intubation as a basic skill

[MeaganIV]

Here, EMT-I's can perform cric's.

OMG...


omg...


I don't think thats right. I'm really sorry but I don't.

Here in Alberta we are allowed to perform IV therapy, IMs, SQs, more drugs, and some advanced airway stuff.

cric's are really pushing it though. I'm an EMT-I... yeah.

 

[Fedmedic]

I don't think thats right. I'm really sorry but I don't.

Why not? They get the EXACT same training and education in performing cric's that paramedics get. It's just a skill that can be taught. If I am dying and need cric'ing, I don't care who does it, the alternative is DEATH.

 

[jeepmedic]

THe thing about intubation is that it actually does require more skill then you think.

Its dangerous, invasive, and has consequenses especially when trying to place it.


It should not be a basic skill because it is NOT basic.

I have been intubating for over 10 years. It is a basic skill. Look for the cords see the tube pass the cords. simple. And as I was told not just any old hole will do. That is where most people get into trouble. They see a hole and stick a tube in it.

I.V. sticks are harder than intubation.

 

[jeepmedic]

Here, EMT-I's can perform cric's.

you beat me to the punch there old man.

 

[MeaganIV]

its the same reason why docs go to school for 7 years and its the principle of the matter.

Here, CCPs have gone through 6-7 years of school, adding onto their paramedic. They have the know how and the experience. They ARE like doctors, they just do it all faster.

Even though the skill can be taught and learned it shouldn't be. Its an advanced technique and should be saved for the advanced professionals.


Thats why we all have ALS back up 2 minutes away.

 

[Fedmedic]

and its the principle of the matter.

I'm sorry, but I just can't see letting someone die as a matter of principle. My ego isn't near that large.

 

[jeepmedic]

Thats why we all have ALS back up 2 minutes away.

In a perfect world yes maybe. But I have worked in large systems that you don't ALWAYS have ALS back up. The airway needs to be protected no matter what. Because if you don't have an airway you don't have a pt. you have a body.

 

[MeaganIV]

THis isn't about ego! its about the know how and adding onto that know how. That is why we have different levels of training. Thats why we go through it all.

Its about delivering the best possible care to that Pt. It was never about ego. I resent anyone saying that I have a large ego just because I'd rather leave the paramedic stuff to the paramedics...


Why do you think insulin isn't a drug that we can administer? it has detrimental effects. Its could kill the Pt. Same with tubing. Same with cric's.

I'm not trying to step on anyone's toes. Really. Those are just my thoughts.

 

[MeaganIV]

In a perfect world yes maybe. But I have worked in large systems that you don't ALWAYS have ALS back up. The airway needs to be protected no matter what. Because if you don't have an airway you don't have a pt. you have a body.

In city... and rural... ALS isn't that far behind and BLS units are usually staffed with someone who can perform tubing skills like a paramedic.

If I have a paramedic supervising, I will tube just incase I don't landmark properly or i can see anything with the mac...

 

[jeepmedic]

Why do you think insulin isn't a drug that we can administer? it has detrimental effects. Its could kill the Pt. Same with tubing. Same with cric's.

I can give insulin and do every shift I work.

If you do not intubate a pt. that needs it there is no "could" you will let them die.

 

[MeaganIV]

I can give insulin and do every shift I work.

If you do not intubate a pt. that needs it there is no "could" you will let them die.

you can give insulin and can ET but you can give an IV?

 

[jeepmedic]

you can give insulin and can ET but you can give an IV?

???????:huh:

 

[Fedmedic]

I'm not implying that it is about your ego. I'm just saying that I don't have that much of an ego to support the fact that I would let someone die just because another provider didn't have the same level of training as myself. We're talking about a procedure that a couple minutes are the difference between life and death, and we can't just wait for someone of higher taining to arrive or wait to get to the ER. So if they get it wrong, the patient isn't anymore dead than they would have been in the first place. But if they get it right, they just saved a life.

 

[MeaganIV]

Sorry I meant "CAN'T do IV's."


I just don't get that.

 

[MeaganIV]

I'm not implying that it is about your ego. I'm just saying that I don't have that much of an ego to support the fact that I would let someone die just because another provider didn't have the same level of training as myself. We're talking about a procedure that a couple minutes are the difference between life and death, and we can't just wait for someone of higher taining to arrive or wait to get to the ER. So if they get it wrong, the patient isn't anymore dead than they would have been in the first place. But if they get it right, they just saved a life.

Thats a valid point but if its that bad then why wouldn't dispatch just send ALS or have ALS standing by?

 

[jeepmedic]

Sorry I meant "CAN'T do IV's."


I just don't get that.

I didn't say I couldn't do IV's I said that IV sticks are harder than Intubating. I can do anything I feel that the pt. needs done at work as long as the Doc will sign off on it. In the field I only have call in for atropine (WTF)

 

[Fedmedic]

Thats a valid point but if its that bad then why wouldn't dispatch just send ALS or have ALS standing by?

Maybe in your system that is how it works. But here and a lot of rural US, you don't always have the luxury of a paramedic or even an ALS ambulance being available, at all, anytime. So you have to make do with what you do have.

 

[MeaganIV]

luxery?

I don't think this system anywhere is that at all.

if the doc signs off on it... i suppose thats not bad. My dad plays medical direction every now and then and he tries his best to see if ALS is available with the more advanced stuff first.

 

[Airwaygoddess]

OPA's NPA's and BVM for EMT-B on the ambulance service here. only a few FD here can put in a Combintube here due to the long response time by ambulance. I wish the medical directer would allow it on the ambulance here for EMT-B's. Only the medic can intubate and Combitube a pt.

 

[Flight-LP]

If you do not intubate a pt. that needs it there is no "could" you will let them die.

Sorry, but I have to respecfully disagree with this statement. Several recent studies have shown an equal efficiency by utlilizing a properly placed and sealed BVM with adequate ventilations of 10-12 / minute vs. immediate endotracheal intubation. Other than in the rare case of a patient who cannot physically be ventilated and thus requiring a surgical airway, endotracheal intubation itself is not a life or death item. Place an OPA/NPA and bag them. At the BLS level a combitube would be appropriate. For anyone who doubts the validity of this statement, you can refer to the current AHA standards for ACLS, PALS, and NRP. Advanced airway management in a full arrest now calls for intubation after the placement of an IV and after the initial administration of meds. There are enough Paramedics out there who can't successfully intubate because of the "stick the straw in the hole" mentality. What happens when you get a Cormick-Lehane grade IV airway with less than 10% POGO? What do you do now? No hole visible to stick it in!

On a quartely basis, I put on an advanced airway seminar. At the beginning of the class I give a pretest on the current trends and algorhythms of airway management. Here are 3 of the questions on the pretest.............

1. Describe the B.U.R.P. mneumonic.

2. You have a 12 year old, 40kg. patient. What size ET tube would you use to intubate this patient?

3. Which of the following are contraindications for the administration of Succinylcholine........

A. Myasthenia Gravis
B. A Potassium level of 7.2
C. Burns sustained 18 hours ago
D. A hypothermic patient
E. A and B
F. All of the above

The average grade.................46%

Now mind you, this is the average of the Paramedic grades. Experience varied from brand new patch to 20+ year medics.

Taking this information and adding it to recent studies which indicate a decrease in Paramedic intubation success rates in the "skill" of intubation, do you really want a BLS provider attempting it?????

Sorry, intubation should not be performed by EMT-B's.....................