Is an ET Tube Really ALS?

Jon said:
Time out - so why was it in the back of my EMT-B text as an "optional module"... I thought that was what the national standard had it as.
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It shouls have only included the combitubbe in the Brady books that i assume your talking about.
 
Jon said:
Time out - so why was it in the back of my EMT-B text as an "optional module"... I thought that was what the national standard had it as.
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Optional module is the key.. meaning not in the standard curriculum. NREMT has never endorsed EMT Basics to intubate nor even the standard Intermediate level. Their experts agree as well, it is a skill far more advanced that is in the curriculum. ETI is only endorsed by the NREMT level as EMT/I -99 and EMT/Paramedic level. The States may supersede and test while performing the NREMT examination, and be testing for their own state level requirement. Alike mine does.. Intermediate can intubate here, so one tests while getting evaluated for the NREMT.

There are so many myths about what is in NREMT and the curriculum. Again, I suggest that anyone that has problems sleeping read a few pages of the curriculum outline and NREMT by-laws and educational standards for testing. It will make a good sleep enhancer..

R/r 911
 
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Ridryder911,
I apologize for the fact that I shot in here talking about the "Paragods", it is only that I am educated, and a competent basic, and pride myself in my quality of work that my Paramedic partner enjoys, why, because I can either interpret her every move or I already have what she needs ready for her. I worked a shift the other day without my normal partner and he treated me like I was "Just a Basic" and that I wouldn't know an ET tube from a OPA. He literally told me that because he is the Paramedic that I am below him and don't belong in the back of an ambulance. I am a 68 Whiskey in the Oklahoma Army National Guard, ad recieved a Combat Medic Badge for actions that saved 3 of my comrades lives in Baghdad. I think I deserve a little more respect then that.
 
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wolfie23b said:
Ridryder911,
I apologize for the fact that I shot in here talking about the "Paragods", it is only that I am educated, and a competent basic, and pride myself in my quality of work that my Paramedic partner enjoys, why, because I can either interpret her every move or I already what she needs ready for her. I worked a shift the other day without my normal partner and he treated me like I was "Just a Basic" and that I wouldn't know an ET tube from a OPA. He literally told me that because he is the Paramedic that I am below him and don't belong in the back of an ambulance. I am a 68 Whiskey in the Oklahoma Army National Guard, ad recieved a Combat Medic Badge for actions that saved 3 of my comrades lives in Baghdad. I think I deserve a little more respect then that.
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I honor your position, but that does not gather automatic respect in the medical profession. I have worked along and seen many combat medics.. some are the most outstanding heroic and best medics I have ever seen, some I wonder how they ever
stayed alive, even more so to keep somebody else alive.. some of those even being awarded heroic citations.

Again, I honor you as a citizen for what you did over there, but in civilian terms military/combat medicine is a specialty medicine. The same as gerontology, pediatrics, etc.. You maybe great at implosion injuries, and be able to crich a 25 year old under fire, but that does not help granny with an inferior wall AMI. Again, that is not intended to be disrespectful. Just the truth. The reason I do not believe in "blanket cert" for military that many are trying to legislate.

Maybe your partner was not being diplomatic or even being an arse.. (yes, there are plenty out there on all levels, who knows?} Do I agree that an EMT should not be in the back... yes if it is a true medical emergency patient. One does not hand off from a RN to nurse aide..the same should be said about Paramedic to EMT..

I believe or hope you will see a much difference after you start practicing as a Paramedic. When it is your license on what happens. It will be you that will get sued and loose your license when that other person intubated and broke the teeth & did not have a license to do so.. One starts having a much different idea and feeling.. Believe it or not, my attitude was a lot different several years ago.. then I started becoming more familiar and educated more in depth of EMS and more in emergency medicine.. not just EMT. Again, not that they do not have a place or should be disrespected..rather that their roles and education do not meet the expectations of today's requirements of emergency care.

Again, welcome home.. and thanks..

p.s. I have a fellow Paramedic that had been instructing some of your division ?, I believe at Camp Gruber...

R/r 911
 
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wolfie23b said:
Ridryder911,
I apologize for the fact that I shot in here talking about the "Paragods", it is only that I am educated, and a competent basic, and pride myself in my quality of work that my Paramedic partner enjoys, why, because I can either interpret her every move or I already have what she needs ready for her. I worked a shift the other day without my normal partner and he treated me like I was "Just a Basic" and that I wouldn't know an ET tube from a OPA. He literally told me that because he is the Paramedic that I am below him and don't belong in the back of an ambulance. I am a 68 Whiskey in the Oklahoma Army National Guard, ad recieved a Combat Medic Badge for actions that saved 3 of my comrades lives in Baghdad. I think I deserve a little more respect then that.
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Well as a Whiskey you once were a Paragod yourself. the difference is that in the Military you wouldn't ever catch one of your fellow colleague talking down to you...if they did your unit would have something to say about it.
 
ridryder, When was your paramedic friend there. I wasn't pre-mobilized in Gruber but I know some that were.
 
This discussion shows a weakness in EMS at all levels:

Itching to be able to do one more trick, technic, thingee.
On one hand, you can always bring up a limitless array of "what-if's" to try to support getting another thingee.

On the other hand, considering frequency of need, time to next higher level of care, how it will interfere with that next level, and time element of pt need, how much stuff do we hanker to do because it makes us feel better?

Try this measure : since you MUST know intubating (or other procedures/thingees) with real people is almost always much harder than the dummies, what can you bring to the table if your thingee goes to sh#t on you? Will you even recognize it? Some experienced para's will do better than third year medical students with no experience, and some para's, due to "target fixation", will fail to spot a botched attempt a bystander would see.

Know what your role in the big scheme is, and if you want to play with the neat thingees, get yourself to class and get some experience too, but do not cite class hours as certainty of proficiency. Be nice, we're all brethern and sisteren... ;).
 
PS Wolfie: Hooah!

Mycrofft, former USAF 57150, 90270, then O-4 Nurse.
 
I am going to Paramedic SCHOOL at Oklahoma State. I will have a Assoc. of Applied Science. NOT A " Trade School". Happy?
 
wolfie23b said:
I am going to Paramedic SCHOOL at Oklahoma State. I will have a Assoc. of Applied Science. NOT A " Trade School". Happy?
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So you will be graduating this fall or had graduated this spring? .. Since they usually do not have summer end sessions. Russ & Mike are personal friends of mine. In fact, statements of increasing the need of professional standards and education was heavily discussed by the three of us at the last State EMS Educators meeting held at the OSU/Safety Campus.

Although, I cannot speak for them, I do believe I know the instructors well enough to say that would had never taught or endorse anyone to perform procedures before getting a license to do so. As well, I am glad you are correcting your postings per spelling and some grammar. Would you not agree, it kinda defeats the purpose of describing that one is educated if the posts are filled with misspelled words and very poor grammar? Again, just one representation of a way to demonstrate being educated, the other is to recognize your current limitations.

By doing so, this is NOT being derogatory. Even though you have been in EMS for a while, you have just now reached a new level. So in reality, it is like starting over. Yes, you have some road experience, but no you do not have the Paramedic experience. Again, totally two different things. Something most lower levels do not and cannot understand. Many Paramedics realize this in the later part of their first year of being a Paramedic. After you and only you were responsible for that patient with conscious V-tach, or that difficult intubation and realizing others assisted and helped you; but it was you that was solely responsible for the procedures, the outcome and treatment of the patient. That anything good or screwed up was going to be solely on your shoulders. It is a humbling feeling, something that can only be recognized after being there.

After you have been a Paramedic on a truly critical patient without any other ALS support members, I would then like to see your opinions to see if it remains the same. If you work at EMSA, you will probably never get to experience it to the full degree but will understand the jest of it.

I wish you luck, and success in your career...

R/r 911
 
i have signed up for a class in a few months titled defibrillation/combi tube , which would allow me to analyze rhythems and intubate, the class is 14 hours , and the only way they will allow you to practice your skills is if you are on an ALS rig for the county anyways, so i dont see it being any major problem since you have a trained and experienced medic literally 3 ft away shoul anything go wrong
 
alex71 said:
i have signed up for a class in a few months titled defibrillation/combi tube , which would allow me to analyze rhythems and intubate, the class is 14 hours , and the only way they will allow you to practice your skills is if you are on an ALS rig for the county anyways, so i dont see it being any major problem since you have a trained and experienced medic literally 3 ft away shoul anything go wrong
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Slow down there Alex... As far as I knew (and I did a lot of research, as I was once considering moving to California) the defib/combitube only touches on the AED, and obviously combitube. You're right in saying you'll be able to intubate, but it will only be with a combitube and not an ET tube. That takes much more education and skills than are provided in the defib/combitube class.

Maybe you're talking about a more advanced class, but this is just what I heard...

I just didn't want you to get excited over a fairly simple class :p

Jeremy
 
im pretty sure you right haha, for some reason i thought this thread was about both . either way im still excited ill be able to provide more care than a opa or npa . my major concern is always not being able to provide some life saving intervention because i dont know how, so education is always number one on my list and always the most exciting and rewarding for me
 
It was mentioned that OTT isn't a NR standard, but out of curiosity, why were we (in Ohio) tested on NREMT Practical sheets for our intubation checkoff?

Also it was mentioned vocal cord paralaysis is a possibilitity, we learned that its more important to get a patent airway thna worry about vocal cords, if pt is not breathing and you can't get chest rise with BVM, you have to try intubation. Also, if pt is choking with full blockage, you might be able to shove the obstruction into the right mainstem and at least get the left lung some air. Worse case scenario, i know, but better than the alternative.
 
alex71 said:
i have signed up for a class in a few months titled defibrillation/combi tube , which would allow me to analyze rhythems and intubate, the class is 14 hours , and the only way they will allow you to practice your skills is if you are on an ALS rig for the county anyways, so i dont see it being any major problem since you have a trained and experienced medic literally 3 ft away shoul anything go wrong
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combitube in not intubation.
 
I dunno, Wu, but we didn't "sign off" ETT, or Combi at all. We got to "play" with them, after a lecture and demonstration, for familiarization only.
 
Yeah, we had a signoff for combitube and another one for ETT. That one was especially memorable since the there were so many points to get and the hwole sheet was filled with lines of points and critical criteria.

We had familiarization with LMA but no signoff.

Also with the other ALS skills like CPAP and 12 Lead EKG we didn't have NEMT sign offs but we had one for ETT for some reason.
 
WuLabsWuTecH said:
Also it was mentioned vocal cord paralaysis is a possibilitity, we learned that its more important to get a patent airway thna worry about vocal cords, if pt is not breathing and you can't get chest rise with BVM, you have to try intubation. Also, if pt is choking with full blockage, you might be able to shove the obstruction into the right mainstem and at least get the left lung some air. Worse case scenario, i know, but better than the alternative.
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I hope this is not a justification for the minimal hours of training. The indication in OH's protocols for EMT-Bs intubating is pulseless and apneic. Not worrying about what damage is done is never accepted in other professions regardless of the situation. You are trained and educated to the best of your ability to minimize any further complications that may also distract from the situation at hand and eventually decrease any chances of survival for the patient. The excuse "it's an emergency" should not mean you perform sub par. You do not skimp on your technique or skill and do things haphazardly. Of course, this comes easier with adequate training and experience. Accountability and monitoring quality of care is something EMS still has to accept within the profession as a whole.

As far as the choking scenario, if the blockage is above the cords, I would hope a "skilled" provider has the good sense and training to make a good attempt to remove it. If the blockage is already past the cords and lodged in the trachea, then yes, pushing it through may be the only option besides a cric in the field.

My next question would be, are these EMT-Bs that intubate also trained to remove obstructions with the laryngoscope and Magill forceps?

I know that is covered in at least one EMT Enhanced program but not covered in another because the intubation by laryngoscope is very specific in the protocols and forceps are not carried. And then, you have it in the protocols for one service but not another for that same state.
 
VentMedic said:
My next question would be, are these EMT-Bs that intubate also trained to remove obstructions with the laryngoscope and Magill forceps?
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i have seen it in the ER since a Tech who was a Basic had the equipment and supervision to do so. My huge question was "why didn't the supervisor do it himself?" no no, not like it was an emergency.:rolleyes:
 
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