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BLS Automated Transport Ventilators

Discussion in 'BLS Discussion' started by EpiEMS, Mar 20, 2017.

  1. EpiEMS

    EpiEMS Forum Deputy Chief

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    So, Automated Transport Ventilators are in the National Scope for EMTs (see pg. 26)...
    Does anybody have them? If so, have they proven useful?
     
  2. VentMonkey

    VentMonkey Sagacious Louse Premium Member

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    Hmmm, interesting stuff for sure. I'd reckon they'd have to be a pretty squared away service if they do/ did allow for this. Seeing how many paramedics are uncomfortable with transport vents, do you think many, or most EMT's should have this in their scope without any type of training, or familiarization at all?

    I almost guarantee most EMT's don't know this; heck, I didn't. Thanks for the link though, Ep.
     
  3. EpiEMS

    EpiEMS Forum Deputy Chief

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    @VentMonkey thanks for your reply! I don't think it should be in the national EMT scope, it seems like something where a service medical director should be providing guidance. That said, I have a 15 minute (max) transport time, so I cannot say what would be appropriate for a really rural service. I certainly know I wouldn't want to be BVM'ing a patient that needed PPV for much longer than my 15 minute transports if I could avoid it.

    Maybe it's intended for already intubated patients? I wouldn't guess this is the case, but, you know, perhaps?
     
  4. GMCmedic

    GMCmedic Forum Lieutenant

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    I didnt know it was in the national scope, I knew it was in the Indiana scope. I think the AV2000 counts as an automated ventilator. I worked briefly at a service that carried them for hospital to hospital transfers and some scene scenarios but it was Paramedic use only.

    I liked them much better than the impact vents that I used at another service. Im very comfortable with the impacts but as I hinted at in another thread, theyre super annoying and picky.

    I cant think of a scenario where a BLS provider could use it where there wasnt some other drug or procedure that conflicts with BLS scope. Im sure there are some but it would be rare.

    I guess they could be handy in the few BLS only areas that remain but they likely couldnt afford them anyway



    Sent from my SAMSUNG-SM-G920A using Tapatalk
     
  5. VentMonkey

    VentMonkey Sagacious Louse Premium Member

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    In an ideal really rural service, it would warrant an ALS rendezvous with a unit that has both advanced airway management skills down pat, and a ventilator with proficiency enough to get them from the point of intercept to the ED.

    I'm sure some services put their paramedics through some sort of ventilator familiarization with whatever vents they use, many ground services that I know that carry them consider an AutoVent, or something similar still efficient (scary).
    Respectfully, this should never be the case. It's more often than not, operator error. Be it lack of troubleshooting skills, no desire to learn, poor sedation, not asking for help, or what have you. Again, I'm not implying this is you specifically or even what you meant, but just felt it warrants a good opportunity to learn from this, for others sake.

    When I first went to CCT, and began to learn about ventilator management the paramedic in charge of "training" me all but had this mentality. Within 2-3 weeks I learned enough to learn how not to make it so annoying, or picky...aside from the "silent alarm" button; hey, I'm still learning, too:).

    I still think any patient worth intubating in the field should be placed on the ventilator. Hand-bagging even for 15 minutes is often not done properly, and we can seriously mess some of these folks up. I feel if paramedics had a healthier respect in general for vent management, and how catastrophic improper hand-bagging can be, we would be in a better place with airway management, but generally speaking, we're not.

    I have seen, and heard paramedics scoff at the ventilator, rely solely on an SPO2 (ee-gad!, not even taking the time to hit, or read the waveform pleth option on the monitor). In a young, presumably healthy adult is it going to make a huge difference with a routinely short transport time? Maybe not, but where's the harm in applying a ventilator to the patient over having another person (incorrectly) squeeze the BVM in that same amount of time? Would you want that for your own lung protection if you had the options available because the paramedic "wasn't comfortable"?

    Again, a routine set of parameters, PRVC, and NIV should be sufficient enough to get most paramedics intubated patients to and from the hospital. It's really not all that difficult to learn, though there does appear to be an infinite amount of "ways to skin a ventilated cat" so to speak. We would also have to enlighten these folks with some advanced paramedic respiratory care, and formulary of course.

    Until we get paramedics on the same page with vent management (if ever), there's no reason EMT's should be expected to know how one functions. We're having a hard enough time showing providers the importance of proper BVM techniques.
     
    EpiEMS likes this.
  6. GMCmedic

    GMCmedic Forum Lieutenant

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    It may vary well be a case of operator error and that is what I always thought of myself, especially considering I had to practically train myself on the vent at that service. Though I have recently encountered a few flight services whose approach to alarms was to hit the silent button (admittedly that made me feel better about myself). I also have always felt that hospitals tend to under sedate for transport conditions which contributed to some of the alarms. That is just a theory. Another theory is that a majority of our vent transfers were awake (trached), it seemed the impact did not play well with patients that needed volume support.

    In short, i would be happy to go the remainder of my career and never use an impact vent again.

    Sent from my SAMSUNG-SM-G920A using Tapatalk
     
  7. luke_31

    luke_31 Forum Asst. Chief

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    We are supposed to have a transport ventilator at our service, but RT seems to have appropriated it and hasn't given it back. Fortunately we get them to ride in with us on on vent transports from the hospital, but supposedly we are supposed to have one to use for when RT isn't available and we need to go. Hope that doesn't happen, only done one in service on the vent, and then one transport since then about a year later. We really need to get a protocol though, patient needed more sedation and it took the doc a few minutes to get to the phone, and I had the patient staring at me while still having the dipravan running. Ironically the RT looked at me like umm, what should we do? Little versed with the dipravan and the patient was sedated.
     
  8. EpiEMS

    EpiEMS Forum Deputy Chief

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    Quoted for truth. I'm with you 100%. That said, if there is no medic - which is the case in some rare places - is it worthwhile to give a BLS crew have a vent?
     
  9. VentMonkey

    VentMonkey Sagacious Louse Premium Member

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    Assuming they have the proper training and are comfortable and confident with it, I don't see why not.

    Again, it's something beyond even the standard paramedic curriculum, so if I was the tech at 'XYZ' service that was providing me with a ventilator, I'd best be served with a proper introduction followed with routine in-services.

    From a practical standpoint it probably won't happen, and it's most unfortunate; but why on earth would we want "uber-EMT's" taking away the job, and getting credit for their more superior, higher-level provider counterparts theoretic "cup of tea" (sarcasm)?
     
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  10. NomadicMedic

    NomadicMedic formerly DEmedic

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    Sure. If they transport codes and can put in an SGA.
     
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  11. EpiEMS

    EpiEMS Forum Deputy Chief

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    There's the rub! I'm not very sanguine on the efficacy of transporting codes...though I would love to see SGAs (LMAs or Combitubes, perhaps?) in the National Scope model for EMTs
     
  12. VentMonkey

    VentMonkey Sagacious Louse Premium Member

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    Perhaps SGA's in a respiratory arrest would be more practical. Still, understanding how to troubleshoot alarms, and why and when to adjust parameters has their purpose.

    I forget not all EMT's are doing SGA's since it's (ironically) in their scope in this California county. Do they do it often? Hardly, so couple that with a presumably infrequent ventilator call.
     
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  13. medichopeful

    medichopeful EMT, ED/ICU RN, CEN

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    I could maybe (and that's a big maybe) see transport vents for BLS being appropriate for chronic vent patients with uncomplicated complaints (for example, going to a doctor's appointment). That would be about it in my opinion.
     
  14. EpiEMS

    EpiEMS Forum Deputy Chief

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    Sounds sensible!
     
  15. NomadicMedic

    NomadicMedic formerly DEmedic

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    I recall EMTs in Washington being able to transport vented patients that had their OWN vent.

    However, I believe the intent of adding transport vents to the BLS scope is exactly for the reason I mentioned, transporting a cardiac arrest or patient that required an SGA to the ED. Remember, in lots of rural America, volunteer EMS may only be an EMT and a driver.

    I dont believe that anyone really thinks that an EMT can manage a complex vent patient with an autovent.
     
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