EMT-B's use of the Combitube

[MMiz]

Hey,

As an EMT-B in Michigan, insertion, maintenance, and removal of the Combitube was part of the curriculum. I often see lengthy discussions, often turning into arguments, of why or why not EMT-Bs should be using the device.

As an EMT-B I have been trained in the indications and contraindications to the use of the device, and have my trusty common sense. Because of the short commute times and high availability for ALS units in my county, I service I did my practicals with, one of the largest in the nation, did not carry the Combitube on BLS units at the time.

How do you feel about its use? Do you see it used in the field often?

 

[southernEMTgal23]

i am from north carolina and our state decided in jan. to let basics use the combitube. I think it is a good idea. My opinion is that sooner or later there will only be Emt-B and Paramedics, no Emt-I. I say that b/c the basics are being able to do more and getting closer to the intermediate level. Thats all 4 now, and im sure glad a site like this is here

 

[MMiz]

Originally posted by southernEMTgal23@Jan 27 2004, 12:23 AM
i am from north carolina and our state decided in jan. to let basics use the combitube. I think it is a good idea. My opinion is that sooner or later there will only be Emt-B and Paramedics, no Emt-I. I say that b/c the basics are being able to do more and getting closer to the intermediate level. Thats all 4 now, and im sure glad a site like this is here

Welcome aboard!

In the county of Michigan where I live there are only EMT-Bs and EMT-Ps. While the local community college and surrounding communities still offer an EMT-I course, it is usually the first half of the EMT-P course. Here EMT-Is follow the EMT-B protocol, which I think creates a bit of frustration.

In reality I dont think the combitube will ever catch on around here, there is a Level 1 Trauma Center every 15 minutes or so, and a high availability of ALS intercepts. I think the combitube really will catch on in rural areas where ALS isn't so readily available.

I'm glad you're contributing to the forum, and look forward to future discussions!

Be safe out there!

 

[SafetyPro2]

California currently allows it, but L.A. County does not (see my post under Are you Nationally Registered? for how California EMS works). However, we CAN be advanced airway certified, and I'll be getting that in a couple months.

When the certification system changes in 2006, the state will probably get rid of advanced airway for BLS, but add the CombiTube across the board.

One thing I should add is that in the urban areas, there really is no EMT-Intermediate, only Basics and Paramedics. In the rural counties, there are some EMT-2s (aka EMT-Intermediate).

 

[Medic2B]

I am an EMT-I in North Carolina, and as stated before the combitube is a B skill now. I have never seen it used, but have heard Paramedics talk of using it when a ET tube couldn't be placed. I am trained in it's use, but will grab for an ET tube first everytime. Looking forward to getting further in the Medic class and learning more airway techniques!

 

[SafetyPro2]

I took the PHTLS course this weekend. For those who aren't familiar with it, it's for all levels of responders, so the class was probably about half Basics and half Paramedics with a few nurses thrown into the mix. During the airways skills section, we all got to "play" on the mannequins with ET tubes and CombiTubes (not to teach/certify us Basics how to do it, just for familiarization). I'd forgotten just how easy the Combi is to place. The instructor, an LAFD medic, said he still prefers the ET tube because it protects the airway better than the Combi does, but that he knows quite a few medics who've started going to the Combi more as a first choice when the situation warrants.

 

[AngryGeek]

I don't think the CombiTube, PTL, or LMA should be used at any certification level before traditional intubation has been attempted twice. Intubation protects the airway better and is useful for medication administration in an emergency by ALS or even in a hospital. In addition, since dual-lumen airways are inserted somewhat blindly, there is a greater risk of tearing the airway. Fortunately in Ohio EMT-Bs can intubate. We don't even bother carrying anything but standard tubes in our units

Just my view.

 

[Jon]

Ok. I'm going to drag this up again, as we have a lot of newer folks here who haven't seen it.

I love the idea of Combi-tubes. I think if ALS can be intubating in 5 or 6 minutes, dropping a combitube isn't a good idea, but if you are looking at 15+ minutes untill some sort of advanced airway, a combitube should be placed by an EMT.

What do you folks think / are allowed to do

Wish PA would progress past the days of Johnny and Roy (We still have a service with 2 medics where the one medic, in the truck, follows the other, in the BLS rig, to the hospital )

Jon

 

[emtbuff]

Well okay I will add my little section on combitubes in now.

I am an EMTB in a rural volley squad. Our squad is mostly EMTB with like three that are Intermediates. I for one have placed a combitube in while actually in the hospital. We don't do ALS with our community because we are close to the hospital and even once we get to the hospital we are still relied on helping out especially if it is a code. Our closes ALS unit is the chopper from the city hospitals which the choppers take about 15 minute our about 45 minutes to an hour by ground. We at one point had a paramedic with our squad who would get permission from the doctor in charge to us an ET tube. But for the most part it doesn't seem that the Nursing staff let alone doctors are comfortable with the ET tube. I know that with in the last year the hospital has gotten some combitubes for use in the hospital settings. So I guess it is up to each person individually if they want to use the combi or ET tube.

 

[rescuecpt]

Originally posted by emtbuff@May 26 2005, 12:00 PM
Well okay I will add my little section on combitubes in now.

I am an EMTB in a rural volley squad. Our squad is mostly EMTB with like three that are Intermediates. I for one have placed a combitube in while actually in the hospital. We don't do ALS with our community because we are close to the hospital and even once we get to the hospital we are still relied on helping out especially if it is a code. Our closes ALS unit is the chopper from the city hospitals which the choppers take about 15 minute our about 45 minutes to an hour by ground. We at one point had a paramedic with our squad who would get permission from the doctor in charge to us an ET tube. But for the most part it doesn't seem that the Nursing staff let alone doctors are comfortable with the ET tube. I know that with in the last year the hospital has gotten some combitubes for use in the hospital settings. So I guess it is up to each person individually if they want to use the combi or ET tube.

Wow, remind me not to get hurt in your neighborhood...

(not because of the EMTs, but because of a hospital that isn't comfortable with ET tubes... sounds like they need a few good RTs or Anesthesiologists)

 

[Jon]

Originally posted by rescuecpt+May 26 2005, 01:12 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ May 26 2005, 01:12 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-emtbuff@May 26 2005, 12:00 PM
Well okay I will add my little section on combitubes in now.

I am an EMTB in a rural volley squad.  Our squad is mostly EMTB with like three that are Intermediates.  I for one have placed a combitube in while actually in the hospital.  We don't do ALS with our community because we are close to the hospital and even once we get to the hospital we are still relied on helping out especially if it is a code.  Our closes ALS unit is the chopper from the city hospitals which the choppers take about 15 minute our about 45 minutes to an hour by ground.  We at one point had a paramedic with our squad who would get permission from the doctor in charge to us an ET tube.  But for the most part it doesn't seem that the Nursing staff let alone doctors are comfortable with the ET tube.  I know that with in the last year the hospital has gotten some combitubes for use in the hospital settings.  So I guess it is up to each person individually if they want to use the combi or ET tube.

Wow, remind me not to get hurt in your neighborhood...

(not because of the EMTs, but because of a hospital that isn't comfortable with ET tubes... sounds like they need a few good RTs or Anesthesiologists) [/b][/quote]
Or CRNA's.

Can't forget the CRNA's

Jon

 

[emtbuff]

Originally posted by rescuecpt+May 26 2005, 12:12 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ May 26 2005, 12:12 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-emtbuff@May 26 2005, 12:00 PM
Well okay I will add my little section on combitubes in now.

I am an EMTB in a rural volley squad.  Our squad is mostly EMTB with like three that are Intermediates.  I for one have placed a combitube in while actually in the hospital.  We don't do ALS with our community because we are close to the hospital and even once we get to the hospital we are still relied on helping out especially if it is a code.  Our closes ALS unit is the chopper from the city hospitals which the choppers take about 15 minute our about 45 minutes to an hour by ground.  We at one point had a paramedic with our squad who would get permission from the doctor in charge to us an ET tube.  But for the most part it doesn't seem that the Nursing staff let alone doctors are comfortable with the ET tube.  I know that with in the last year the hospital has gotten some combitubes for use in the hospital settings.  So I guess it is up to each person individually if they want to use the combi or ET tube.

Wow, remind me not to get hurt in your neighborhood...

(not because of the EMTs, but because of a hospital that isn't comfortable with ET tubes... sounds like they need a few good RTs or Anesthesiologists) [/b][/quote]
I know it is a scary thought isn't it. But not to fear all the EMTs are around and if we call in for a chopper we can lots of time have it landing about the same time we arrive so the medics can drop an ET tube. Or we usually jump at the chance to place a combitube.