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.
