Advanced Airways for Basics

TraumaJunkie

TraumaJunkie

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Are there any agencies that train EMT-B's to uses Advanced airways such as a Combitube? I know this is a ALS skill but i was just curious to see if anyone was recieving training to do it as a basic. Thanks
 
In Florida, the Combitube was one of the stations we were tested on for practicals...my sister (who was here in Virginia practicing as an Intermediate when I was going through my Basic class), kept saying that I was learning a more advanced skill than the B's here in Virginia do...
 
In Wisconsin, EMT-Bs are taught to use a combitube... as well as administer, in addition to oxygen, epi, glucogon, aspirin, nitro and albuterol.
 
In MA anything other than an NPA or OPA is advanced and basics cannot do afaik.

You might be able to do combitube, ET, King LT airway at the intermediate level.
 
Ohio, has them in state scope of practice
 
Plenty of OMDs allow their emt-basics to use the combitube (ETC) and some even intubate. Since the ETC is not completely idiot proof, many are now moving to the King airway. In my opinion, this is all half *** ALS. In my experience, you just can't trust emt-basics with ALS airways and they're better off just bagging with an OPA and suction if needed. Lately this opinion seems to be the opposite of where we are going (at least in my area) and many OMDs seem to be more than willing to let basics use ETC or King airway. Maybe they know more than I do. I haven't actually looked at any data to make an educated decision either way.
 
Guardian,

We have been teaching Combitubes in the New York Sate cirriculum for some time --yet they are not in the protocols for the Basics. I am like yourself, give me a good EMT that can suction and bag with confidence and the outcomes are always pretty good. If it aint broke--------

Canoeman
 
I think combitubes are a great idea especially in areas with limited or delayed ALS (wilderness rescues and rural services).

Some services around here have them on a waiver.
 
Washington State has Combi-tube as an EMT-B skill but after one year of practice as an EMT-B. Also has to have quarterly updates.
 
Oregon EMS has added the combitube to the EMT-Basic scope as well. I've been trained to use it but have never used it since we always have paramedics on scene to intubate. It's entirely up to your agency to train you on this skill and your medical director to approve of it's use in your area.
 
We've been taught and tested on the Combitube in our Basic program. The ALS guys that teach the class would like to see them used more often, if protocol allows.
 
I have used Combi-tubes in the field multiple times. They really do the job!
 
Easy said:
We've been taught and tested on the Combitube in our Basic program. The ALS guys that teach the class would like to see them used more often, if protocol allows.
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I can't imagine for the life of me why. I've brought a couple of patients in with combitubes and it's a bad feeling. I failed, I couldn't intubate those patients. When ED staff sees a combitube, they immediately think "we have someone here who couldn't intubate and protect the airway properly and now we have to pull this stupid thing and intubate ourselves." The combitube is better than nothing, but not much.
 
Guardian said:
I can't imagine for the life of me why. I've brought a couple of patients in with combitubes and it's a bad feeling. I failed, I couldn't intubate those patients. When ED staff sees a combitube, they immediately think "we have someone here who couldn't intubate and protect the airway properly and now we have to pull this stupid thing and intubate ourselves." The combitube is better than nothing, but not much.
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You've pretty much summed up what we do think in the hospital. As a Respiratory Therapist in the ER, my personal ETT intubation numbers have more than tripled since the Combitube. We actually are not supposed to hook up to our ventilator until we put a regular ETT in place.
 
Combitubes are a nice airway, because it is simple to use and is a "blind insertion". They are however; not the optimum airway and personally would not consider them an advanced airway, since most of the time they have only occluded the esophagus.

Yes, I agree it is better than nothing, thus the reason they are used by those not able to intubate or in a failed intubation attempt.

R/r 911
 
Our frequency of combi-tube use has to do with our location and ALS being at least 20 minutes away. A combi-tube secures the airway as we scoop and scoot towards our ALS intercept.
 
BossyCow said:
Our frequency of combi-tube use has to do with our location and ALS being at least 20 minutes away. A combi-tube secures the airway as we scoop and scoot towards our ALS intercept.
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I'm no expert on very rural ems. Maybe the combitube does have a place here. Regardless, you are not securing an airway with the combitube.
 
*** shakes head ****

overcoming the gag reflex has a lot more interesting applications than that...B)
 
Guardian said:
I'm no expert on very rural ems. Maybe the combitube does have a place here. Regardless, you are not securing an airway with the combitube.
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We're improving the pt's chances of being viable when we rendezvous with ALS. We reduce the incidence of gastric inflation and improve the delivery of O2. Without the combi-tube we have an airway adjunct but no real airway either. While there may be better options, of the options available to us, Combi-tube is the best.
 
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