Is an ET Tube Really ALS?

[Ridryder911]

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.

Sorry, WuLabsWuTecH not to just to be singling you out but there is SO MUCH WRONG with statements and ideologies as such. This is becoming a dangerous approach on teaching and learn in airway techniques. As well, why intubation soon maybe a thing of the past for prehospital providers.

There is far more to be taught and learned in than in a simplistic manner. Not worrying about damaging vocal cords? .. See ya' in court buddy! Yes, I will testify against any EMT or Paramedic that describes such!

We have to get a handle on this! Whom and what is able to provide medical care, especially advanced airway area. Folks, we are talking about potentially n-e-v-e-r ever talking again, and possibly walking around with a stoma for the rest of their lives, all because someone was not taught or learned properly!.. YES it is that serious!

If you do not know the importance and the dangers as well as having the education and knowledge to treat if there is a mishap.. One should NOT be doing the procedure!

R/r 911

 

[WuLabsWuTecH]

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.

We are trained in how to remove obstructions, be we are taught if we can't get it, then the next option is to push it down.

Sorry, WuLabsWuTecH not to just to be singling you out but there is SO MUCH WRONG with statements and ideologies as such. This is becoming a dangerous approach on teaching and learn in airway techniques. As well, why intubation soon maybe a thing of the past for prehospital providers.

There is far more to be taught and learned in than in a simplistic manner. Not worrying about damaging vocal cords? .. See ya' in court buddy! Yes, I will testify against any EMT or Paramedic that describes such!

We have to get a handle on this! Whom and what is able to provide medical care, especially advanced airway area. Folks, we are talking about potentially n-e-v-e-r ever talking again, and possibly walking around with a stoma for the rest of their lives, all because someone was not taught or learned properly!.. YES it is that serious!

If you do not know the importance and the dangers as well as having the education and knowledge to treat if there is a mishap.. One should NOT be doing the procedure!

R/r 911

What I'm saying is not that I won't take every precaution to prevent this, but that the risk of this happening is something that we have to accept in that situation. When I say worry, i don't mean disregard, and I apologize if it came out that way, but that I won't lose sleep over taking that risk.

 

[shannon williams]

Are you allowed any other airway techniques? Like the Combi-Tube? Our EMT-Bs are allowed to do that.

 

[mikeylikesit]

Are you allowed any other airway techniques? Like the Combi-Tube? Our EMT-Bs are allowed to do that.

Most places allow an EMT acces to the King and Combi airways but rarely ever teach teh skills in class.

 

[Jon]

Most places allow an EMT acces to the King and Combi airways but rarely ever teach teh skills in class.

Most?

Some do. Some don't.

All the states in my area DON'T have advanced airways for BLS providers... NJ, PA, DE.

 

[mikie]

Most places allow an EMT acces to the King and Combi airways but rarely ever teach teh skills in class.

We were taught the BASICS on the CombiTube and the EOA. We were expected to know how to use it for the NR practical test (random selection) and that's about it! And from what it seems, they are becoming more plebeian amongst the basic curriculum. I don't know about "most places" but surely are becoming popular.

 

[piranah]

I am a medic STUDENT and I say basics should not intubate...so many things ca n go wrong that a basic does not have the skills or the knowledge to deal with...such as laryngospasm,ICP,anxiety(due to no premed for intubating because basics can't give the sedation meds), or how bout identifying certain situations not to intubate,how bout perforation.......let's say a pt has copd and you intubate...good luck weaning them off of it...if you can't control an airway as a basic you Do NOT deserve to be in that truck or touching any pt .....,sorry for any mispelled words I'm on an iPhone

 

[Granola EMT]

It is definitely great for Basics to have the "know how" to assist ALS providers, but I'll leave the should they/should they nots alone...
There are other means of airway control, and I almost always use an OPA, even before an ETT. I would consider it an ALS skill though, but I have been taught BLS before ALS, so that's just me...

 

[Ridryder911]

How about just medicine?.. seriously, can we ever remove such stigma that we in EMS only have?...

 

[emtc9019]

ett ? als

i have been a emt for 14 years the last 6 as a als provider i got my ett certifaction 1 year after i got my basic licence and i used it quite a bit as is helped the als provider to be doing his als tx. i guess it depends on how agresseve you ems system is, i am from rhode island

 

[Nickjm908]

Yes I'm with ya on that one.

Yeah during my basic class and refresher we've had time to practice Combi-tubes and ET tubes and i'll agree with you that tubing lil annie isnt too hard but i'm a firm believer that combi-tubes should be avail. to basics at least... can hardly go wrong. and it will def. save lives!

 

[JPINFV]

i have been a emt for 14 years the last 6 as a als provider i got my ett certifaction 1 year after i got my basic licence and i used it quite a bit as is helped the als provider to be doing his als tx. i guess it depends on how agresseve you ems system is, i am from rhode island

Can someone translate this into English because I'm having a hard time telling if he's the paramedic provider or an EMT-B?

 

[VentMedic]

He might be one of them EMT-Cs from Rhode Island. Or, an EMT-B with an intubation "cert".

Quote from RI's web:

EMT-Cardiac ("EMT-C"): All EMT-B skills plus: IV therapy, adult and pediatric oral intubation, cardiac monitoring and interpretation, defibrillation, transcutaenous pacing, administration of IV medications, and modern concepts of trauma care.

• The EMT-C is a certification between the EMT-I and EMT-P, allowing the use of more cardiac drugs than the EMT-I, but fewer than the EMT-P.

You can now refer to my recent post on the EMT-I thread.

 

[marineman]

I don't know if it was mentioned yet but I don't think anyone should be doing ett's unless you carry and are allowed to push meds. If you don't get it right the first time and cause a laryngeal spasm you're kind of up a creek without a paddle.

I see talk about basics and combitubes which I already thought was a NR skill but definitely all basics should be carrying combi's. Our FR/EMR's are carry combitubes.

And lastly I guess I don't understand the big deal about advanced airways. Yes you can technically put meds through an ett but studies are showing that they don't really work as well as we hoped. Our policy is use the most basic airway that you can get adequate ventilations. The biggest benefit I see is the advanced airways do fairly decent job of preventing aspiration.

 

[KEVD18]

every time this topic comes back to the top, i die a little inside.....

 

[reaper]

And lastly I guess I don't understand the big deal about advanced airways. Yes you can technically put meds through an ett but studies are showing that they don't really work as well as we hoped. Our policy is use the most basic airway that you can get adequate ventilations. The biggest benefit I see is the advanced airways do fairly decent job of preventing aspiration.

Uhhhhh!!:unsure:

 

[snaketooth10k]

Yeah during my basic class and refresher we've had time to practice Combi-tubes and ET tubes and i'll agree with you that tubing lil annie isnt too hard but i'm a firm believer that combi-tubes should be avail. to basics at least... can hardly go wrong. and it will def. save lives!

WHAT?!

hardly go wrong? I think what you say is based on ignorance. You can DEFINITELY mess up with a combi-tube. Most basics that I've met cannot discern between their own breath sounds and their patient's in the back of a bouncing rig.A Combi-Tube uses two lumens because it has a possibility of tracheal intubation. According to http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijeicm/vol5n2/combi.xml, the likelihood of esophageal intubation is "up to 98%". But what if you manage to do a blind ET? If you seat the device improperly you could kill a patient. My friend with ALS has told me that he would take an ET tube over a Combi-Tube any day, and I believe him.

 

[basicemtccm26]

I agree with Reaper. I also work in Upstate SC, and yes the EMT_B training is miniscule at best. I think that it should be that advanced emts should be allowed to insert a ET tube and Basics only LMA's Or Combitubes. The only thing to that is you have basics that think they are Critical Care Paramedics and will buck the system as much as they can. We were their at one time or another (basic level EMT) but the more experience the better, so in conclusion please only let NREMT-P do a ETT placement, the numbers state the facts

 

[emt_angel25]

there are different means of obtaining an airway as a Basic EMT. i think teaching basics intubation is just crazy. i have no desire to learn how to intubate my pts as an EMT its a personal thing but i wouldnt want to do it. where i come from the EMT program is one semester long and that is NOT enough time to teach such a skill to students.

 

[marineman]

Uhhhhh!!:unsure:

eh wording was kind of off. Not saying there's no use for an ETT but they have a tendency to be overused. I've seen medics get on scene where a FR has already placed a combi that was working fine and the first thing they did was remove the combi to place an ETT. For us as long as we have some sort of airway that is facilitating the transport of O2 we will let it be until after we start a line, hook up the ECG, etc depending on the call. We do place ETT's but it's not a priority thing when we arrive on scene when other lifesaving interventions are indicated.