Dr Blesoe has called us out.....

[Veneficus]

I agree. They should probably take away all of drugs you carry too, even less for you to worry about. Maybe the keys to the rig too.

However, on a non-trolling note:

The points raised in this article (and here) are valid. However the vignette at the start of the article does no credit to the authors by reinforcing a biased view of the lowest common denominator paramedic with inadequate education and oversight as being the norm. Some of you may have seen this scenario played out (or even played a part in it yourself) and we all know that in certain areas this may be the norm. However, constant reinforcement of such negative stereotypes is unhelpful when the root causes and solutions aren't part of the discussion.

I was surprised that Dr Wang was as unbiased as he seemed in this article given some of the 'studies' he has been responsible for in the past.

I suspect we all know that with education, training, oversight and the will to institute these things, paramedics are capable of intubating even in difficult situations or with drug assistance. The real question is why do we continue to accept the lowest standard as being acceptable, then get up in arms when some people want to take our "toys" away instead of addressing the root causes of the problem?

If you are familiar with the Naples, Florida debacle it may be the EMS providers who are driving the problem with the physicians unable to impose a solution.

Or perhaps the Louisiana proposal to remove select municiple services from under the authority of the EMS board because they are "too harsh" holding up their standards.

 

[fma08]

I agree. They should probably take away all of drugs you carry too, even less for you to worry about. Maybe the keys to the rig too.

However, on a non-trolling note:

The points raised in this article (and here) are valid. However the vignette at the start of the article does no credit to the authors by reinforcing a biased view of the lowest common denominator paramedic with inadequate education and oversight as being the norm. Some of you may have seen this scenario played out (or even played a part in it yourself) and we all know that in certain areas this may be the norm. However, constant reinforcement of such negative stereotypes is unhelpful when the root causes and solutions aren't part of the discussion.

I was surprised that Dr Wang was as unbiased as he seemed in this article given some of the 'studies' he has been responsible for in the past.

I suspect we all know that with education, training, oversight and the will to institute these things, paramedics are capable of intubating even in difficult situations or with drug assistance. The real question is why do we continue to accept the lowest standard as being acceptable, then get up in arms when some people want to take our "toys" away instead of addressing the root causes of the problem?

I'm just gonna throw this question out here because I see a lot of reference to the statement in bold above yet not a lot of discussion on how we can actually fix it (it's entirely possible that I'm blind and missed it too). So, how do we go about fixing it?

(Not trying to pick a fight here, just trying to get some relevent talk about solutions we can start implimenting and hopefully start turning the tide. ^_^)

 

[Veneficus]

I'm just gonna throw this question out here because I see a lot of reference to the statement in bold above yet not a lot of discussion on how we can actually fix it (it's entirely possible that I'm blind and missed it too). So, how do we go about fixing it?

(Not trying to pick a fight here, just trying to get some relevent talk about solutions we can start implimenting and hopefully start turning the tide. ^_^)

The best solution I can think of is that the service medical directors should be appointed by the local medical boards, not a for hire position by the individual agencies that can fire them if they don't do wht the agency wants.

 

[Smash]

If you are familiar with the Naples, Florida debacle it may be the EMS providers who are driving the problem with the physicians unable to impose a solution.

Or perhaps the Louisiana proposal to remove select municiple services from under the authority of the EMS board because they are "too harsh" holding up their standards.

I'm afraid I'm not familiar with that situation, but I certainly don't think that the problem (is it a problem? Situation maybe?) is down to just medical directors, or just EMS providers or just OEMS in any particular area. The trick is to get everyone working together, and when this happens, we see progressive, effective EMS. It doesn't take much to derail that however!

 

[Smash]

I'm just gonna throw this question out here because I see a lot of reference to the statement in bold above yet not a lot of discussion on how we can actually fix it (it's entirely possible that I'm blind and missed it too). So, how do we go about fixing it?

(Not trying to pick a fight here, just trying to get some relevent talk about solutions we can start implimenting and hopefully start turning the tide. ^_^)

The 'fix' will certainly not be easy. It would require a great deal of work on a great number of peoples behalf. I think the first thing that we need to work out is exactly how big a 'problem' the while intubation thing really is. We need standardised reporting in systems and we need to make sure that our QI/QA is not punitive so we can get some real numbers without risk of providers fudging their success rates. Then we need to work on making sure that paramedics can intubate successfully, with appropriate education, training, regular refreshers, re-training and oversight and we need to ensure that they have the right tools (intubating without waveform capnography in this day and age is just not appropriate)

Once we have got that out of the way, and we are confident that paramedics can intubate, we need to work out if we should intubate. That means we need to get some solid research underway. Maybe the result will show that we shouldn't be intubating. However, at the moment we are really in the dark, because there is not a great deal of good quality research on intubation and mortality/morbidity. The bulk of the research we have generally just shows that a procedure done badly is bad for the patient. We need to find out whether a procedure done well is good for the patient. Stephen Bernard from Australia has addressed this to some extent, and the results semed very promising (for RSI), however I have not seen his paper published yet, so I'm not sure if there was a problem with the data, or there is some other reason his paper hasn't been published.

Now, that is a lot of work, and it will take a lot to achieve, so I guess the question really is, are we up to it? It is certainly possible. In my road based service we carry out approximately 1000 drug assisted intubations per year. Since we started RSI about 5 years ago we have had exactly 0 unrecognised esophageal intuabtions. We have never had to cric due to a failed intubation/RSI (crics have been done in other situations) and we have a first attempt success rate of around 97%. So paramedics certainly can intubate if the will is there to make it safe and effective, but that still doesn't answer whether we should be or not.