Keeping Intubation Skills Sharp

[tpchristifulli]

As we all know intubation is slowly catching a back seat in recent studies and treatment. While studies show that intubation should be used carefully, the majority of us do not intubate on a daily basis. As with all skills that are not regularly used, practice is needed. I am working on setting up OR time for our paramedics at my service to set a required amount of tubes a year. The problem I have is that once you are out of school you are not on the schools insurance policy for medical clinicals. I know many services do clinical time for tubes to stay fresh. How do you work the legalities of it?

 

[wanderingmedic]

1) We can't give legal advice here. Talk to a lawyer.

2) You will have to talk with your company's insurance company to see if you are covered. Usually students are under the license of their school and preceptor.

 

[chaz90]

We routinely return to the OR for intubations, both as new hires and as needed/yearly. I know we have a partnership with that specific hospital, but I don't know the specifics of liability or malpractice coverage. I would imagine it's the same insurance that covers our daily practice, particularly as all patients we intubate in the OR sign an additional consent form authorizing our participation under the supervision of the anesthesia provider(s).

 

[drjekyl75]

While not the same as practicing on a live patient, we have medical control physicians that come in once a year to our company. The doc's go over proper technique for intubation and different scenarios for which type of intubation should be used. We then have to nasal and oral intubate the mannequin under the physicians supervision to see if we use good technique or if someone needs remediation. It's not a perfect system, but it gets around some of the issues of trying to schedule OR time.

 

[medicsb]

This isn't a question of legalities, it's a matter of liability and who pays for it and whether or not an anesthesia practice wants to take on the additional liability. Insurance only covers you, the physician or CRNA is already covered. However, if you screw up, they will undoubtedly be named, and the physician, for sure, will bear the brunt of the suit. The only way you're getting into the OR is out of kindness from the anesthesia practice group. They have nothing to gain by paramedics being there, but they do potentially have something to lose.

 

[Christopher]

We do OR time, our service's insurance covers us. Likely you'd need proof of insurance plus a MOU detailing who pays for what and when.

 

[Carlos Danger]

I know many services do clinical time for tubes to stay fresh. How do you work the legalities of it?

There isn't much involved in the way of "legalities", really. You need to first get the anesthesia department and the OR to be willing to do it, and then the hospital credentialing or risk-management people will let you know what you need to have in the way of insurance, HIPAA and other training, etc.

It's tough to work out because, as medicsb said, there just isn't anything in it for the anesthesia department or the OR aside from hassle and increased liability. Damaged teeth are surprisingly expensive, and even minor complications like a sore throat or a pinched lip are very poorly tolerated by healthy people who were in for an elective surgery. There's a lot of production pressure in the OR too, which certainly isn't helped by "guest intubators". And, even if every anesthesia provider and all the OR personnel are 100% in support of it, it's often the administrators who quash it.

All you can do is just keep looking around and trying to establish relationships with area hospitals and anesthesia staff. Be willing to look at hospitals a little ways away.