Technology, brave men and their proud simulators
You can have every tube confirmation device in the world, with every fiberoptic, tv guided, device on the planet, if a provider sucks to begin with, all the technology in the world will not help.
If you guys didn't know, there are actually lobbists pushing for mandatory simulation technology in healthcare. There is already a major marketing push.
A simulator will never be able to replace actual patient contact. But if you listen to the salesmen and people pushing it, it is going to be the savior of medical training. This week I demonstrated intubating 4 "fred the heads" in under 30 seconds. Never once did the mallampati score change, there was no secretions or vomitus in the airways, they were NPO for years and years, no diseased broken teeth, no selecting of tube or blade size, not one anatomical variance, and in the best conditions available, airconditioned, well lit room.
Even with the $10,000,000 dummies (not nearly as dumb as the people spending that kind of money on it) will always tube the same so you don't actually get practice intubating, you get practice intubating that specific simulator. Does anyone beleive you could become a professional sportsman in any event with your playstation game?
I mentioned about the powerless medical director already, I will not rehash it.
Every Podunk town wants paramedics. Every City wants 1 paramedic for every 10 or so citizens. So you are up against a lack of opportunity to practice in both training and in a more controlled environment with an expert.
Mom and Pop's community hospital simply doesn't do enough procedures to allow a reasonable amount of practice.
Academic hospitals are saturated with residents, CRNAs, respiratory techs, critical care teams, and a host of people with more urgent need of intubation practice than paramedics.
With the cost of insurance and the pityful educational requirements of a paramedic, who in the right mind would expose their agency or practice to that liablity?
The amount of intubations are decreasing. Alternate devices, shorter less invasive or non inasive care of surgical pathology put the numbers on a downward trend. We also figured out that tubing people because we can causes things like increased hospital stays. That is not only bad for patients but the economics.
Many paramedics, including most I see graduate, will never intubate anything other than fred the head prior to being in the field. For most of them, opportunities to intubate are so rare that many will be independantly in charge of a unit with a basic partner before the first tube they attempt on a live person.
I worked at one place that on a truck of 6, 4 crewmen were paramedics. At best a person would get one attempt at every 4th tube.
There are still places that have no FTO or field internship prior to being released to full duty.
How about low volume volunteer agencies or 1 or 2 truck outfits?
How about the IFT unit that catches the occasional 911 call?
There are a few systems (because it is a system wide issue, not just an agency) that actually dedicate the resources needed to maintain proficency with this procedure. Fewer still that dedicate resources to the many procedures performed by paramedics.
How about instead of $10,000 on a simulator, we start sending paramedics to the local animal pound to intubate euthanized animals? It is a lot cheaper, and while not a substitute for a human in an OR under the supervision and direction of anesthesia, it is what was used historically.
Would you let a surgeon who only operated on a simulator operate on you?
Why not?
Then what on earth would cause you to not demand intubation be removed from EMS providers who cannot obtain and maintain proficency in a procedure that could actually cause death when it fails?
When did being good a a procedure become less important than knowing when you failed at it?
Stands to reason if you are good at something you fail less often and probably recognize quickly when you do.
EMS has become the excellence of half assed mediocrity.
