# BLS Intubations



## Ray1129 (Oct 14, 2004)

I have a question.  It's probably something I'm going to have to look into here in Maryland, but do any of you have suggestions or ideas as to who I would talk to in reference to suggesting the idea of BLS providers using ET Tubes, or even Combi-tubes for that matter, and possibly being allowed to use/read/decipher EKG's?  

I was thinking that maybe I should talk to my local medical director.....but is there someplace lower I would have to start with?

Ray


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## rescuecpt (Oct 14, 2004)

I don't want to discourage you, but adding those two skills would add probably 50 hours to the EMT-B curriculum.  And what good is it to know how to read an ECG if you can't do anything for it (no drugs)?  At a basic level, it's either "SHOCK" or "NO SHOCK".  I know that stinks, but that's what Intermediate, Critical, and Advanced courses are for.

Although, some municipalities are working LMA's or Combi-tubes into the Basic protocols.  Start with your city or county medical director.  They know what ideas are on the table, what the feasibility is, and when it'll happen.

It's great that you want to provide better patient care.  You should consider an advanced course.

Good luck.


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## Ray1129 (Oct 14, 2004)

Well, it's not so much knowing how to read/decipher EKGs for treatment, but to help the ALS providers when the need-be.  I can kinda-sorta read EKGs, which helps my paramedic when he/she's busy doing other things.  It also comes in handy when you have a paramedic en route and you can tell them what kind of rhythm the patient is in before they even get there....

But I was more focused on the BLS Intubation, primarily with the Combi-tube.  While the BLS provider is doing that, the first responder is doing chest compressions, the ALS provider can play ALS provider and push what needs to be pushed/play with the monitor.

Ray


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## Margaritaville (Oct 14, 2004)

Ray,

I think I know  what you are looking for and what you need. PM me and we will figure out a way to discuss this. I am also aware of the reasoning behind the EMT-B skills, but i won't go into that discussion here.

Take care - 

Margaritaville


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## SafetyPro2 (Oct 15, 2004)

Check out my post entitled We Lost Advanced Airway for BLS further down in this forum. We used to have ET intubation as an optional skill for BLS, but the State/LA County yanked it earlier this month. We were the only BLS agency in the county doing it for the last couple years.

CombiTubes were supposed to be part of the new scope, but alas, that's not going to happen either.

Good luck.


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## kyleybug (Oct 15, 2004)

I had training in both combi and PTL during my course as an EMT-IV it was also a station for NR. If you have NR certification then you are required to know the skill of both tubes. My state (TN) doesn't have a state test, they use the NR test and if you pass it then you get your license. I am not sure whom you would contact about it. I figure I will just go ahead and do the Medic course too and then I really get to play......RSI looks like a whole lot of fun to me


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## Alpha752 (Oct 16, 2004)

This reply will not help you at all, but I know in Ohio we, as Basics can Intubate and use CombiTubes.  Perhaps you can find stats from states who let Basics do this for your argument.  

Advanced Airway I think Basics can handle.  EKG's are a whole nother kettle of fish.  Thats starting to get into ACLS type stuff, and as a Basic, I dont think that is something we should have to deal with.  I am a paramedic student and I know cardiology is going to be one of our hardest sections.  In my opinion, EKG/Monitor is a bit much for basics, AEDs work well for our uses.  Becides what good is it to identify the rythem if you cant treat it.  Sure you can give the medic a heads up, but they have to assess for themselves anyway.

Russ


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## ResTech (Oct 16, 2004)

> *But I was more focused on the BLS Intubation, primarily with the Combi-tube. While the BLS provider is doing that, the first responder is doing chest compressions, the ALS provider can play ALS provider and push what needs to be pushed/play with the monitor.
> *



Ray1129, 
I totally understand your intention's in wanting to provide a more advanced level of care to your patients and wanting to make the team approach to patient care more efficient between ALS & BLS. I am all for BLS providers having the authority to utilize the Combi-Tube and think all states should permit this skill. It is a very easy airway to use with minimal risk for improper use. 

Although in the above scenerio that you mentioned, the Combi-Tube would definitely not be considered the airway of choice when an ALS provider is onscene. Endotracheal Intubation is the "gold standard" for airway control and using an airway device that offer's no additional clinical benefit and is deemed to be inferior to an ET tube would just not be providing good patient care. I do see your rationale though and understand how it would seem to free up the medic to initiate other treatment modalities but again, airway control is of vital importance as we all know and inserting a Combi-Tube when an ET tube is sitting right there beside the patient just is'nt prudent. 

And also, you mentioned about while BLS is inserting the CT the medic can be pushing drugs and what not. Here's something to think about. After the patient is intubated by the paramedic, they're is now a direct pulmonary route for drug administration and certain medication's can be pushed down the tube. A very good way for a BLS provider to help the medic is to open the medications, assemble them, and be ready to hand the correct drug to the medic as soon as the ET tube is in. And in some states where EMT's can start IV's (MARYLAND), while the medic is intubating you as an EMT can get the line established and secured.

I just don't see where the CT would best serve the patient's interest in this scenerio. The main reason for me mentioning all this is so when you do approach administration about adding this treatment modality you will hopefully not use this scenerio as a foundation to base your recommendation on. I just don't think it would add any weight to your recommendation and could actually "backfire" by not showing a firm understanding of the treatment importance and sequence, and interface between ALS and BLS.

Again, CT are great for BLS and good luck in your endeavor to get this skill added.


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## MMiz (Oct 16, 2004)

Some great points were made here, let's see if I can add something.

I absolutley believe EMT-Basics should be trained in the use of the CombiTube, and it should be available as a piece of equipment.

I don't see CombiTubes being used a lot in the field, and I've never heard of an EMT-Basic inserting one.  I have heard Paramedics talk about using them when it's difficult to secure an airway, and seen one used in this situation.  Combitubes also have a place in rural EMS, allowing EMT-Basics to secure an airway when ALS is not immediately available.  

Where I work, we EMT-Basics are permitted to insert Combitubes.  This isn't a reality in my mostly suburban county though, as ALS must be available for all respiratory calls.  An ALS intercept is also only minutes away, and hospitals would rather us bag w/ oral airways than intubate.  I'd get a weird look if my BLS unit arrived at a hospital with a patient intubated.

Most importantly though, there is no reason why you shouldn't push to get the combitube available as a tool on your unit.  It's just another option available when one is having difficultly securing an airway.

Combitube training is part of the National Registry, and part of the national registry curriculum.  I believe either Ohio or Indiana also allow their EMT-Basics to insert ET tubes, and the training is only an additonal 10 hours.  I can tell you that learning to insert a combitube can be done in a matter of hours, and after enough repetition on the practical stations, it becomes second nature.  

I hope that helps a bit.


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## ddman466 (Nov 29, 2004)

hee in ky. emt b can use a combitube. right now it is a testing phase and my squad is doing it as a pilot prog.  i see nothing wrong with bls using combitubes.it will provide a almost positive airway, and yes you can push drugs thru it. one of the issues when looked at was the paramedics said yu cant push drugs and if it were in place it would have to be removed when als got there. with a et tube if you cant see the cords, your not supposed to use it. a combitube dont require oyu to be able to see the cords. if a comb goes in to the stomach and you dont hear lung sounds to varify you blow up the other bulb and there you are, an established airway. that is my thought on it, but im only a first responder of 6 years. i have been to many emtb trainings, and no i dont think im in any way as good as an emt. but im just as important. dont mean to offend anyone here with this post, that is just my opinion.


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## rescuecpt (Nov 29, 2004)

> _Originally posted by ddman466_@Nov 29 2004, 02:49 PM
> * hee in ky. emt b can use a combitube. right now it is a testing phase and my squad is doing it as a pilot prog.  i see nothing wrong with bls using combitubes.it will provide a almost positive airway, and yes you can push drugs thru it. one of the issues when looked at was the paramedics said yu cant push drugs and if it were in place it would have to be removed when als got there. with a et tube if you cant see the cords, your not supposed to use it. a combitube dont require oyu to be able to see the cords. if a comb goes in to the stomach and you dont hear lung sounds to varify you blow up the other bulb and there you are, an established airway. that is my thought on it, but im only a first responder of 6 years. i have been to many emtb trainings, and no i dont think im in any way as good as an emt. but im just as important. dont mean to offend anyone here with this post, that is just my opinion. *


 The problem with drug administration through the Combi tube is that the majority of the time, the tube ends up in the esophagus.  Air is forced into the trachea through the holes in the side of the tube.  The cuffs above and below these holes force the air down the trachea.  If you were to push drugs (liquid) this way, they will pool at the end of the tube, which is blocked distal to the air holes.  Gravity and the force with which the drugs are pushed will win the fight and not spread the drugs through the holes.  The small amount that does make it through will not make it deep into the lungs, where circulation occurs (which is already less effective than intravenous, hence the reason we give twice as much down the tube).

If it were me, and I couldn't get an IV line to push drugs through, I would remove the Combi tube and attempt to intubate so that I would have a patent route for drug administration.  Worse comes to worse I dont get the tube - I put the Combi tube back in and pray that the patient makes it to the hospital.

Our protocols are 2 attempts on intubation, then the Combi tube as the last resort.  This is before you ever start an IV (because B comes before C in ABC's)...  and if you get the tube, you win a double prize - you secure the airway and a drug route at the same time.  So it is more important (in my State's theory) to intubate than to start an IV (obviously we're talking about unconscious patients who are not breathing.)

Check this out for a diagram - Figure 4 shows you how the tube works when it's in the esophagus.
http://www.medradio.org/combitube/
Click on "Description & Direction" on the left side menu.


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## ks_medic (Dec 22, 2004)

As far as being allowed to read ECG no one can really stop you from learning how.  you can take a ecg class or read books and self teach your self.  i know a lot of emt-b's that
can read ecg strips they just cant treat them.  

as far as ET tubes go, theres a lot of liabitlity in it.  its cosidered a highly advanced skill.
nurses and some dr. cant intubate.   I wouldn't mined an emt-b intubating but if it went to court they could say they don't have the qualification for it.  you spend a lot of time in
paramedic school refining your intubation skills.  you learn to intubate in just about 
every position posable from standing to laying flat.   you also learn RSI and other difficult intubations.  I had to spend almost 3 weeks in a OR clinical to get the 20 
intubations required by my school.   plus not too mention all the lab time and state boards.   

as for the combi-tube i prefer the EOA.   and emt-b'a can use them.


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## Ray1129 (Dec 22, 2004)

> *As far as being allowed to read ECG no one can really stop you from learning how. you can take a ecg class or read books and self teach your self. i know a lot of emt-b's that
> can read ecg strips they just cant treat them. *




Yes, that is a very good point.  I should probably do that.  But what I meant is an optional class for BLS providers just to help those along that can't teach themselves, or want additional help.  Not anything mandatory.

Though, I'm still all over having Combi-tubes be an BLS skill.  It would be nice for the Medic to get on scene and have an airway and a rapid acces to push drugs already established or even to have the BLS provider establish the airway while the Medic gets prepared.  Though I'm going to have to look into what rescuecpt said:



> *The problem with drug administration through the Combi tube is that the majority of the time, the tube ends up in the esophagus. Air is forced into the trachea through the holes in the side of the tube. The cuffs above and below these holes force the air down the trachea. If you were to push drugs (liquid) this way, they will pool at the end of the tube, which is blocked distal to the air holes. Gravity and the force with which the drugs are pushed will win the fight and not spread the drugs through the holes. The small amount that does make it through will not make it deep into the lungs, where circulation occurs (which is already less effective than intravenous, hence the reason we give twice as much down the tube).*



...I really appreciate everyones input!

-Ray


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## rescuecpt (Dec 22, 2004)

As an ALS provider, there are only 3 people on my ambulance who I let tell me what the rhythm is:

1. A county designated field physician.
2. Another ALS provider (known to me)
3. ME.

Ultimately, the pt is my responsibility.  If someone tells me what the rhythm is, I treat that, and it's wrong, that's my card you hear being torn up, and my *** being hauled off to jail.


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## Jon (Dec 22, 2004)

> _Originally posted by rescuecpt_@Dec 22 2004, 12:48 PM
> * As an ALS provider, there are only 3 people on my ambulance who I let tell me what the rhythm is:
> 
> 1. A county designated field physician.
> ...


 Amen. But unless the other paramedic is my partner of 2+ years, I STILL would take another look.

But from an EMT prespective, most medics appreaciated it when I pointed out the FLB's or something else that seemed not right. Luckly I've usually worked with the same 2 squads, and know most of the guys and gals on a first name basis, and they are usually more than willing to help push me along towards that little -P after my name I hope to get one of these days.


Oh, and really quickly:

This is good:



ooooo/\ooooooooooooooo/\ooooooooooooooo/\ooooooooooooooo/\                   
/--,oo /o \oooo _____/--,o/oo\ooo______/--,oo/oo\ooo_____/--,oo/oo\oo_______
ooo\/ooo \oo /ooooooo\/ooo \oo /ooooooooo\/oooo\oo/ooooooo\/ooo\oo/            
oooooooo\/ooooooooooooooo\/oooooooooooooooo\/ooooooooooooo\/              

This is bad:

__________________________________________________________________



Beyond that, call a medic.




Jon


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## coloradoemt (Jan 17, 2005)

My volunteer service carries some waivers that let us do certain things just to help out "soon to follow" ALS. Combi tubes are being looked at right now. Among a few other things if we have called for ALS we have the ok to hook up a moniter so when they do arrive they can just push print and start working their magic!!  B)


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## Ray1129 (Jan 17, 2005)

> _Originally posted by rescuecpt_@Dec 22 2004, 12:48 PM
> *As an ALS provider, there are only 3 people on my ambulance who I let tell me what the rhythm is:
> 
> 1. A county designated field physician.
> ...


I wouldn't expect you to treat something without you double checking it yourself.    

What I meant is that I can give the paramedic a heads up, while they are still en route, as to what they have....  it was just a thought, anyway.


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## PArescueEMT (Jan 17, 2005)

Even though I am (currently) an EMT, There are some medix that I know that I won't let touch my Pt. 

Eika is one... did I just say that out loud :wub:


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## rescuecpt (Jan 18, 2005)

> _Originally posted by PArescueEMT_@Jan 17 2005, 11:03 PM
> * Even though I am (currently) an EMT, There are some medix that I know that I won't let touch my Pt.
> 
> Eika is one... did I just say that out loud :wub: *


 Well I wouldn't want to touch your Pt. anyway you dirty dirty boy! h34r:


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## PArescueEMT (Jan 18, 2005)

> _Originally posted by rescuecpt+Jan 18 2005, 11:29 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (rescuecpt @ Jan 18 2005, 11:29 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-PArescueEMT_@Jan 17 2005, 11:03 PM
> * Even though I am (currently) an EMT, There are some medix that I know that I won't let touch my Pt.
> 
> Eika is one... did I just say that out loud :wub: *


Well I wouldn't want to touch your Pt. anyway you dirty dirty boy! h34r: [/b][/quote]
 I love you too.


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## Jon (Jan 18, 2005)

> _Originally posted by PArescueEMT+Jan 18 2005, 08:46 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (PArescueEMT @ Jan 18 2005, 08:46 PM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


I love you too. [/b][/quote]
 yeah,ya'all will be too busy touching each other.....


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## Wingnut (Jan 18, 2005)

Dammit nobody told me we got to touch each other!!!!


I hate being a noobie


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## Jon (Jan 18, 2005)

> _Originally posted by Wingnut_@Jan 18 2005, 09:53 PM
> * Dammit nobody told me we got to touch each other!!!!
> 
> 
> I hate being a noobie *


 but she's a girl....She has COOTIES!!!!!


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## ffemt8978 (Jan 18, 2005)

> _Originally posted by MedicStudentJon+Jan 18 2005, 07:58 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Jan 18 2005, 07:58 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Wingnut_@Jan 18 2005, 09:53 PM
> * Dammit nobody told me we got to touch each other!!!!
> 
> 
> I hate being a noobie *


but she's a girl....She has COOTIES!!!!!
    [/b][/quote]
 That's why you wear the gloves... :lol:


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## PArescueEMT (Jan 19, 2005)

Non-latex for me please... You Erika?


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## rescuecpt (Jan 19, 2005)

> _Originally posted by PArescueEMT_@Jan 19 2005, 12:14 AM
> * Non-latex for me please... You Erika? *


 If I leave work tonight and you're standing by my car you're going to be in a world of hurt, I promise you that.

Non-powdered for me, allergic to the damn powdered things.


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## Luno (Jan 19, 2005)

> *Dammit nobody told me we got to touch each other!!!!
> *


Nobody told that was what the bench seat was for, so you don't have to use the gurney......... not that I know anything about that


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## Wingnut (Jan 19, 2005)

No, but I kinda figured that one out on my own...

Not that I've thought about it or anything.


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## MedicPrincess (Jan 19, 2005)

Hmmm....somehow I don't think this conversation is about Intubation anymore??

Bench seat, not for sitting on?  What else would you use it for???  Well other than sleeping on between calls, that is???   :unsure:  :unsure: 


(insert angel here.......   )


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## Wingnut (Jan 19, 2005)

Oh you're full of it hahaha.....Angel huh? Why don't I believe that's entirely true?


And I'm still talking about intubation....

Anyone can be intubated...

On the bench seat


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## Luno (Jan 19, 2005)

as long as we don't go into the ETT cuff, we're all good...... (how did this degrade so quickly?)


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## Wingnut (Jan 19, 2005)

HHAHAHAHA

This happened cause ya'll got some dirty minds!


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## rescuecpt (Jan 20, 2005)

> _Originally posted by Wingnut_@Jan 18 2005, 09:53 PM
> * Dammit nobody told me we got to touch each other!!!!
> 
> 
> I hate being a noobie *


 And you didn't help one bit, did you Wingnut, nooooooooo.........


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## Wingnut (Jan 20, 2005)

"  Well I wouldn't want to touch your Pt. anyway you dirty dirty boy!  "






mmm hmmm...You helped before I did!


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## rescuecpt (Jan 20, 2005)

Yes, but I wasn't accusing OTHER people of having dirty minds.

"Hello, pot?  This is the kettle calling..."


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## Wingnut (Jan 21, 2005)

LOL....Busted, ok ok...


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## PArescueEMT (Jan 21, 2005)

> _Originally posted by MedicStudentJon+Jan 18 2005, 10:36 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Jan 18 2005, 10:36 PM)</td></tr><tr><td id='QUOTE'>
> 
> 
> 
> ...


yeah,ya'all will be too busy touching each other.....  [/b][/quote]
 Here's the start of the degradation. 

It's fun to come back an have my partner worry because of the fact that I'm LOL over here reading from the last time I was on.


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## MCSHughes (Jan 23, 2005)

Among a few other things if we have called for ALS we have the ok to hook up a moniter 




Do you need permission in your service area to hook up a monitor?  Would I be correct in guessing 12/15 leads are completely out of line for EMT's to do there?

Hopefully they will teach you the advantages of MCL monitoring and not Lead II.


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## ffemt8978 (Jan 23, 2005)

We just do straight 3-lead and monitor Lead III.  Most of the people in my squad don't like to use our ECG to monitor a patient, but I throw it on just about every patient I have contact with.


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## rescuecpt (Jan 23, 2005)

> _Originally posted by MCSHughes_@Jan 23 2005, 09:47 AM
> * Among a few other things if we have called for ALS we have the ok to hook up a moniter
> 
> 
> ...


 EMT-D's are not allowed to use the monitor.  They are only permitted to use the AED when there is no pulse.

EMT-CC's and EMT-P's use a minimum of 3 Lead, looking at Lead II usually.  Some units have 12 Leads (our 80 car at the Corps, FD doesn't have the capability).


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## medic03 (Jan 31, 2005)

I gota ad my 2 cents. I think it's a great idea for EMT's to use combitubes. it helps secure an airway, you get less gastric distention (come on, I know you have all seen the rookie bag the pt at a rate of 40X a min and with as much force to cause a double pneumo) and it's one less thing an als provider has to be concerned with during an intercept.  You can't push drugs down (unless you are a mirical worker and get it in the trachea) but that's what IV's are for.  if you got no IV access, then remove and try for an ETT, but I would love to see a combitube inplace prior to my arrival (on a cardiac arrest or resp arrest pt).  as for ECG monitoring and interp strips, I'm leaning towards no.  There is so much info you have to take into concideration when reading a strip and so many diffrent effects meds do, that I feel if you want to hook up the monitor, then become an als provider.  Plus that desire to just see what rhythm the pt is in even when not an als call might become too great and that's not something an EMT -b should be doing.  If you want to learn to better yourself, that's great and I'm all for that, but  not for interpreting rhythms in the field as a non als provider.


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## Jon (Jan 31, 2005)

> _Originally posted by medic03_@Jan 31 2005, 02:07 PM
> * I gota ad my 2 cents. I think it's a great idea for EMT's to use combitubes. it helps secure an airway, you get less gastric distention (come on, I know you have all seen the rookie bag the pt at a rate of 40X a min and with as much force to cause a double pneumo) and it's one less thing an als provider has to be concerned with during an intercept.  You can't push drugs down (unless you are a mirical worker and get it in the trachea) but that's what IV's are for.  if you got no IV access, then remove and try for an ETT, but I would love to see a combitube inplace prior to my arrival (on a cardiac arrest or resp arrest pt).  as for ECG monitoring and interp strips, I'm leaning towards no.  There is so much info you have to take into concideration when reading a strip and so many diffrent effects meds do, that I feel if you want to hook up the monitor, then become an als provider.  Plus that desire to just see what rhythm the pt is in even when not an als call might become too great and that's not something an EMT -b should be doing.  If you want to learn to better yourself, that's great and I'm all for that, but  not for interpreting rhythms in the field as a non als provider. *


 It is however, always nice as an ALS provider to have BLS personel to attach the leads, etc, as that is one less thing for you to do. However, I agree that BLS people should not try to read the strips.

I've worked a code or 2 where the medic (knowing I'm going through P-school) has asked me "what does that look like" - Once, my response was, "well, sort of agonal with a bunch of I don't know what." let me see - yep agonal with something, but it ain't motion artifact.

the other - "Ummm...looks like v-fib. someone want to shock this" (as I slap the other fast-patch pad on the patient - for some reason they had the 3-leads on) Medic B then shows up and medic A tells him to shock....


Jon


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## Phridae (Feb 2, 2005)

Around here Basics can use combitubes. ET tubes are strictly a medic skill, I think. I'll look into that. I'm just fine with the combitubes. They're pretty much fool-proof if you've been trained. Maybe thats why basics can use them here....

And the derailment that this topic took was crazy. Glad to see someone put the train back on its tracks.


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## shorthairedpunk (Feb 12, 2005)

Our basics have been intubating for over a decade now, its a monkey skill, I dont understand why people make such a big deal about this. The majority of the intubations in this system are done by BLS providers with equivalent success rates to ALS only intubation systems.


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## Wingnut (Feb 13, 2005)

I'm also a CPR instructor, and I get articles and newsletters from our local hospitals. A few of the articles I have received lately are about how intubating with an ET tube may not be very effective, and I read a study somewhere claiming that pt's who were intubated out in the field were less likely to survive than those intubated in an ER. (I wish I could remember where I read it, it wasn't conclusive and I don't know where the study was done, but it's something they are checking out.)
 I don't see how any of that can be remotely possible as securing an airway is numero uno in this field.  
But maybe all the debate has something to do with EMT-B's being restricted. While we can use combitubes here, when we go to medic school and learn to intubate with ET tubes, it's its own mini-class and you have to have some 20-30 successful intubations on a cadaver to pass.


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## colafdp (Feb 27, 2005)

Well here in Saskatchewan, at the Primary Care Paramedic level (Formerly known as the EMT) we are allowed to cardiac monitor, and are expected to interpert the strip (that's why we're taught all the different rhythms) and plus within the next year they are expecting that ET Tubes, as well as some emergency meds (Epi, Ventolin, Nitrous, and Diazepam) are going to brought down to the basic level. So it's interesting, cause the basics, aren't really basics anymore.


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## Jon (Feb 28, 2005)

> _Originally posted by colafdp_@Feb 27 2005, 02:09 PM
> * Well here in Saskatchewan, at the Primary Care Paramedic level (Formerly known as the EMT) we are allowed to cardiac monitor, and are expected to interpert the strip (that's why we're taught all the different rhythms) and plus within the next year they are expecting that ET Tubes, as well as some emergency meds (Epi, Ventolin, Nitrous, and Diazepam) are going to brought down to the basic level. So it's interesting, cause the basics, aren't really basics anymore. *


 OK, everyone, I'm moving to Saskatchewan 



jon


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## Phridae (Mar 6, 2005)

> _Originally posted by colafdp_@Feb 27 2005, 02:09 PM
> * Well here in Saskatchewan, at the Primary Care Paramedic level (Formerly known as the EMT) we are allowed to cardiac monitor, and are expected to interpert the strip (that's why we're taught all the different rhythms) and plus within the next year they are expecting that ET Tubes, as well as some emergency meds (Epi, Ventolin, Nitrous, and Diazepam) are going to brought down to the basic level. So it's interesting, cause the basics, aren't really basics anymore. *


 Holy cow. Being a basic in wisconsin pretty much sucks! As far as I can remember, the only drug we can give is asprin. For everything else, we have to call for orders or it has to be the pt.s own. Again, I'm not real sure anymore. I'm on a medic squad, so I never have had to call for orders and I'm not clear on what I'm allowed to legally give anymore.


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## Jon (Mar 6, 2005)

> _Originally posted by Phridae_@Mar 6 2005, 04:45 PM
> * As far as I can remember, the only drug we can give is asprin. For everything else, we have to call for orders or it has to be the pt.s own. *


 Thats better than PA.

It USED to be that we could ASSIST the Pt. admin. thier own Fast-acting inhaler, epi-pen, or NTG, but now we can carry our own epi-pens.


Otherwise - nothing.


Jon


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## Ray1129 (Mar 15, 2005)

Hmmm....it is very interesting to see who can give what and where and who can't.  Here in MD, we're definately not allowed to give aspirin.  We're allowed to give O2, Epi-pens, Pt. prescribed NTG, Pt. prescribed Albuterol, Charcoal w/ consult, and Ipecac w/ consult.  It's crazy to see what everyone else can do above us.  And vice-versa....

-Ray


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## rescuecpt (Mar 15, 2005)

> _Originally posted by Ray1129_@Mar 15 2005, 01:22 AM
> * Hmmm....it is very interesting to see who can give what and where and who can't.  Here in MD, we're definately not allowed to give aspirin.  We're allowed to give O2, Epi-pens, Pt. prescribed NTG, Pt. prescribed Albuterol, Charcoal w/ consult, and Ipecac w/ consult.  It's crazy to see what everyone else can do above us.  And vice-versa....
> 
> -Ray *


 Suffolk Cty NY is the same except we can give our own albuterol.


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## rescuejew (Mar 28, 2005)

We dont run basic response in the county I work in, our first responders are all ALS, but I do have an opinion.  

I think in rural settings when an ALS provider is several minutes away, a CT would be ideal for basics to be able to utilize.  Intubation, Im not so sure about.  We let Intermediates intubate here and we have a pretty good record, but the average has gone down adn we have since stopped letting newly hired EMT-Is intubate because county intermidates and fire dept intermediates are quick to secure an airway with a combitube when intubation seems impossible.  Sometimes this is done before a county medic is even on scene to attempt the intubation.  I have to address a comment I read earlier about taking a CT out to attempt to intubate.  CT should be used as a last resort.  ET Intubation is the best airway one can get, and CTs should only be used in the event that all atempts at ET Intubation have failed.  Removing a CT to Insert and ETT for med administration will further traumatize an already traumatized airway, you may not be able to intubate after a CT is pulled.

On EKGs:  When I first get to a pt, I want to know several things about the HR, regular?  fast or slow?  present or absent?  beyond that, there needs to be monitor wih 4 and 12 lead capabilities and someone there to interpret it.  And no offense, after the Franklin county fiasco, no one is going to tell me anything about a pt I will ultimately be responsible for that I am not going to re-verify myself.  If people want to be proactive, thats awesome, I recommend Dale Dubins 12 lead EKG guide.  Its a great book for explaining heart rhythms and physioanatomy.


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## Punisher (Apr 10, 2005)

I work down in Central Florida.  We have epecac on our rigs.  But we don't even bother with it.  You need permission from the md.  Usually the medic that I work with doesn't even bother calling.  Its a load and go situation.

I agree with rescue on the ct tubes.  Me and my partner, also an EMT-b only use ct tubes if there will be a delayed response of ALS.


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## MedicPrincess (Apr 12, 2005)

Around there the units are all staffed ALS...one medic, one basic.  So pretty much whatever the protocols allow for the medics to use, they use.

Basics can give O2....and pretty much thats about it.  The medics give the rest.


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## TTLWHKR (Apr 12, 2005)

:wacko:


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## rescuemedic7306 (Apr 27, 2005)

Not wishing to wave the ol' "I remember when.........' flag but....
I started in EMS in 1975 when we were basic, with a capital 'B'. (mind you, this was in the UK!) Then in 1980 I become one of the first advanced intubation and IV medics which took 560 hours of training and clinicals.......nowadays (I believe) it's a 40 hour course, at least in Minnesota, which shows how things change. As for Intubation, it still seems to be one of the most jealously guarded skills of all, which is strange since I took part in an 'intubation obstacle course' in 2003 (not having wielded a laryngoscope in anger for more than 15 years) and came 3rd out of 20, the field comprising numerous medics and CRNAs. Maybe it's like riding a bike?

Personally, I think a lot of guff is talked about intubation and how it's so difficult and dangerous and how only men and women of iron nerve and vast experience can possibly hope to accomplish it successfully. Seems to me it's more that people are guarding their turf. If it is the 'gold standard' of airway and patient care, it should be a skill that's taught to all, especially in Rural EMS where it can be 30 minutes and up to an ER or medic intercept, even if it means sticking another 60 or so hours on the curriculum.

PS. I REALLY like the Combitube though, it's quick, easy and effective and it's part of the EMT-B course in MN.


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## KEVD18 (Apr 27, 2005)

how do you folks feel about lma's?

dont know a whole lot about them but from what i know, they sound like a really cool toy to have

opinions?>


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## Jon (Apr 27, 2005)

> _Originally posted by KEVD18_@Apr 27 2005, 10:09 AM
> * how do you folks feel about lma's?
> 
> dont know a whole lot about them but from what i know, they sound like a really cool toy to have
> ...


 LMA's are nice, and cause less trauma to the airway. As a backup airway, I like the intubationg LMA i've seen. The LMA itself isn't real great for prehospital use - it doesen't fully protect the trachea. I like it a lot better than bagging someone, but Intubation is still the "gold standard"

Jon


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## rescuecpt (Apr 27, 2005)

We can't use LMA's but I think they're great.  When I have my back surgery I'm going to request an LMA rather than a ET tube, if the situation allows.


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