TransportJockey
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Well, I did pass my skill test for combitube, but I was wondering how many other EMT-B's can use the skill? I know out instructor said we were one of the few states where they are allowed to.
Combitube question
- Thread starter TransportJockey
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HI jt. Don't know if this helps, but in WI, First Responders and Basics are allowed to use combitubes. Our FR's just completed training and we put the skill into service, but soon we will change to the King LT. Our MD has decided to slowly implement a change to a (assumably) better product with the LT. Personally, I don't know much about it. TRAINING!
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TransportJockey
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katgrl2003
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EMTs in Indiana are allowed to use them too.
-Kat
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And for good reason. Oh me, I shouldn't have typed that because of the massive debate that will follow. If you search this site though, you can read about that debate--it's pretty interesting. My opinion, they should only be used as als backup when ET intubation isn't successful and basics shouldn't touch them. If you read the debate, you'll understand my reasoning and maybe even agree. And, welcome to the site. To answer your question, where I live (on the northern east coast) basics are allowed to use the combitube.
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TransportJockey
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We actually had a similar debate in class. Part of the new procedure for most of ABQ area is that the medics get 1 shot to intubate, if they fail, we go in with an MLA. Or if we're the only unit available and it needs to be done.
Thanks for the welcome
And I'll check out the details of the online debateFFPARAMEDIC08
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Our basics are allowed to use the Combitube by state law. As long as they know how to do it, I don't see too big of a problem with it. FR's can use OPAs and NPAs.
Just to add, FR's have used OPA & NPA here for as long as I know. We are generally 20ish minutes away from ALS. We utilize a strong FR squad that works very closely with the ALS provider. I have only ever "installed" (sorry, carpenter's term) one in the last year of our new protocols. That case happened to be that the ALS crew, upon arrival, chose to leave it in place and use it for transport.
Side note, not to hi-jack: with our newer protocols, we are now assisting patients with epi-pens. We also are allowed to package a patient in the KED prior to ALS arrival.
Side note, not to hi-jack: with our newer protocols, we are now assisting patients with epi-pens. We also are allowed to package a patient in the KED prior to ALS arrival.
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TransportJockey
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Thread-jacking is fine with me
We are KED trained at Basic here, and we also carry Epi in the rigs.
BossyCow
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WA Basics with one year experience can use Combi-tubes. Only used if ALS is not available in our district. Not sure about other systems in the state.
Ridryder911
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Wow! What a dangerous predicament! I am surprised that a medical director would ever sign off a "blind intubation" to a MFR. That is asking to be sued, and to be in litigation. I personally do not believe basics should even be able to perform this tasks. It is an advanced airway, with the potential (or goal) is to be able to intubate the trachea.
Sorry, a first-aider should never be allowed to introduce anything or device into the trachea. There is too many complications and dangers involved. It would be much wiser to emphasize, stress, and mandate complete perfection of basic level devices.
R/r 911
Sorry, a first-aider should never be allowed to introduce anything or device into the trachea. There is too many complications and dangers involved. It would be much wiser to emphasize, stress, and mandate complete perfection of basic level devices.
R/r 911
FFMedic1911
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Here in Kentucky basics and medic can use the combitube.I think it is a wonderful device.Sure it isn't as nice as an Et tube but it has it place.The first thing beat into are head as a FR,basic,or medic is airway,airway,airway.Maybe the ones that don't think it is right for a basic to use it have had bad results from first responding units that have used them.Have I seen them used wrong, yes and that was by a doctor.Long story short medic had an airway with it doc pulled it out because that wasn't a secured airway.End result pt ended up with a surgical cric.Of coarse that may be a little out of the realm we are discussing.But the point being no matter how many degrees you have you must use common sense and know how to use the tools laid in front of you.
Ridryder911
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I read where WI has 2 levels of First Responders. Basic and Advanced (combitube and Epi) Wow! Geez let's add some more levels ... might as well just train them to do surgery...
Why is it states attempt to allow anyone to perform anything they choose without research and scientific studies first?
How well do we do they know that they can perform those skills, as well as maintaining performance levels? Is there such a shortage of EMS personal in WI, that we need anyone that attends a few hours of class to able to perform these procedures? Is it really in the best interest of the patient, or would having qualified personal be the best case? Or is this a good way to justify "the same care, only cheaper and easier" method?
R/r 911
Why is it states attempt to allow anyone to perform anything they choose without research and scientific studies first?
How well do we do they know that they can perform those skills, as well as maintaining performance levels? Is there such a shortage of EMS personal in WI, that we need anyone that attends a few hours of class to able to perform these procedures? Is it really in the best interest of the patient, or would having qualified personal be the best case? Or is this a good way to justify "the same care, only cheaper and easier" method?
R/r 911
FFMedic1911
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Rid I also see your side of the coin too.Yes I agree we have to many different levels of providers,and depending on where you are at determines what each one of those levels can provide.As a fire based paramedic I fined it silly that when I am here at work there is somethings I can't do that when I am home working for a private I can.
Simple answer to the OP's simple question. RR, why does everything always turn into an argument why no one is nearly as good as you?
I don't care why the medical direction allows me to use these skills. I care that they are there for me to use. You have an issue about how and why we do things here, become a doctor and take it up with my medical director.
I don't care why the medical direction allows me to use these skills. I care that they are there for me to use. You have an issue about how and why we do things here, become a doctor and take it up with my medical director.
Ridryder911
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Simple EMS is part of medicine. I know and realize many EMT's do not understand that. Medicine is science and requires research. As in the past, we jump into something not knowing why and if what we are doing is really in the best interest of the patient.
You are right, I don't take things at face value. I am an educated professional, and as such I realize that I should question and be able to validate any and all of my treatment. If your medical director asked or wrote protocols for enema, would you not question it?
If EMS and those that want to be treated as a professional, then we need to become one. We need to question and be sure what we do is the best for patient care. MFR may be great, or maybe not.. but, we should at least attempt to validate it with research prior to ever implementing it. Our history of errors such as PASG, CISD is a good example of that.
I am still searching for lit review and studies on MFR using such devices.
R/r 911
FFPARAMEDIC08
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Hook, that is a rather ignorant approach to emergency medicine. That's right, as rr put it, we are employed in the medical field as healthcare providers and need to act accordingly.
It's your JOB as a professional healthcare provider to be a patient advocate. Which, in this case, is knowing whether or not allowing you to use a combitube to intubate the patient is really in that patient's best interest.
I see two issues with your personal attack on rr:
1) I have seen no instances where he claims to be the top authority on emergency medical treatment.
2) He DOES hold a very high level certification. When you get the same certification as him, then maybe you'll be able to see his side of the argument.
I honestly don't see why you take his opinion so personally, yet you expect him and everyone else to "become a doctor and take it up with your medical director" when they disagree with your opinion.