IFT Trach Patients by BLS.

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Hi there. I currently work for an IFT company as an EMT-B, as it's my first year in EMS and apparently this is how I'm supposed to get my foot in the door. Anyways, my questions pertains to transporting Trach patients as an EMT-B.

Sometimes, these transports can be up to 1 1/2 hours to 2 hours long. As an EMT-B, I was not properly trained to suction trach patients, and in my area it is an ALS skill due to it being invasive. My first transport with a trach patient, we had a respiratory therapist ride along with us who performed suctioning during the transport, so I was okay with transporting the patient as she was well versed when it came to suctioning; however, this wasn't always going to be the case.

The next trach patient I had to transport, and ever since then... We've never had a respiratory therapist come with us. I was quite concerned with this my first time transporting solo, I asked the Nurse if she was sending anyone with us and she said no. When I brought up the fact that I wasn't trained to suction the patient's airway due to his trach, she said "he'll be fine". I called my dispatch and they told me to just go with what the nurse says and transport him. So, I did.

Recently however, we were transporting a patient with a trach and they started to sound very congested to the point where I had a pretty good concern for how long he'd be able to continue breathing. So, I called dispatch and told them to send a medic truck our way to perform some suctioning. Which they did, and my patient was fine and we continued the transport.

While the medic was suctioning, he himself was kind of curious as to why they had the patient being transported by a BLS crew. I told him I didn't really know, and that I to was pretty confused as to why it was a BLS transport instead of an ALS, even though from my experience it's common practice. He agreed with me that it should have been an ALS transfer, and after he completed the suctioning, he put my patient on 3 LPM of oxygen and we continued the transport.

Long story short, I'm wondering why it is that these transports with trach patients are put as BLS instead of ALS when suctioning the trach correctly is an ALS skill in my area.
 
As long as they don't need suctioning, a simple trach does not need anything above bls. Some places allow bls to be trained to do trach suctioning.
 
I say good job on being mindful enough to preemptively request ALS when you think the patient will need a skill out of your scope BEFPRE the patient actually needs that skill.
 
Also, when transporting junky trach patients, don't lean in front of them when the cough.

I usually ask for a pre emptive suck before I leave the facility.

And as stated, trach patients as stable for BLS as the general population, but don't be afraid to divert or request an intercept if you need an intervention.
 
I transported trachs alot (Mostly with t bar involved). We suctioned when needed but was very rare. If pt wascon vent it became a cct.
 
Jim37F said:
I say good job on being mindful enough to preemptively request ALS when you think the patient will need a skill out of your scope BEFPRE the patient actually needs that skill.
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Agreed.

Ewok Jerky said:
I usually ask for a pre emptive suck before I leave the facility.

And as stated, trach patients as stable for BLS as the general population, but don't be afraid to divert or request an intercept if you need an intervention.
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This. No harm in asking for suction before you get going. Like Ewok says trach patients are relatively stable and can go by BLS. If he needs a intervention thats out of your scope of practice then theres no problem calling for a higher level of care to preform said intervention.

Good job in knowing when to call ALS.
 
Ewok Jerky said:
Also, when transporting junky trach patients, don't lean in front of them when the cough.

I usually ask for a pre emptive suck before I leave the facility.

And as stated, trach patients as stable for BLS as the general population, but don't be afraid to divert or request an intercept if you need an intervention.
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I don't think you could have worded that second statement any better...
 
If the patient needs "frequent trach suctioning", then it is ALS. Otherwise, it's a BLS transport.
So it usually comes down to the judgement of the nurse requesting the transport on behalf of the doctor who has no idea how much sputum the pt is producing. Be sure to talk to the nurse/RT before leaving the facility to make sure you're not getting more than you bargained for due to a miscommunication.

And yes, one last suck "for the road" is always a good idea ;)
 
What area you from? Where im from its a bls skill unless your on a vent.
 
gonefishing said:
Not deep suctioning but suctioning of a trach.
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That's the only real way to suction a trach (threading a soft suction catheter down to the corina). Otherwise, all you're doing is clearing the opening with a Yankhauer, which is pretty useless.
 
Granted, suctioning with an existing T-piece makes deep suctioning easier and safer, but it is still considered the same process as deep suctioning with sterile gloves and a soft cath.
 
Underoath87 said:
Granted, suctioning with an existing T-piece makes deep suctioning easier and safer, but it is still considered the same process as deep suctioning with sterile gloves and a soft cath.
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This is a basic skill in LA county now and alot of other areas.
 
Hand the patient the suction tubing and let them suction themselves. They don't call for a medic everytime they need suctioning at home.
Talk to your manager and your medical director. If the Medical director says it should be ALS everytime then the company makes more money so they should be happy
 
I'm surprised to hear that trach suctioning is not a BLS skill where you're at. In all three states I practice, EMT's suction trach patients.
 
Chewy20 said:
Haaaa so LA can deep suction but can't use a pulse ox or dstick? Or did yall get those too?
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There are pulse ox now but "optional" bls equipment. No dstick because the board for LA looked at OC and said well they never do it there so its a waste here.
 
gonefishing said:
There are pulse ox now but "optional" bls equipment. No dstick because the board for LA looked at OC and said well they never do it there so its a waste here.
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The fact that a rig would carry o2 but not a pulse ox is incredibly stupid.
 
redundantbassist said:
The fact that a rig would carry o2 but not a pulse ox is incredibly stupid.
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Not necessarily there is always cap refill. You could walk into a house fire and come out with a saturation of 100% it's just like Private ALS companys in LA county not being able to pace unless having a special certification from the county and as well no requirement for cpap and also having to have a special certification from the county even though BOTH are taught in school.
 
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