paramedics.

Kevin


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## AntonioEMT (Dec 18, 2007)

*Emt-i*

EMT-I in italy are allowed to:

_Airways management...only "mayo canule oropharingee", not rhinofaringee.
intubation is a medic competence, "only medic".
We don't use combitube etc....

_Adrenaline, athropine, glucose 33%, NaCl 0.9%, ringers.....

_monitoration: Glucose level with glucometer. PaCO2, Sp02, Bp, F.C., E.C.G. 12 and Tele E.C.G, with lifepack 12.

_defibrillation: only AED....semi-manual end manual "only medic"

_vacuum splint, traction splint.

Extrication and immobilization techincs....similar of yours.


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## iamjeff171 (Dec 27, 2007)

we were taught the combitube in my basic class that i just finished.  although as far as i know the protocols in my area dont allow basics to use them.


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## kiwimedic (Dec 27, 2007)

Us Kiwi's dont use dual lumen's but both OPA and LMA are EMT-B skills, ETT and surgicals are EMT-P.


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## RESPONDA (Dec 28, 2007)

*curious*

kiwimedic,

I am not too familiar with the comparisons between NZ qualification levels and those of the USA. Can you please explain the comparisons? for eg: emt-b is the equivalent to what level here in NZ?

Responda


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## kiwimedic (Dec 28, 2007)

Primary Care:  EMT-Basic
Ambulance Officer:  EMT-Basic or EMT-Basic with enhanced skills
Paramedic: EMT-Intermediate
Advanced Paramedc:  EMT-Paramedic

Remember that because Ambulance Officers (National Certificate) can do nitro, glucose etc they are (in some jurisdictions) considered EMT Intermediate.  Generally speaking an EMT-I can give ALS drugs and do EKG/manual defib, which here are Paramedic (IV/Cardiac) level interventions.

Not sure if the Wairarapa DHB uses the same levels and scopes of practice as the rest of the country but I would be interested to find out.


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## enjoynz (Dec 29, 2007)

kiwimedic said:


> Primary Care:  EMT-Basic
> Ambulance Officer:  EMT-Basic or EMT-Basic with enhanced skills
> Paramedic: EMT-Intermediate
> Advanced Paramedc:  EMT-Paramedic
> ...



Just would like to make one correction to this one, if you don't mind Kiwimedic.
As I am a Primary Care Ambulance Officer and have talked to a good many of our American EMT friends, I can tell you that our PC level is not the same as EMT-B. But the US do have a First Responder level which would be much the same. We can give Entonox, but that's all that is different. 
EMT-B is equal to our AO level here!

Cheers enjoynz


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## enjoynz (Dec 29, 2007)

wildmedicspm said:


> We got a memo from our state ems division last week that said that the DOT had not included the combitube as a skill for EMTBs in it's latest National Standard Training Cirriculum.  Has anyone out there heard similiar or read through the NSTC yet?  I haven't had time and was hoping someone would be able to confirm or deny that. Thanks.



Sorry for stealing your thread before, just wanted to clear any confusion with my skill level. (I don't want people thinking I'm something, that I'm not!:blush.
As Kiwimedic said. In NZ we don't use a combi tube, but recently the Laryngeal mask airway (LMA) has been added to the (AO) EMT-B level.
So it seems weird that they would take that skill at EMT-B level away from you? Or have I mis-understood your post?

Cheers Enjoynz


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