# intubation as a basic skill



## jakobsmommy2004 (Dec 23, 2006)

i was just wondering where u all live and learned intubation as a basic skill. i live in ohio and it was a station for our national registry practical. i know its in the Brady text book for basics but some states dont require for testing.


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## MeaganIV (Dec 23, 2006)

What do you mean intubation as a basic skill.


Paramedics, right now, are the only ones allowed to perform ET's. 

eek


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## jakobsmommy2004 (Dec 23, 2006)

alot of the companies in the toledo ohio area have protocols that allow it on an apnic and pulseless Pt as a basic but only from on-line medcontrol


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## MeaganIV (Dec 24, 2006)

So they don't even need a supervising paramedic?


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## jakobsmommy2004 (Dec 24, 2006)

no only online medcontrol but at that point we would have already called for ALS intercept


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## Ridryder911 (Dec 24, 2006)

Some states allow basics to intubate, but that does not make it right. There is even a heated debate to see if Paramedics should still be taught intubation techniques. 

Again, skills versus knowledge is not the same!

R/r 911


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## MeaganIV (Dec 24, 2006)

I agree with R/R.  I mean, intubating takes skill.  Its a highly invassive procedure and needs a great deal of know how.  I'm not allowed to do it as an EMT-A but with the supervision of a paramedic I'm allowed. 


A lot can go wrong with tubing such as insertion.  The tube could be placed in the esophogus and create gastric distension, even though the placement isn't blind.  It could be placed in to far and will only inflate the right lung.  

it can also hit the vagus nerve and mess up the heart rate leading to dangerous arrythmias.

ugh.


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## Nycxice13 (Dec 24, 2006)

No intubation for EMT-B's in NY.


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## MeaganIV (Dec 24, 2006)

thats a good thing!


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## Epi-do (Dec 24, 2006)

Basics can't intubate in Indiana, and if I heard anyone around here suggest that they be able to do so, I think I would have to knock some sense into them.  At the basic level we most certainly do not receive the education needed to go along with the skills training and, unfortunately, I don't see that changing anytime soon.  You can train a monkey to do just about anything, but that doesn't mean you should.


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## jeepmedic (Dec 24, 2006)

Intubation is so easy my 8 year old can intubate the dummy. 

Intubation is and should be a basic skill. With out air the pt. dies plan and simple.


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## Fedmedic (Dec 24, 2006)

jeepmedic said:


> Intubation is so easy my 8 year old can intubate the dummy.
> 
> Intubation is and should be a basic skill. With out air the pt. dies plan and simple.



Especially with pulseless and apneic patients, they are already dead. The worst thing you could do would be save their life...


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## yowzer (Dec 24, 2006)

Are you talking combitube or et intubation?


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## JavaMedic (Dec 24, 2006)

*Basic intubation*

I agree with JeepMedic. It's too easy. If you can stick a straw into a drink without poking your eye out then you're pretty much qualified to intubate. The time spent teaching intubation skills is less in the medic program than it is in the basic. Even most medical schools spend less time teaching intubation for soon to be doctors. I WANT my basic to be able to tube. Keeps my hands free to do other things (ie: defib, IV's, drugs...). If all you want is too have your basic partner carry your bag then you need to check your ego. This isn't rocket science.


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## jeepmedic (Dec 24, 2006)

It is not the skill of intubation it is doing the assessment to find out if they need intubation. Airways are not used enough in the field. I am talking about the basic OPA and NPA airways.


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## KEVD18 (Dec 24, 2006)

with the appropriate training, basics should absolutely be able to intubate. i am a basic. i have had advanced airway management training, based on previous work requirments. its not that complictaed a skill that a basic cant do it and any statement to the contrary is paragodism at its finest


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## MeaganIV (Dec 24, 2006)

THe thing about intubation is that it actually does require more skill then you think.

Its dangerous, invasive, and has consequenses especially when trying to place it. 


It should not be a basic skill because it is NOT basic.


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## MeaganIV (Dec 24, 2006)

I know how to intubate too and I still think it should be left to the guys who have had substantially more training then me... paramedics.  


I'm happy sticking with my combitube, my LMA and my BVM until I complete my paramedic... 


Its kind of why only CCP's can perform cricothyroidotomies..

I think thats how you spell it.

I'm sorry if anyone disagrees but those are my thoughts.


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## Fedmedic (Dec 24, 2006)

JavaMedic said:


> If all you want is too have your basic partner carry your bag then you need to check your ego. This isn't rocket science.



Amen Brother, preach it!!!!


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## Fedmedic (Dec 24, 2006)

MeaganIV said:


> Its kind of why only CCP's can perform cricothyroidotomies..



Here, EMT-I's can perform cric's.


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## MeaganIV (Dec 24, 2006)

Fedmedic said:


> Here, EMT-I's can perform cric's.





OMG... 


omg... 


I don't think thats right.  I'm really sorry but I don't. 

Here in Alberta we are allowed to perform IV therapy, IMs, SQs, more drugs, and some advanced airway stuff.

cric's are really pushing it though.  I'm an EMT-I... yeah.


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## Fedmedic (Dec 24, 2006)

MeaganIV said:


> I don't think thats right.  I'm really sorry but I don't.



Why not? They get the EXACT same training and education in performing cric's that paramedics get. It's just a skill that can be taught. If I am dying and need cric'ing, I don't care who does it, the alternative is DEATH.


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> THe thing about intubation is that it actually does require more skill then you think.
> 
> Its dangerous, invasive, and has consequenses especially when trying to place it.
> 
> ...



I have been intubating for over 10 years. It is a basic skill. Look for the cords see the tube pass the cords. simple. And as I was told not just any old hole will do. That is where most people get into trouble. They see a hole and stick a tube in it. 

I.V. sticks are harder than intubation.


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## jeepmedic (Dec 24, 2006)

Fedmedic said:


> Here, EMT-I's can perform cric's.



you beat me to the punch there old man.


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## MeaganIV (Dec 24, 2006)

its the same reason why docs go to school for 7 years and its the principle of the matter.

Here, CCPs have gone through 6-7 years of school, adding onto their paramedic. They have the know how and the experience.  They ARE like doctors, they just do it all faster.

Even though the skill can be taught and learned it shouldn't be.  Its an advanced technique and should be saved for the advanced professionals.


Thats why we all have ALS back up 2 minutes away.


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## Fedmedic (Dec 24, 2006)

MeaganIV said:


> and its the principle of the matter.



I'm sorry, but I just can't see letting someone die as a matter of principle. My ego isn't near that large.


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> Thats why we all have ALS back up 2 minutes away.



In a perfect world yes maybe. But I have worked in large systems that you don't ALWAYS have ALS back up. The airway needs to be protected no matter what. Because if you don't have an airway you don't have a pt. you have a body.


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## MeaganIV (Dec 24, 2006)

THis isn't about ego! its about the know how and adding onto that know how.  That is why we have different levels of training.  Thats why we go through it all. 

Its about delivering the best possible care to that Pt.  It was never about ego.  I resent anyone saying that I have a large ego just because I'd rather leave the paramedic stuff to the paramedics...


Why do you think insulin isn't a drug that we can administer? it has detrimental effects.  Its could kill the Pt.  Same with tubing.  Same with cric's.  

I'm not trying to step on anyone's toes.  Really.  Those are just my thoughts.


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## MeaganIV (Dec 24, 2006)

jeepmedic said:


> In a perfect world yes maybe. But I have worked in large systems that you don't ALWAYS have ALS back up. The airway needs to be protected no matter what. Because if you don't have an airway you don't have a pt. you have a body.




In city... and rural... ALS isn't that far behind and BLS units are usually staffed with someone who can perform tubing skills like a paramedic.

If I have a paramedic supervising, I will tube just incase I don't landmark properly or i can see anything with the mac...


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> Why do you think insulin isn't a drug that we can administer? it has detrimental effects.  Its could kill the Pt.  Same with tubing.  Same with cric's.



I can give insulin and do every shift I work.

If you do not intubate a pt. that needs it there is no "could" you will let them die.


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## MeaganIV (Dec 24, 2006)

jeepmedic said:


> I can give insulin and do every shift I work.
> 
> If you do not intubate a pt. that needs it there is no "could" you will let them die.



you can give insulin and can ET but you can give an IV?


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> you can give insulin and can ET but you can give an IV?



???????:huh:


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## Fedmedic (Dec 24, 2006)

I'm not implying that it is about your ego. I'm just saying that I don't have that much of an ego to support the fact that I would let someone die just because another provider didn't have the same level of training as myself. We're talking about a procedure that a couple minutes are the difference between life and death, and we can't just wait for someone of higher taining to arrive or wait to get to the ER. So if they get it wrong, the patient isn't  anymore dead than they would have been in the first place. But if they get it right, they just saved a life.


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## MeaganIV (Dec 24, 2006)

Sorry I meant "CAN'T do IV's."


I just don't get that.


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## MeaganIV (Dec 24, 2006)

Fedmedic said:


> I'm not implying that it is about your ego. I'm just saying that I don't have that much of an ego to support the fact that I would let someone die just because another provider didn't have the same level of training as myself. We're talking about a procedure that a couple minutes are the difference between life and death, and we can't just wait for someone of higher taining to arrive or wait to get to the ER. So if they get it wrong, the patient isn't  anymore dead than they would have been in the first place. But if they get it right, they just saved a life.




Thats a valid point but if its that bad then why wouldn't dispatch just send ALS or have ALS standing by?


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> Sorry I meant "CAN'T do IV's."
> 
> 
> I just don't get that.



I didn't say I couldn't do IV's I said that IV sticks are harder than Intubating. I can do anything I feel that the pt. needs done at work as long as the Doc will sign off on it. In the field I only have call in for atropine (WTF)


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## Fedmedic (Dec 24, 2006)

MeaganIV said:


> Thats a valid point but if its that bad then why wouldn't dispatch just send ALS or have ALS standing by?



Maybe in your system that is how it works. But here and a lot of rural US, you don't always have the luxury of a paramedic or even an ALS ambulance being available, at all, anytime. So you have to make do with what you do have.


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## MeaganIV (Dec 24, 2006)

luxery?

I don't think this system anywhere is that at all. 

if the doc signs off on it... i suppose thats not bad.  My dad plays medical direction every now and then and he tries his best to see if ALS is available with the more advanced stuff first.


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## Airwaygoddess (Dec 24, 2006)

OPA's NPA's and BVM for EMT-B on the ambulance service here. only a few FD here can put in a Combintube here due to the long response time by ambulance.  I wish the medical directer would allow it on the ambulance here for EMT-B's.  Only the medic can intubate and Combitube a pt.


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## Flight-LP (Dec 24, 2006)

jeepmedic said:


> If you do not intubate a pt. that needs it there is no "could" you will let them die.



Sorry, but I have to respecfully disagree with this statement. Several recent studies have shown an equal efficiency by utlilizing a properly placed and sealed BVM with adequate ventilations of 10-12 / minute vs. immediate endotracheal intubation. Other than in the rare case of a patient who cannot physically be ventilated and thus requiring a surgical airway, endotracheal intubation itself is not a life or death item. Place an OPA/NPA and bag them. At the BLS level a combitube would be appropriate. For anyone who doubts the validity of this statement, you can refer to the current AHA standards for ACLS, PALS, and NRP. Advanced airway management in a full arrest now calls for intubation after the placement of an IV and after the initial administration of meds. There are enough Paramedics out there who can't successfully intubate because of the "stick the straw in the hole" mentality. What happens when you get a Cormick-Lehane grade IV airway with less than 10% POGO? What do you do now? No hole visible to stick it in! 

On a quartely basis, I put on an advanced airway seminar. At the beginning of the class I give a pretest on the current trends and algorhythms of airway management. Here are 3 of the questions on the pretest.............

1. Describe the B.U.R.P. mneumonic.

2. You have a 12 year old, 40kg. patient. What size ET tube would you use to intubate this patient?

3. Which of the following are contraindications for the administration of Succinylcholine........

A. Myasthenia Gravis
B. A Potassium level of 7.2
C. Burns sustained 18 hours ago
D. A hypothermic patient
E. A and B
F. All of the above

The average grade.................46%

Now mind you, this is the average of the Paramedic grades. Experience varied from brand new patch to 20+ year medics. 

Taking this information and adding it to recent studies which indicate a decrease in Paramedic intubation success rates in the "skill" of intubation, do you really want a BLS provider attempting it?????

Sorry, intubation should not be performed by EMT-B's.....................


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## MeaganIV (Dec 24, 2006)

Flight-LP said:


> Sorry, but I have to respecfully disagree with this statement. Several recent studies have shown an equal efficiency by utlilizing a properly placed and sealed BVM with adequate ventilations of 10-12 / minute vs. immediate endotracheal intubation. Other than in the rare case of a patient who cannot physically be ventilated and thus requiring a surgical airway, endotracheal intubation itself is not a life or death item. Place an OPA/NPA and bag them. At the BLS level a combitube would be appropriate. For anyone who doubts the validity of this statement, you can refer to the current AHA standards for ACLS, PALS, and NRP. Advanced airway management in a full arrest now calls for intubation after the placement of an IV and after the initial administration of meds. There are enough Paramedics out there who can't successfully intubate because of the "stick the straw in the hole" mentality. What happens when you get a Cormick-Lehane grade IV airway with less than 10% POGO? What do you do now? No hole visible to stick it in!
> 
> On a quartely basis, I put on an advanced airway seminar. At the beginning of the class I give a pretest on the current trends and algorhythms of airway management. Here are 3 of the questions on the pretest.............
> 
> ...





Right there.  Right there is every reason why EMRs should not and cannot perform ETs.

I shouldn't even be able to do it as an EMT-I under the supervision of a paramedic.


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## MeaganIV (Dec 24, 2006)

We always employ the most basic maneouvers first.  Thats the way it is.  If I have a Pt who is in a hypoglycemic state and they can talk to me and follow commands and swallow I will administer oral glucose even though I do have D50W at my disposal and I have already established an IV line.

If I can secure the airway with an OPA or NPA then thats what I'll do. advanced airways are for enroute.. not for on scene.


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## jeepmedic (Dec 24, 2006)

Ok I don't know who taught you folks how to intubate. I have pictures and video of my 3 year old intubating in a class this summer. And she is not even CPR certified. So *NO IT IS NOT THAT HARD!!!!!!!*

Flight LP as far as your little test.

1.Back up Right Pressure

2. You have to look at the pt. not a peace of paper.

3. If you don't use it you will not know. I don't so I don't care.

Now. If an EMT-B can't start an I.V. then how do you expect them to do a MAI? We are not talking about a Pt. that needs MAI we are talking about an unresponsive pt. that can't protect his/her airway. And yes if you do not do something they WILL DIE. Do you not remember that from First Aid. No Airway No Pt. you have a Body for the Funeral Home.


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## MeaganIV (Dec 24, 2006)

Just because its "Easy" doesn't make it right!

dangerous things can happen with ETing.  Things that as an EMR you cannot fix and WILL need a paramedic... 


Thats the bottom line.


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> Just because its "Easy" doesn't make it right!
> 
> dangerous things can happen with ETing.  Things that as an EMR you cannot fix and WILL need a paramedic...
> 
> ...



No just a competent EMT-B that was educated correctly. The airway is the first thing you should control. No air going in no O2 going in. IV's are missed more than Intubations. But I don't see you folks saying you should be a Dr. to start IV's. All you have to do is study, and try to understand what you are dealing with. I have seen Paramedics that could not put on a Traction Splint that could intubate. It is all about practice. The providers that miss the intubations are the one's that go back to the station after a call and sit on there arse and watch TV never studying or doing any practicals. When I was in class and even now we would get the dummys out and practice intubating, and do practicals to learn. We would also sit back and listen to the older Medics calls and ask questions. That is how we got to be where we are today. And yes we have EMT-B's that can intubate and do. We also have EMT-B's that can tell you the drugs in the drug box and what they are for. Why you ask? Because they ask questions and study what the medics are doing. I have one girl in my Dept. that just got her EMT-B that when we run codes she will hand me the drugs out of the box and she gets it right. She knows the drugs because she has studied and asked questions.

So to the ones who don't think an EMT-B can intubate you need to do some work and show them. How and Why. And for the ones who think it is to hard you need to get off the couch and practice.


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## Flight-LP (Dec 24, 2006)

jeepmedic said:


> Ok I don't know who taught you folks how to intubate. I have pictures and video of my 3 year old intubating in a class this summer. And she is not even CPR certified. So *NO IT IS NOT THAT HARD!!!!!!!*
> 
> Flight LP as far as your little test.
> 
> ...



Perhaps a little less emotion may be in order, after all you are getting kind of freaked out over words written in an online forum!

How you can remotely coorelate a success rate of intubation between a live person and a lifeless, stiff, perfect anatomy mannequin is irrelevant. You are comparing apples to oranges my friend.............

I NEVER said anything about "not doing something". I said that an appropriately used BVM with airway adjuncts can effectively ventilate most patients initially. There is a distinct difference.............

I also never said anything about an EMT-B performing RSI / PAI/ MAI/ DAI (what ever your agency refers it as). The remote thought is horrific.........

As far as my "little test"...........

The reason that most people have difficulty with intubation is not due to the skill itself, but the assessment, evaluation, and delivery of the two. Failure to identify a need, waiting too long and then getting hurried, not properly evaluating and assessing a difficult airway (i.e the 3-3-2 rule, Mallampati classification), and failing to maintain an advanced airway are all causitive agents in why intubation fails and the bottom line is that too few know or realize it. Many have the exact attitude that you have "its easy and you just stick it in the hole". And that attitude is why current literature shows an increase in out of hospital death or neurological deficit post "intubation". It is also the reason why the AHA no longer recommends pre-hospital intubation of children (fyi - a documented 46% FAILURE rate).

Your response tells me all I need to know about your view of the subject so there will be no further debate from me, you are entitled to your beliefs and I'll leave it at that...............

BTW, You scored a 33% and Dr. Paul Pepe walked me through my first live intubation (since you wondered who taught me).................


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## jeepmedic (Dec 24, 2006)

Flight-LP said:


> The reason that most people have difficulty with intubation is not due to the skill itself, but the assessment, evaluation, and delivery of the two. Failure to identify a need, waiting too long and then getting hurried, not properly evaluating and assessing a difficult airway (i.e the 3-3-2 rule, Mallampati classification), and failing to maintain an advanced airway are all causitive agents in why intubation fails and the bottom line is that too few know or realize it. Many have the exact attitude that you have "its easy and you just stick it in the hole". And that attitude is why current literature shows an increase in out of hospital death or neurological deficit post "intubation". It is also the reason why the AHA no longer recommends pre-hospital intubation of children (fyi - a documented 46% FAILURE rate).
> 
> Your response tells me all I need to know about your view of the subject so there will be no further debate from me, you are entitled to your beliefs and I'll leave it at that...............
> 
> BTW, You scored a 33% and Dr. Paul Pepe walked me through my first live intubation (since you wondered who taught me).................



I too think that the main reason for Failed intubation is not acting. But this is also true all the way up and down the Health Care system. The failure to act only makes a pt.'s condition worse. My point is and will continue to be that you educate Providers on the why of a skill before teaching them the skill. The physical skill is very easy most of the time. The problem with most providers is just getting them to see and act on a condition before it gets worse. I prefer to be proactive instead of reactive. Its like on the CO2 thread. Someone there said that you could see the changes in the waves before the pt. had a period of apnea. They bagged him and kept him from having that period. They saw a need and addressed it before it got worse. The same with Airway and Intubation if an EMT-B can see the need and can address it before I get there then great we are one step ahead of the game. It is not the EMT-B who can't intubate it is the provider.


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> We always employ the most basic maneouvers first.  Thats the way it is.  If I have a Pt who is in a hypoglycemic state and they can talk to me and follow commands and swallow I will administer oral glucose even though I do have D50W at my disposal and I have already established an IV line.
> 
> If I can secure the airway with an OPA or NPA then thats what I'll do. advanced airways are for enroute.. not for on scene.



Ok if you have a Pt. that can talk and is just hypoglycemic and can follow commands, Why did you Start an IV in the first place? And if you have an IV then is quicker to give D-50. Or if no IV and they are talking to you why not fix them some breakfast? (this is not a sarcastic comment and the one who did this knows what I am talking about.)

You should not intubate in a moving ambulance. What happens if you have a sudden stop, or a bump? 

Can a Pt still aspirate with a OPA or NPA? yes. So the airway is not secure.


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## MeaganIV (Dec 24, 2006)

jeepmedic said:


> Ok if you have a Pt. that can talk and is just hypoglycemic and can follow commands, Why did you Start an IV in the first place? And if you have an IV then is quicker to give D-50. Or if no IV and they are talking to you why not fix them some breakfast? (this is not a sarcastic comment and the one who did this knows what I am talking about.)
> 
> You should not intubate in a moving ambulance. What happens if you have a sudden stop, or a bump?
> 
> Can a Pt still aspirate with a OPA or NPA? yes. So the airway is not secure.



Very good question.  We start an IV of NS, TKVO incase we do need to administer drugs via IV line. 

We only admininster D50W if the Pt is unconsciouse.  IF they are able to swallow, we always implement the simplest solution because there are certain risks with D50W.  After the administration of oral glucose, dextrose, or glucagon we do have food ready for them.  They're hypoglycemic. They need food. 

A pt can still aspirate any time! thats what happens! Intubation isn't going to stop them from throwing up and sucking it back in.  Thats always a precaution.  Always.


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## jeepmedic (Dec 24, 2006)

MeaganIV said:


> A pt can still aspirate any time! thats what happens! Intubation isn't going to stop them from throwing up and sucking it back in.  Thats always a precaution.  Always.



Yes it will.


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## JavaMedic (Dec 24, 2006)

MeaganIV said:


> THe thing about intubation is that it actually does require more skill then you think.
> 
> Its dangerous, invasive, and has consequenses especially when trying to place it.
> 
> ...



It's about as basic as you can get. See the cords. Drop the tube. I've been through EMT-B, EMT-I, EMT-P and CCP. The training I received for intubation was more indepth in the basic class than any other class with the exception of RSI. I've had more in field tubes than years I've been on this earth. I've missed my share and am damn glad that my "just a basic" partner was there to bail me out. Some basics have way more experience at intubation than a lot of street medics out there.


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## MeaganIV (Dec 24, 2006)

JavaMedic said:


> It's about as basic as you can get. See the cords. Drop the tube. I've been through EMT-B, EMT-I, EMT-P and CCP. The training I received for intubation was more indepth in the basic class than any other class with the exception of RSI. I've had more in field tubes than years I've been on this earth. I've missed my share and am damn glad that my "just a basic" partner was there to bail me out. Some basics have way more experience at intubation than a lot of street medics out there.



I'm really not debating that.  Truely.  I just really think the skill needs to be done with a paramedic present.


I'm sorry. Thats how I feel..


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## JavaMedic (Dec 24, 2006)

You feel that intubation is above you yet you'll start an IV. Can't get more invasive than that. A myriad of dangerous consequences follows IV cannulation including overload, aterial puncture, catheter shear, allergic reactions, local infections, air embolism, necrosis...etc. The list goes on. Sounds like that should be a medic only skill as well then.


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## MeaganIV (Dec 24, 2006)

ohhhkay.  Thats fair.  I'm not going to argue my point. I think it has been made. 

I think that IV's are easier and less invasive but thats my opinion.


To each his/her own right?


Gotta get back to this here studying, have a gooder all!


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## JavaMedic (Dec 24, 2006)

I agree to each his/her own. But regardless of what level you are at learn EVERYTHING that you can about the next one up. The more that you know and the more aggressive that you are means a much better partner that you will become and a much better advocate for your patients.


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## jeepmedic (Dec 24, 2006)

JavaMedic said:


> You feel that intubation is above you yet you'll start an IV. Can't get more invasive than that. A myriad of dangerous consequences follows IV cannulation including overload, aterial puncture, catheter shear, allergic reactions, local infections, air embolism, necrosis...etc. The list goes on. Sounds like that should be a medic only skill as well then.



thats what I wanted to say.


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## Bandaid (Dec 24, 2006)

MeaganIV said:


> I agree with R/R.  I mean, intubating takes skill.  Its a highly invassive procedure and needs a great deal of know how.  I'm not allowed to do it as an EMT-A but with the supervision of a paramedic I'm allowed.
> 
> 
> A lot can go wrong with tubing such as insertion.  The tube could be placed in the esophogus and create gastric distension, even though the placement isn't blind.  It could be placed in to far and will only inflate the right lung.
> ...



Have you even intubated before?


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## MeaganIV (Dec 24, 2006)

Bandaid said:


> Have you even intubated before?



Nope.  Haven't needed to.


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## Fedmedic (Dec 24, 2006)

If a pt. is properly intubated and the tube properly secured. There is no chance of aspiration unless someone pours something down the tube.


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## MedicPrincess (Dec 24, 2006)

Meagan-

First I will tell you I am going to be starting my fourth 48 hour shift in 2 weeks tomorrow, so it may be  day or two before I can read your response....

I understand your point that ET intubation should be a paramedic procdure.  Its an ALS skill, Medics are ALS.  But what I would like you to help me understand is your belief that intubation is harder than starting IV's, because in most cases I would strongly disagree with that.


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## MeaganIV (Dec 24, 2006)

EMTPrincess said:


> Meagan-
> 
> First I will tell you I am going to be starting my fourth 48 hour shift in 2 weeks tomorrow, so it may be  day or two before I can read your response....
> 
> I understand your point that ET intubation should be a paramedic procdure.  Its an ALS skill, Medics are ALS.  But what I would like you to help me understand is your belief that intubation is harder than starting IV's, because in most cases I would strongly disagree with that.



I dunno.  I just do.  Its the same reason why some people thing that intubating is easier.


We all have our strengths and weaknesses.  I didn't mean to step on anyone's toes and I'm sorry if I've offended anyone but we've all got our opinions and that one was mine. 

Thanks.


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## jakobsmommy2004 (Dec 24, 2006)

Epi-do said:


> Basics can't intubate in Indiana, and if I heard anyone around here suggest that they be able to do so, I think I would have to knock some sense into them.  At the basic level we most certainly do not receive the education needed to go along with the skills training and, unfortunately, I don't see that changing anytime soon.  You can train a monkey to do just about anything, but that doesn't mean you should.



 i dont understand.  i had a excellent instructor that has 20plus years in the field. you are acting like just because we are "basics" its like we are  10 year olds trying to do surgury. we are all adults here with an education. so you are saying if one of your family or somebody needed to be intubated you are going to have a fit because there are only basics on the sene to do that. are you gonna let them die because you believe its not right to have a basic do it and there is not a paramedic on the scene?

just my 2 cents


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## Mercy4Angels (Dec 24, 2006)

they dont teach us that here. if you have to intubate get medics fast. See here in New Jersey there is no EMT-I just basic and paramedic and the basic dosent intubate. Sure i would like to know how to do it but i guess that will come when i go for EMT-P


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## Ridryder911 (Dec 24, 2006)

jakobsmommy2004 said:


> i dont understand.  i had a excellent instructor that has 20plus years in the field. you are acting like just because we are "basics" its like we are  10 year olds trying to do *surgury*. *w*e are all adults here with an education. *s*o you are saying if one of your family or somebody needed to be intubated you are going to have a fit because there are only basics on the sene to do that. *a*re you gonna let them die because you believe its not right to have a basic do it and there is not a paramedic on the scene?
> 
> just my 2 cents




First, intubation is far more than just a procedure. If you do not know that or aware of that, then you do not need to be intubating or understand the respiratory/pulmonology physiology. Do you understand Mallampati grade, chord damage, right main stem bronchial intubation, Bleb's, tidal volume amounts? 

It is not the procedure of performing the skill of raising a tongue and exposing the glottic opening. Same as an IV is simple enough to "train" anyone above the age of 6 to perform these procedures, however only those that have the understanding and in-depth of these systems should perform these procedures. It is knowing why, the dangers, the actions to take if these procedures fail, and what to do after these procedures have been performed that really counts. 

There is a reason it is considered an advanced level skill. If one wants to perform advanced procedures, then one should attend advanced level classes to be able to do so. Never attempt to compare skills with knowledge. 

p.s. correct spelling.... surgery. 

R/R 911


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## Mercy4Angels (Dec 24, 2006)

i agree. Theres a difference between just doing it and understanding it. Thats not to say you can never do it you just would have to take the proper courses at an advanced level to really understand it.


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## trauma1534 (Dec 25, 2006)

MeaganIV said:


> THe thing about intubation is that it actually does require more skill then you think.
> 
> Its dangerous, invasive, and has consequenses especially when trying to place it.
> 
> ...




It is more dangerous to give D-50 than it is to intubate!!!  Point blank, to the point.  If you can't get a good airway by bagging, you have to be able to do something.  No airway= no life!!!


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## trauma1534 (Dec 25, 2006)

MeaganIV said:


> We always employ the most basic maneouvers first.  Thats the way it is.  If I have a Pt who is in a hypoglycemic state and they can talk to me and follow commands and swallow I will administer oral glucose even though I do have D50W at my disposal and I have already established an IV line.
> 
> If I can secure the airway with an OPA or NPA then thats what I'll do. advanced airways are for enroute.. not for on scene.



Approx how many ALS calls have you actually been on???  You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway???  My God!!  Where do you practice???  You need more experience before you can come in here trying to stand up to the big dogs!  You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there.  You have to stay ahead of the game!!!  If you hold back, then your patient will get away from you!  That's streight up!  EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out!  That is crazy!!!


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## MeaganIV (Dec 25, 2006)

trauma1534 said:


> Approx how many ALS calls have you actually been on???  You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway???  My God!!  Where do you practice???  You need more experience before you can come in here trying to stand up to the big dogs!  You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there.  You have to stay ahead of the game!!!  If you hold back, then your patient will get away from you!  That's streight up!  EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out!  That is crazy!!!



Hhahaha man, this is getting blown way out of proportion.  I am not afraid to do it, I just believe that in the time it takes to shove a tube down someones throat I could have inserted my OPA, began artificial vents and performed half of my rapid physical.  

We're all supposed to employ the most basic methods first.  Thats just the way it is.  It is think quick but it's also do quick.  If an OPA is good enough to get that Pt oxygen then thats what I'm gonna do.  

I'm not here to try and change minds or sway ppl to see it my way. I'm just here to put in my opinion.  This is what I was taught and I agree with it.  I'm sorry if that upsets you but thats the way it is.

ETs require a lot of knowledge about pulmonology, respiratory, and what might happen. Such as a laryngeal spasm.  If you irritate the vocal cords and close the airway, then you're not gonna be giving the Pt any O2 either... in anyway.  

ETing isn't the only way to do it.


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## Ridryder911 (Dec 25, 2006)

trauma1534 said:


> Approx how many ALS calls have you actually been on???  You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway???  My God!!  Where do you practice???  You need more experience before you can come in here trying to stand up to the big dogs!  You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there.  You have to stay ahead of the game!!!  If you hold back, then your patient will get away from you!  That's streight up!  EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out!  That is crazy!!!




Actually, and legally one is supposed to place an airway in the patient and ventilate up to 3 minutes prior to intubation! You intubate the patient in my state and not licensed as an advanced or student, I see you at the State Dept hearing. This is the proper way for testing for the NREMT/ Advanced airways skill station. 

If you do not know how to control an airway with BLS skills, such as oropharyngeal or nasopharyngeal airway with BVM, then you are not qualified to intubate ... period! 

Come and play with the real "big dogs" of anesthesiology, which most in residency have to control airways for the first 6 months with proper head alignment, O.P's, N.P's etc.. then they get to intubate. 

R/r 911


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## YYCmedic (Dec 25, 2006)

trauma1534 said:


> Approx how many ALS calls have you actually been on???  You mean to tell me that you would actually take the time to put in an OPA or NPA at the scene in a secure environment over getting that patient tubed and securing the airway???  My God!!  Where do you practice???  You need more experience before you can come in here trying to stand up to the big dogs!  You should not be in the EMS field if you are afraid of something as simple as an ET!!!Furthermore... EMS is about giving the very best treatment for your patient right then and there.  You have to stay ahead of the game!!!  If you hold back, then your patient will get away from you!  That's streight up!  EMS is a think quick and do now thing, not wait till they get so far down the drain you can't pull them out!  That is crazy!!!



I'd always try to get an OPA in any environment before even considering tubing them. Why would you go putting in tubes if an OPA works just fine? In fact I believe if someone from a review board read on any one of my PCR's that I just went ahead and tubed my pt. without trying any BLS level airway control I'd probably have my license up for review. I agree that EMS is about giving your pt the best care possible, so why would you put a tube down their throat if you didn't have to? By staying ahead of the game you should have an ET tube on hand incase your pt. starts to go downhill, not shove a garden hose down their throat immediatley on the small chance that they might, possibly, may crash on you. That also seems like a malpractice case waiting to happen.


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## MeaganIV (Dec 25, 2006)

TJ_EMT said:


> I'd always try to get an OPA in any environment before even considering tubing them. Why would you go putting in tubes if an OPA works just fine? In fact I believe if someone from a review board read on any one of my PCR's that I just went ahead and tubed my pt. without trying any BLS level airway control I'd probably have my license up for review. I agree that EMS is about giving your pt the best care possible, so why would you put a tube down their throat if you didn't have to? By staying ahead of the game you should have an ET tube on hand incase your pt. starts to go downhill, not shove a garden hose down their throat immediatley on the small chance that they might, possibly, may crash on you. That also seems like a malpractice case waiting to happen.



Wow.  TJ come to the rescue.  Thanks for the back up, sweets.


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## Fedmedic (Dec 25, 2006)

TJ_EMT said:


> I'd always try to get an OPA in any environment before even considering tubing them. Why would you go putting in tubes if an OPA works just fine? In fact I believe if someone from a review board read on any one of my PCR's that I just went ahead and tubed my pt. without trying any BLS level airway control I'd probably have my license up for review. I agree that EMS is about giving your pt the best care possible, so why would you put a tube down their throat if you didn't have to? By staying ahead of the game you should have an ET tube on hand incase your pt. starts to go downhill, not shove a garden hose down their throat immediatley on the small chance that they might, possibly, may crash on you. That also seems like a malpractice case waiting to happen.



Well, I don't know the way everyone else was taught. But I was taught to "secure" the airway, not to just "control" it. If your patient has an OPA or NPA in and vomits your in deep s***. If my intubated patient vomits, I don't care because I have a secure airway. Now if you had the ability to intubate and secure it but didn't and the patient aspirates on vomitous, now let's talk about negligence and lawsuits and review boards. You keep doing it your way and I'll keep doing it mine. I've been playing this game a long time my way and haven't went before any review boards or had any lawsuits filed against me. But I have received numerous commendations.


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## Nycxice13 (Dec 25, 2006)

MeaganIV said:


> Thats a valid point but if its that bad then why wouldn't dispatch just send ALS or have ALS standing by?



Im in NYC, in NYC traffic, can you honestly in all seriousness, tell me that ALS is 2 minutes away? POINT


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## Mercy4Angels (Dec 25, 2006)

not in NYC unless its frekin 3am. Luckily here in jersey ALS is maximun 5minutes out.


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## MeaganIV (Dec 25, 2006)

Nycxice13 said:


> Im in NYC, in NYC traffic, can you honestly in all seriousness, tell me that ALS is 2 minutes away? POINT



Usually. Yeah. 

ALS intercept isn't far away.  The same with the FD and the police.


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## Ridryder911 (Dec 25, 2006)

Even intubated patients can aspirate (albeit mor difficult), but if your patient vomits one should be able and be ready to suction. Intubation is the "gold standard" as log as one has adequate education and clinical skills, thus this would and should move them to the advanced level. 

Again, even most surgical procedures are very simple and non-complex, yet we don't just allow anyone to perform them. The same should be true on all and any medical procedures. One should possess a thourough understanding of the effects of all and any treatment, procedures, anatomy, patho-physiology and several hours of clinical practice before allowing one to proceed as part of their certification. 

R/r 911


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## jeepmedic (Dec 25, 2006)

Fedmedic said:


> Well, I don't know the way everyone else was taught. But I was taught to "secure" the airway, not to just "control" it. If your patient has an OPA or NPA in and vomits your in deep s***. If my intubated patient vomits, I don't care because I have a secure airway. Now if you had the ability to intubate and secure it but didn't and the patient aspirates on vomitous, now let's talk about negligence and lawsuits and review boards. You keep doing it your way and I'll keep doing it mine. I've been playing this game a long time my way and haven't went before any review boards or had any lawsuits filed against me. But I have received numerous commendations.



Same folks taught me. And I have been before review boards and on them. I ahve yet to be repremanded for my Airway skills, or practice's. Driving now that is a diffrent story.:blush: 

As for OPA, that is a good way to check for a gag reflex.


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## Nycxice13 (Dec 25, 2006)

MeaganIV said:


> Usually. Yeah.
> 
> ALS intercept isn't far away.  The same with the FD and the police.



Are you nuts?


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## Fedmedic (Dec 25, 2006)

jeepmedic said:


> As for OPA, that is a good way to check for a gag reflex.



As a matter of fact, that is my rule of thumb; if they will take an OPA then they will take a tube.


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## Mercy4Angels (Dec 25, 2006)

Nycxice13 said:


> Are you nuts?



gotta remember where some of us are comming from. im in union county NJ and ALS is only minuts away tops. I have spent alot of time in the city and surrounding areas and unless you can fly i cant imagine ALS getting there faster than 12 minutes on a very good day.


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## jeepmedic (Dec 25, 2006)

Fedmedic said:


> As a matter of fact, that is my rule of thumb; if they will take an OPA then they will take a tube.



Where you think I learned it from?


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## Nycxice13 (Dec 25, 2006)

Mercy4Angels said:


> gotta remember where some of us are comming from. im in union county NJ and ALS is only minuts away tops. I have spent alot of time in the city and surrounding areas and unless you can fly i cant imagine ALS getting there faster than 12 minutes on a very good day.



depending on the day and time, about right


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## Jon (Dec 25, 2006)

The biggest issue with intubation is that providers are taught it once, practice it a few times on dummys and "Easy" OR patients, and then they are cut loose.

You need a good QA/QI program with intubation, and the ability to have staff spend some time in the OR as an on-going thing so that they can KEEP their skill up.


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## KEVD18 (Dec 25, 2006)

the most important fact about intubation as it relates to this discussion is that it is a skill. a mechanical skill. being such, it can be taught to anybody that posses the physical ability to perform it. its not terrifically complicated. 

the only argument against bls intubation would be medication. basics cant carry the meds commonly associated with intubation(versed, etomidate, succinylcholine, vecuronium et al). to counter that, essestially the only time a basic should be tubing is in the worst possible situation. a code comes to mind. for the medics out there: wouldnt it be nice to get the call for the intercept, show up on scene with iv access and ett in place. now all you have to do is hook up your monitor and push your drugs. better for you. better for the pt. better all around.

to have the attitude that a person cant be taught to intubate because they're "just a basic" is pigheaded, rude and smacks of the over inflated egos  commonly associated with the paragod.


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## Fedmedic (Dec 25, 2006)

KEVD18 said:


> to have the attitude that a person cant be taught to intubate because they're "just a basic" is pigheaded, rude and smacks of the over inflated egos  commonly associated with the paragod.



F' en ey, that's what I have been saying all along. Thanks for the reinforcement. 

If they are pulseless and apneic and you intubate them and screw it all up, what have you lost; they were dead to start with.


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## Ridryder911 (Dec 25, 2006)

Fedmedic said:


> F' en ey, that's what I have been saying all along. Thanks for the reinforcement.
> 
> If they are pulseless and apneic and you intubate them and screw it all up, what have you lost; they were dead to start with.



Because that would be "gross incompetence and negligence". Just because the patient is in cardiac arrest, does not exempt competency and performance. Why not crack the chest? Their dead right, what could it hurt?

Actually, it is the ignorance of realizing that intubation is much more than a "skill". Should basics be allowed to place NG tubes as well, or maybe foleys' as well? Since all skills are really only mechanical. Heck, even crich's, chest tubes are just skills?  

It always amazes me it is always those without the education and knowledge to attempt to justify their existence, and as well add procedures to which they have not a clue or have an in depth knowledge of this process. 

Intubation will not be added into the new curriculum, in fact discussion is being made of even potentially removing from the Paramedic curriculum. Since the new advances of alternative airways, recent studies of inadequacy of even Paramedics' not being able to maintain proficiency. 

There is a reason most states do not allow basics to intubate.... they are not educated enough. This is not demeaning, just the truth, the same reason they are not able to administer medication (even though you may *assist* in administering nebulizers', and yes some of the non-harmful medications such as ASA.) I should highly recommend those that are "bragging" about administering Ipecac and Activated Charcoal to obtain and read the new suggested national guidelines. Ipecac has not been recommended for several years, as well as now most poison centers do not recommend Activated Charcoal in most poisons as well. Since new research is showing more harmful effects to no difference in outcomes without administering of those two medications. 

One can argue on this forum and attempt to justify anything, but it will only fall on deaf ears for those that make decisions. Those that have formally been educated in advanced airway techniques, realize it is far more than a "mechanical" procedure. 

Again, when one wants to perform an advanced level procedure then one go to school and learn appropiately. 
R/r 911


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## fyrdog (Dec 25, 2006)

The only reason I don't see EMTs or EMT-Is in Connecticut intubating with Et tubes is the lack of availability for OR time.  They want paramedic students to get a minimum of 10 ET tubes to graduate. Some students have had to have extended semisters due to use of LMAs and other students (Docs, med students and paramedics). One school petitioned to use maniquins for 5 of the 10 to get their students through. They were denied.


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## jakobsmommy2004 (Dec 25, 2006)

THis is actually her husband writing now.  I work primary response in Lincoln Park, MI as a paramedic. And be it a full code for a patient in asystole, or any other situation, I alway skeep it simple to start with. An OPA or an NPA, the idea is to maintain an airway, and ensure proper ventalation of the patient.  Even the most current ACLS guidelines no longer push intubation as mandatory or the big necessity as it once did and our protocols effective the beginning of the year 07 will intoduce IO access even for the adult patients especially for the administration of cardiac meds being the preferred route when IV access is unobtainable in the field setting. With any piece of knoweledge you learn in your EMS career, keep in mind that just because you CAN do something, doesn't always mean you SHOULD do that particular intervention, if something less invasive can be performed and give you the same results.  I have intubated three patients in the last 7 months, (and have been a medic for only 7 months) with 100 % success, but never without utilizing other methods first, continuing then with my ABC's then utilizing my intubation skills, not only verifying placement with auscultaion,  colormetric changes on an ETCO2 detector, but also with capnography (not available on all LP12's) - we are just fortunate to have that luxury.  In all cases I have found it best to be basic first in the field, then utilizing meds, advaced airway management etc, when absolutely neccessary, always with an "atta boy" from the receiving facility. So as you go on in your career, remember these three things: 1 - Just becasue you can, doesnt always mean you should. 2 - Doing whats right and doing the right thing arent always the same. 3 - Use your knowedge, clinical judgement, protocols, and On-line Medical direction  R. Barron, NREMT-P


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## jakobsmommy2004 (Dec 25, 2006)

.................


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## EMT007 (Dec 25, 2006)

Ridryder911 said:


> One can argue on this forum and attempt to justify anything, but it will only fall on deaf ears for those that make decisions. Those that have formally been educated in advanced airway techniques, realize it is far more than a "mechanical" procedure.
> R/r 911



Of course it is more than a mechanical procedure... so it oxygen administration, or any other EMS skill. One should know much more than just the mechanical procedure before being allowed to do any medical procedure. This goes equally for medics as well as basics. 

Basics could learn how to intubate just as easily as medics do. I learned how to do it in a continuing education class several months ago. It wasn't that hard, nor was the anatomy/physiology/etc behind it. Same for venipuncture. However, there is no reason to add it to the basic curriculum. We have a separation of skill levels, and adding intubation and IV access, etc to the basic curriculum only begs the question "why don't they just take the paramedic course?" We apparently have judged there to be a need for all three skill levels, and there are only a finite number of differences between what medics can do and what basics can do.


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## trauma1534 (Dec 26, 2006)

Fedmedic said:


> Well, I don't know the way everyone else was taught. But I was taught to "secure" the airway, not to just "control" it. If your patient has an OPA or NPA in and vomits your in deep s***. If my intubated patient vomits, I don't care because I have a secure airway. Now if you had the ability to intubate and secure it but didn't and the patient aspirates on vomitous, now let's talk about negligence and lawsuits and review boards. You keep doing it your way and I'll keep doing it mine. I've been playing this game a long time my way and haven't went before any review boards or had any lawsuits filed against me. But I have received numerous commendations.



To add to Fed's post... Virginia is a very VERY aggresive state.. esp in the parts we come from.  We have standing orders for everything at every level of training.  Each level is trained to the max of what they can legally get by with.  Now, in Virigina, in this area, EMT-B's can and do intubate in code situations.  Many times, they don't have any hope for a Paramedic to show up.  Everything is done for the very best outcome in the patient.  Unless you live here are are familure with the way we do things and have been in the situation as a Basic with no help on the way in a code, you don't have an arguement.  Now... if you are an intermediate and you don't intubate your patient when it is needed... let's just say, I'd hate to be you standing in front of our Medical Director, or worse being in front of that patient's family in court.  We are aggresive for a reason.  Like I said before, why play around when you can have your airway secured.  If you have been in EMS for any length of time as an ALS provider, then you would know that you have to stay ahead of the game and not behind it.  If you waste time by fooling around with an OPA or NPA, then you are already loosing your battle with that grim reaper!  Now... Meagan, again... I will ask you... how long have you been in EMS, and how many true ALS calls have you been on?  Till you have been around and paid your dues and learned the tricks of the trade, you have no leg to stand on... with me... the courts and the office of EMS!  YOU MUST KNOW YOUR AGUEMENT BEFORE YOU CAN PRESENT IT!!!  Now, you are loosing your arguement with those of us who have been around and know our ****!  Stay in EMS for a few years and come back and talk to us after you have had all that BS to fail on you and you have learned that what we are talking about is true!  You sound like a true book-head rookie!!!


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## trauma1534 (Dec 26, 2006)

I want everyone to take a wild guess... excluding Fedmedic, Jeepmedic and Prizenmedic who know me, what level of training am I?


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## Celtictigeress (Dec 26, 2006)

Alright.. .Meagan Im going to make this known to you and others that dont think emt bs can intubate.....or should not be taught...

Before we moved to Texas....I lived in SC in a rather rural Part....Basics are taught Intubation and it is permitted...We had a call in BFE SC the closest als was 15/20 minutes out it was raining and I as a basic Intubated Plain and simple had I not the Patient would not be living today it is something that SHOULD BE and NEEDS TO BE taught....and honestly if you are taught right.... then there are very few complications Im sorry a pt cant live without air if a patients airway closes off for whatever reason and the only way to salvage them is a tube and you go through protocol and training then there is nothing wrong with it...

just because you dont feel comfortable or perhaps secure in your skills doesnt mean others dont.....I feel rather damn secure in my skills.... and many others taught to practice do as well....its all about your mentality if the person is willing to learn then let them.... If a person isnt comfortable then they will tell you, I have NO issue with my practice...


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## Fedmedic (Dec 26, 2006)

Celtictigeress said:


> Alright.. .Meagan Im going to make this known to you and others that dont think emt bs can intubate.....or should not be taught...
> 
> Before we moved to Texas....I lived in SC in a rather rural Part....Basics are taught Intubation and it is permitted...We had a call in BFE SC the closest als was 15/20 minutes out it was raining and I as a basic Intubated Plain and simple had I not the Patient would not be living today it is something that SHOULD BE and NEEDS TO BE taught....and honestly if you are taught right.... then there are very few complications Im sorry a pt cant live without air if a patients airway closes off for whatever reason and the only way to salvage them is a tube and you go through protocol and training then there is nothing wrong with it...
> 
> just because you dont feel comfortable or perhaps secure in your skills doesnt mean others dont.....I feel rather damn secure in my skills.... and many others taught to practice do as well....its all about your mentality if the person is willing to learn then let them.... If a person isnt comfortable then they will tell you, I have NO issue with my practice...


 
I think SC, NC and VA as are a lot of other southeastern states when it comes to EMS. We have so many very rural settings without the luxury of ALS at a moments notice that we become very secure in our skills as BLS or ALS providers. And our OMD's and state governing bodies also recognize the need to have providers that can provide the best care possible, regardless of certification. Sometime that means letting EMT-B's intubate and do other procedures often reserved for more advanced providers. After all, we aren't in it for ourselves or our egos. We are in it to take care of the patients.


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## Ridryder911 (Dec 26, 2006)

Before you all "strut" your feathers too much I would not be comparing Virginia or the other 49 other states to Canada's EMS system. For as being "aggressive as the law allows"... that's total B.S. ! 

Compare Canada's Basic level with U.S. ... Hmmm don't think I would be doing this since theirs is about 4 times longer (1 year long) Now you want to compare? Their advanced level is 2 1/2 years long (collegiate level) and their Advanced Paramedic level is 4 yrs long with several hundreds of hours clinical time, including cath lab, multiple ICU/Trauma and Flight Services.. so before we start our "bragging rights" we might want to evaluate our own back door. 

U.S. EMS education sucks! Period. We make multiple levels for excuses not advancement. Please, if a town really wanted Paramedics they would educate and hire them, not placing placebo ones on their place. One cannot tell me since the EMT/I is so close to Paramedic level in some states this is not a management technique to get cheap medics. 

Basics have no need to perform advanced level procedures.. If the patient needs advanced level care then they need advanced level practitioners. Please don't tell how aggressive your state is then do not provide "true" ALS providers in >95% of your state. Compare this with Missouri that only has 2 levels.. Basic & Paramedic. They will get "true" ALS when there is an emergency. 

R/r 911


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## Fedmedic (Dec 26, 2006)

Ridryder911 said:


> Before you all "strut" your feathers too much I would not be comparing Virginia or the other 49 other states to Canada's EMS system. For as being "aggressive as the law allows"... that's total B.S. !
> 
> Compare Canada's Basic level with U.S. ... Hmmm don't think I would be doing this since theirs is about 4 times longer (1 year long) Now you want to compare? Their advanced level is 2 1/2 years long (collegiate level) and their Advanced Paramedic level is 4 yrs long with several hundreds of hours clinical time, including cath lab, multiple ICU/Trauma and Flight Services.. so before we start our "bragging rights" we might want to evaluate our own back door.
> 
> ...



When we talk aggresiveness, we're not talking about how long you've been to school. We're talking about "on the street saving lives." Agressive protocols and aggressive providers. From my 15+ years experience, the worst medics I have ever worked with in my life are the over-educated ones, no common sense and just plain out dumber than dirt when it comes to taking care of patients. If was in trouble, I would just as soon they stay in the ambulance and hold the steering wheel. We used to call them "cookbook medics", I would rather work with "street smart, savvy, common sense medics." They are the ones who will save your life. The others just read about how to save lives. If its about years of education, just put lawyers on ambulances, what do they have 8 years+.


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## Guardian (Dec 26, 2006)

Ridryder911 said:


> Before you all "strut" your feathers too much I would not be comparing Virginia or the other 49 other states to Canada's EMS system. For as being "aggressive as the law allows"... that's total B.S. !
> 
> Compare Canada's Basic level with U.S. ... Hmmm don't think I would be doing this since theirs is about 4 times longer (1 year long) Now you want to compare? Their advanced level is 2 1/2 years long (collegiate level) and their Advanced Paramedic level is 4 yrs long with several hundreds of hours clinical time, including cath lab, multiple ICU/Trauma and Flight Services.. so before we start our "bragging rights" we might want to evaluate our own back door.
> 
> ...



advanced level paramedic is 4 years long! wow, I take back anything bad I ever said about Canada's ems.  Canadians know their stuff...what textbooks do Canadians use for basic paramedic as well as advanced paramedic curriculum?  The reason I ask, I don't see it taking anymore than two years at the most to get through a standard brady or mosby paramedic book so the question becomes, what do they study after that.  Do they study critical care textbooks or what?


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## Ridryder911 (Dec 26, 2006)

Amazes me when discussing education it is always the ones that don't have it argue against it. Sure street education is wise, but it is NOT education. Sure, it is essential.. but again if one has the education and then the experience with street wise, look one would have. Anyone can get the experience, not vice versa. 

I am not going to argue this anymore. Obviously physicians and 99.9% of the other health care industry see the need of in-depth education. Only EMS takes short cuts and lowers their standards, thus causing harm and inadequate care to patients. EMS much rather do things half as*, than ever do it the right way. And one wonders why, there is no professionalism ?

R/r 911


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## Fedmedic (Dec 26, 2006)

Ridryder911 said:


> Amazes me when discussing education it is always the ones that don't have it argue against it. Sure street education is wise, but it is NOT education. Sure, it is essential.. but again if one has the education and then the experience with street wise, look one would have. Anyone can get the experience, not vice versa.
> 
> I am not going to argue this anymore. Obviously physicians and 99.9% of the other health care industry see the need of in-depth education. Only EMS takes short cuts and lowers their standards, thus causing harm and inadequate care to patients. EMS much rather do things half as*, than ever do it the right way. And one wonders why, there is no professionalism ?
> 
> R/r 911



Let's put it this way, if I spend 2 years in a paramedic program learning to take care of patients and that is all I am doing is learning patient care. Vs. spending 2 more years getting my Bachelors which incorporates 2 more years of learning english, math, history, basket weaving, etc. etc., I will now be a better paramedic...that's BS. Because that is all a bachelors or even a masters in EMS gets you. Basketweaving 101. That may be fine if you want to get into EMS management, but if your happy just being a street medic, then who cares if you can even spell "paremadik." 

Prime example of education at its finest; there is a paramedic here who has a bachelors from a major four year state university and a MBA from another highly accredited state university. He was in the back with a patient when I heard the defibrilator charging. I asked what he was doing, he said "getting ready to shock, she is in v-fib, I quickly stopped the ambulance and got in back, pt. was A/O x 4, sitting on stretcher, he had paddles in hand, getting ready to defibrilate; a lead had come off and it appeared to be v-fib, even though the patient was A/O x 4, the book said the squiggly little line was v-fib and to shock it. Needless to say, I didn't let him shock her.


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## Guardian (Dec 26, 2006)

Fedmedic said:


> When we talk aggresiveness, we're not talking about how long you've been to school. We're talking about "on the street saving lives." Agressive protocols and aggressive providers. From my 15+ years experience, the worst medics I have ever worked with in my life are the over-educated ones, no common sense and just plain out dumber than dirt when it comes to taking care of patients. If was in trouble, I would just as soon they stay in the ambulance and hold the steering wheel. We used to call them "cookbook medics", I would rather work with "street smart, savvy, common sense medics." They are the ones who will save your life. The others just read about how to save lives. If its about years of education, just put lawyers on ambulances, what do they have 8 years+.



What does common sense have to do with your level of education?  Are you telling me that people who have been through long, extensive, college level paramedic programs are lacking in common sense?  I don't see it, in fact, I see the exact opposite most of the time.  "Cookbook" medics are ones who don't understand why they are treating a pt a certain way, they are just following a set of instructions.  The ones who do this are lacking in formal education and are dangerous if released to practice on the street too early.  I hate to use Rid as an example but here goes...rid has had a lot of "classroom education."  Would you say this has hindered his ability?  Is he lacking in common sense?  Of course not.  Hmmm, I wonder who I would rather have treat a family member during an emergency, a rid or a fedmedic?


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## Chimpie (Dec 26, 2006)

I'm closing this thread temporarily to allow a little breather from this topic.  I hope once we reopen this thread that everyone will have cooled off and be able to post responsibly. 

Any attempt to start a new thread to continue this topic will not be tolerated.

Chimpie


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