Can EMT-B intubate or start IVs?

[MackTheKnife]

Remi, if the tube is properly situated, it doesn't matter who placed it, now does it?

 

[triemal04]

Remi, if the tube is properly situated, it doesn't matter who placed it, now does it?

It's comments like this that make it very clear that you don't understand what you are talking about.

 

[MackTheKnife]

It's comments like this that make it very clear that you don't understand what you are talking about.

Trivial, i mean triemal04, what is clear is that you have no idea what you are talking about. A properly situated tube is a properly situated tube no matter who placed it. Insert laryngoscope, visualize the cords, insert tube with cuff just past the cords, inflate cuff, and secure tube. See? I do know what I'm talking about.

 

[DesertMedic66]

Trivial, i mean triemal04, what is clear is that you have no idea what you are talking about. A properly situated tube is a properly situated tube no matter who placed it. Insert laryngoscope, visualize the cords, insert tube with cuff just past the cords, inflate cuff, and secure tube. See? I do know what I'm talking about.

Tubes never become dislodged right?
You've never heard someone say "but I saw the cords" when answering why the tube was misplaced?

Once a central line is in place it doesn't really matter who did it right?

 

[triemal04]

Trivial, i mean triemal04, what is clear is that you have no idea what you are talking about. A properly situated tube is a properly situated tube no matter who placed it. Insert laryngoscope, visualize the cords, insert tube with cuff just past the cords, inflate cuff, and secure tube. See? I do know what I'm talking about.

Because all that matters is that the tube is in the trachea. That's it. Nothing that came before, during, or after the attempt matters. Just that a tube is in the trachea.

I feel stupider just for saying that.

But, since you are a highspeed/low drag stud corpsman who has been there and done it all (probably twice) I'll go ahead and bow deferentially to your knowledge and superior wisdom. You win masterful one, you win!

edit: this is probably where Mack will mention how long he's been doing this (again) and how he really has done all these cool things (again) and how that obviously makes him an expert and correct in all his statements, what with how superior he is to the rest of the world. Pardon the vomit on my keyboard...

 

[MackTheKnife]

Tubes never become dislodged right?
You've never heard someone say "but I saw the cords" when answering why the tube was misplaced?

Once a central line is in place it doesn't really matter who did it right?

Jeez, why don't we what if this to death? I never said things don't go wrong, no matter what the procedure. You guys who keep on attacking what I said can't be honest and address what I stated: That the skill is not that complicated. I didn't address the what ifs or other issues.

 

[DesertMedic66]

Jeez, why don't we what if this to death? I never said things don't go wrong, no matter what the procedure. You guys who keep on attacking what I said can't be honest and address what I stated: That the skill is not that complicated. I didn't address the what ifs or other issues.

No, the skill it self isn't very complicated. However everything else about the skill gets very complicated Which is what the majority of us are stating.

 

[MackTheKnife]

Because all that matters is that the tube is in the trachea. That's it. Nothing that came before, during, or after the attempt matters. Just that a tube is in the trachea.

I feel stupider just for saying that.

But, since you are a highspeed/low drag stud corpsman who has been there and done it all (probably twice) I'll go ahead and bow deferentially to your knowledge and superior wisdom. You win masterful one, you win!

edit: this is probably where Mack will mention how long he's been doing this (again) and how he really has done all these cool things (again) and how that obviously makes him an expert and correct in all his statements, what with how superior he is to the rest of the world. Pardon the vomit on my keyboard...

You are such a font of wisdom. Of course the other things matter. Like adequately ventilating a pt before attempting an intubation. Having suction ready, etc. In TCCC, the primary airway is an NPA, not an ETT. And thanks for making fun of my experience. I only described my CV when asked. I wish I was a stud but obviously my penis is small compared to yours.

 

[epipusher]

Mack your posts make you seem a little pathetic. True or not it seems as though you are an EMT who so badly wants to be a medic but for some reason have yet to have that P on your card. But as we all know we can be whoever we want to be on the internet.

 

[MackTheKnife]

Mack your posts make you seem a little pathetic. True or not it seems as though you are an EMT who so badly wants to be a medic but for some reason have yet to have that P on your card. But as we all know we can be whoever we want to be on the internet.

Dude, go back to school and learn English, or better yet, reading comprehension. I was a "P". National Registry and Virginia. VA # was 17132-L632-1038-P121. Notice the P? National # MP806346.

 

[MackTheKnife]

Mack your posts make you seem a little pathetic. True or not it seems as though you are an EMT who so badly wants to be a medic but for some reason have yet to have that P on your card. But as we all know we can be whoever we want to be on the internet.

Since you have a hard time reading my post, or believing them:

 

[Flying]

Mack the ease of the skill is not the issue we are trying to bring up.

Let's ignore that we have data (courtesy of DEMedic and Google scholar) that very strongly suggests that only a minority of paramedics that perform the skill regularly and often can demonstrate proficiency (a 9/10 success rate as opposed to 3/4). I think you are in this minority given your experience. But we have other problems even after ignoring the fact that the majority of civilian EMTs don't work in high volume systems with low skill dilution.

I hope we can agree that ET intubation is an invasive procedure that has complications ranging from minor to life-threatening.

How is that ever going to translate to the EMT, the level of "training" that does not even cover A&P and the basic sciences?
Are we going to trust people who aren't even obligated to know Boyle's law or the basics of metabolism to understand the consequences of what they are doing?

Maybe, just maybe, EMTs don't have to understand what they do. Maybe we can work out a Protocol that allows them to provide life-saving intervention when people really need it.
But then they just become dogs. That's how we encourage BS like backboarding, the Golden Hour, being safe by "overtreating" with oxygen.

 

[MackTheKnife]

Mack the ease of the skill is not the issue we are trying to bring up.

Let's ignore that we have data (courtesy of DEMedic and Google scholar) that very strongly suggests that only a minority of paramedics that perform the skill regularly and often can demonstrate proficiency (a 9/10 success rate as opposed to 3/4). I think you are in this minority given your experience. But we have other problems even after ignoring the fact that the majority of civilian EMTs probably don't work in high volume systems with low skill dilution.

I hope we can agree that ET intubation is an invasive procedure that has complications ranging from minor to life-threatening.

How is that ever going to translate to the EMT, the level of "training" that does not even cover A&P and the basic sciences?
Are we going to trust people who aren't even obligated to know Boyle's law or the basics of metabolism to understand the consequences of what they are doing?

Maybe, just maybe, EMTs don't have to understand what they do. Maybe we can work out a Protocol that allows them to provide life-saving intervention when people really need it.
But then they just become dogs. That's how we encourage BS like backboarding, the Golden Hour, being safe by "overtreating" with oxygen.

Appreciate your post and the tone of it. Thanx for acknowledging that I do have experience and am not blowing smoke up people's arses. Some here like to go on the attack because of my admittedly controversial post. Some just like to attack, period. Once again, thanx for the kind words.

 

[epipusher]

Instead of pushing hard for basics to be allowed to intubate, why dont you go after becoming a medic again?

 

[MackTheKnife]

Epi,
Good question. That's exactly what I'm going to do. I'm researching bridge programs now for after I graduate nursing school next year.

 

[Tigger]

hey Mack, just wanted to say that don't get too hung up on the attacks..... I've seen worst, for some reason military EMS personnel don't mix well with civilian EMS providers. I have a feeling they think that we are a bunch of gun toting idiots who treat human beings (patients) like a sack of meat or something...

Telling someone to justify their opinion with facts is not attacking them. Let's not insinuate that it has anything to do with anyone's backgrounds.

 

[Paramagicz]

guys, I don't see a long term logical reason why we all argue over this... I can see both side of your guys opinions.. The paramedics on here thinks that EMT doesn't possess the in-depth knowledge to intubate and can do more harm to the PT than good...

and on Mack's side, I can understand that he see the whole EMT vs Paramedic intubation thing is a blur because in the military, a combat medic can have a really wide range of scope of practice, including people that are working for DOD or in the PMC... and on top of that, in other Countries...Their Arm forces medics can sometimes even goes further with their practice... it really all comes down to if the individual has the ability to pick up the skills.

Personally, I don't see anything wrong with EMT gaining the ability to intubate, going through EMT school.. they always taught us that "airway is king" & "airway comes first!" etc.

so how is it wrong for future EMTs to learn that extra skill that could help them secure the PT's airway in a better and a more efficient way?
rather than sticking a combi-tube in and say "Cool, now let's hope ALS get here before this thing fail..." (which from what i heard happens often due incompatible sizing for each individual patient)


Also, I do feel like they are attacks on the poor dude.... because the comments on here attacks the guy's credentials and his opinions rather than seeing that he is just trying to point out the work-load can be divided (which is already happening based on some of the other guy's input coming from other states and counties... like what EMT11KDL said about "giving the paramedic more wiggle room to perform other important procedures"


I mean I can see some folks might be worried that EMT-B might eventually take over prehospital care and push the job market for paramedics over the cliff or something because they are allowed to do everything a paramedic can (eventually) but get pay less (so ambulance companies would definitely pick them up) I can see that happening since it's happening with ICU nurses that tags along with ambulances, they are being pushed out of that line of work because of paramedics. (just for icing on top, I know some medics don't see it this way but more of the "quality" of care for the patient might diminish if we give such vital role to an EMT-B)

anyways, this ol medic sergeant from my unit used to say "JUST GET that Somah-a-B*tch back on his damn feet so he can go home and see his 300 pounds wife again" lol
all jokes aside, I feel that rings true in a way.

 

[Carlos Danger]

Personally, I don't see anything wrong with EMT gaining the ability to intubate, going through EMT school.. they always taught us that "airway is king" & "airway comes first!" etc.

so how is it wrong for future EMTs to learn that extra skill that could help them secure the PT's airway in a better and a more efficient way?
rather than sticking a combi-tube in and say "Cool, now let's hope ALS get here before this thing fail..." (which from what i heard happens often due incompatible sizing for each individual patient)

There are good reasons why the idea of civilian EMT's intubating is ridiculous, and they have been well documented in this thread already.

The first and most obvious one is initial training: How do you propose EMT's even learn to intubate in the first place? Paramedic programs are many times as long as EMT programs, and even at that, I think most of us would agree that paramedic students don't get enough training in airway management, and it is a fact that they very often struggle to get even the tiny number of live tubes needed to graduate.

If you can come up with a good way around that, then we can move on to one of the several other important reasons why this would never work.

 

[MackTheKnife]

I thought this thread was dead, but apparently not. I find Remi's comment absurd. Some of the comments here show total close-mindedness. I.e., "it'll never work". Pretty final. As Paramagicz said, in the military, who are not paramedics, perform advanced skills. So there goes the " it'll never work" argument. And as for studies, mentioned previously, some are good and some are bad. Just cause there's a study, doesn't mean it's correct.

 

[luke_31]

I thought this thread was dead, but apparently not. I find Remi's comment absurd. Some of the comments here show total close-mindedness. I.e., "it'll never work". Pretty final. As Paramagicz said, in the military, who are not paramedics, perform advanced skills. So there goes the " it'll never work" argument. And as for studies, mentioned previously, some are good and some are bad. Just cause there's a study, doesn't mean it's correct.

Part of why it's not as big a deal for the military is that there is a lot more liability in the civilian world for allowing advanced procedures to be done regardless of skill level. In the military there isn't the same level of liability which is why 68w can do a lot more when working with soldiers.