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That's enough of this thread until everyone cools off a bit.
Magil Forceps's
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Okay, this thread is reopened provided everyone can abide by the forum rules.
BossyCow
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Okay, I'll bite.
I don't understand why a thread that is asking about a piece of equipment and what level of skill and training is required to support its use turns into an argument of "Do you think I'm an idiot" answered by "You're all idiots".
I think we are all frustrated when the skill sits on the border between certifications. Paramedics unable to use their ALS skills in a BLS agency response. EMT-B's who see the need for a particular skill or tool in order to provide for our patients, but can't due to SOG's or protocols.
Maybe its because I know for certain that I'm not an idiot. But when a medic says "I don't want a yo-yo using this, I assume he doesn't mean me. But then, part of not being a yo-yo is I don't want to use a tool I haven't been trained in or in-serviced on.
I'm fortunate to have a medical control who is incredibly lenient when it comes to allowing us to use those borderline tools. But, I better call in first, I better have a plan for what I'm going to do if it doesn't work, and I better know what I'm talking about. And you know what? If I don't meet the above criteria, I don't want my MPD allowing me to do something that going to leave me with a drano pt. no ALS support and a 30 minute transport.
The truth is we can't all work in ALS services. God I wish we could, but we don't. There are those times, places and systems that are not going to fund them. This is the flip side of rural living. When you move way out into the toolie-berries, you better do so with the understanding that there will be inconveniences. You will not have immediate access to state of the art medical care. You will not have police and fire at your beck and call. You will have to occasionally live without power (even to your Oxygen, or C-pap)
The road between you and your doctor may be out and the satellite that your cell phone needs to transmit may or may not be functioning when you need it most.
Now, in those places, there are people, often volunteers who will do whatever they can to pitch in and help when things go south. They train, they practice and they will do whatever they can to help mitigate an emergency. They are held to a standard of training and skill by the state. They are often top notch, professional healthcare providers.
They are not as well trained and do not have the skills of paramedics. paramedics don't have the skills of nurses and nurses don't have the skills of physicians and physicians don't all have the skills of surgeons. While there may be an EMT who can do better CPR than a 30 year floor nurse who has never seen a pt code on her shift, that doesn't mean that nurses are stupider or less skilled than EMT's. Nor does the fact that a paramedic has more tools in his arsenal and the training and skills to use them mean that all EMT's are morons.
I think the bottom line here is that we are all trying to do the best we can with the tools we have. We're on the same team and we need to work together. There is enough ego on both sides of every fence to keep the battles and bashing going for eons. But the mature among us know how to keep that under control, or at least preserve that illusion.
I don't understand why a thread that is asking about a piece of equipment and what level of skill and training is required to support its use turns into an argument of "Do you think I'm an idiot" answered by "You're all idiots".
I think we are all frustrated when the skill sits on the border between certifications. Paramedics unable to use their ALS skills in a BLS agency response. EMT-B's who see the need for a particular skill or tool in order to provide for our patients, but can't due to SOG's or protocols.
Maybe its because I know for certain that I'm not an idiot. But when a medic says "I don't want a yo-yo using this, I assume he doesn't mean me. But then, part of not being a yo-yo is I don't want to use a tool I haven't been trained in or in-serviced on.
I'm fortunate to have a medical control who is incredibly lenient when it comes to allowing us to use those borderline tools. But, I better call in first, I better have a plan for what I'm going to do if it doesn't work, and I better know what I'm talking about. And you know what? If I don't meet the above criteria, I don't want my MPD allowing me to do something that going to leave me with a drano pt. no ALS support and a 30 minute transport.
The truth is we can't all work in ALS services. God I wish we could, but we don't. There are those times, places and systems that are not going to fund them. This is the flip side of rural living. When you move way out into the toolie-berries, you better do so with the understanding that there will be inconveniences. You will not have immediate access to state of the art medical care. You will not have police and fire at your beck and call. You will have to occasionally live without power (even to your Oxygen, or C-pap)
The road between you and your doctor may be out and the satellite that your cell phone needs to transmit may or may not be functioning when you need it most.
Now, in those places, there are people, often volunteers who will do whatever they can to pitch in and help when things go south. They train, they practice and they will do whatever they can to help mitigate an emergency. They are held to a standard of training and skill by the state. They are often top notch, professional healthcare providers.
They are not as well trained and do not have the skills of paramedics. paramedics don't have the skills of nurses and nurses don't have the skills of physicians and physicians don't all have the skills of surgeons. While there may be an EMT who can do better CPR than a 30 year floor nurse who has never seen a pt code on her shift, that doesn't mean that nurses are stupider or less skilled than EMT's. Nor does the fact that a paramedic has more tools in his arsenal and the training and skills to use them mean that all EMT's are morons.
I think the bottom line here is that we are all trying to do the best we can with the tools we have. We're on the same team and we need to work together. There is enough ego on both sides of every fence to keep the battles and bashing going for eons. But the mature among us know how to keep that under control, or at least preserve that illusion.
Ridryder911
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First, I do not personally think all basics are morons myself, I have seen moron at all levels including physician level.
I believe what most people are loosing sight on is the whole picture. Anyone, can perform procedures if guided or talked through, and even if allowed a simple in service could be taught sufficient... even an appendectomy and hernia repair is simplistic...again what most basic level does not understand is the "whole picture".
It is hard to understand the whole picture, when you have not been taught it. One of the reasons such procedures as using the "Magill" forceps is what happens if that fails? Remember, there are steps and the next step after the use of Magills is surgical airway.
As well, as one that had to recently use Magills, I can attest visual landmarks, and having an extreme knowledge in anatomy is crucial. I had a pediatric choking (8 weeks) (the father shoved a baby wipe into the trachea). Upon arrival, there was a large aount of blood, as well as laryngeal edema. Again after BLS, procedures we immediately visualized, and please remember the glottic opening of a pediatric is approximately the size of a dime. Try visualizing and placing pediatric laryngoscope blade and magills into that area. The chords appeared to be torn or was it .... a foreign body? Remember we did not know what exactly had occurred at the time. I attempted to pull on the portion of the chord that appeared to be strange... (remember, pulling a chord out, totally removes the ability of that person to ever speak again!)
Now, please place yourself into that responsibility.
When I pulled on the "supposed" object it did not move, I even asked a new Paramedic to visualize and her self was confused, exactly if it was the chord or an object. I declined to "yank" on it due to again that it could be the vocal chords. I was able to ventilate with some chest rise, although the child heart rate was declining rapidly, and CPR was performed when it went below 60. We rapidly transported to the ER, fortunately it was < 1 minute away.
Upon arrival, the ER physician agreed it was difficult to differentiate. With the CPR a smaller portion of the wipe had dislodged a little enough for him to grasp it with the Magills. I can attest as he did, it was a tough pull and finally removed the object, while doing so the child went into cardiac arrest. We were fortunate enough, that resuscitation was successful.
This was approximately 10 months ago, and about 3 months ago, I had testify against the father.
I can assure you it was h*ll, against the defense attorney, even though the father admitted he forced the wipe into the child's mouth. Acquisitions was made that we forced the wipe down using the Magill forceps, and exactly what education and training did I receive to use such specialize equipment. I was even quizzed on the anatomy. Even though, I hold instructor levels in the Neonatal Resuscitation, PALS, PEPP, etc.. Why, didn't I just transport while doing BLS? Could I be 100% certain, I did not force the object further, or cause more damage?
I can assure you something, I would never want to go through again.
I wished I could say the outcome was good. Even after the ER physician testimony, and the blunt admission of guilt, the jury only awarded him a few months in jail, and worse, the time he had spent was allowed to be entered.
So, I feel my emotional response is valid. From one that has been cross examined and questioned using magill forceps, even though I have used them several times successfully, and have had been extensively trained and educated in using them still was placed on the hot seat. I can just imagine what would occur from those that did not have such education, training, experience as myself.
Here is a link to the story.. http://news-star.com/stories/051707/new_47824.shtml
R/r 911
I believe what most people are loosing sight on is the whole picture. Anyone, can perform procedures if guided or talked through, and even if allowed a simple in service could be taught sufficient... even an appendectomy and hernia repair is simplistic...again what most basic level does not understand is the "whole picture".
It is hard to understand the whole picture, when you have not been taught it. One of the reasons such procedures as using the "Magill" forceps is what happens if that fails? Remember, there are steps and the next step after the use of Magills is surgical airway.
As well, as one that had to recently use Magills, I can attest visual landmarks, and having an extreme knowledge in anatomy is crucial. I had a pediatric choking (8 weeks) (the father shoved a baby wipe into the trachea). Upon arrival, there was a large aount of blood, as well as laryngeal edema. Again after BLS, procedures we immediately visualized, and please remember the glottic opening of a pediatric is approximately the size of a dime. Try visualizing and placing pediatric laryngoscope blade and magills into that area. The chords appeared to be torn or was it .... a foreign body? Remember we did not know what exactly had occurred at the time. I attempted to pull on the portion of the chord that appeared to be strange... (remember, pulling a chord out, totally removes the ability of that person to ever speak again!)
Now, please place yourself into that responsibility.
When I pulled on the "supposed" object it did not move, I even asked a new Paramedic to visualize and her self was confused, exactly if it was the chord or an object. I declined to "yank" on it due to again that it could be the vocal chords. I was able to ventilate with some chest rise, although the child heart rate was declining rapidly, and CPR was performed when it went below 60. We rapidly transported to the ER, fortunately it was < 1 minute away.
Upon arrival, the ER physician agreed it was difficult to differentiate. With the CPR a smaller portion of the wipe had dislodged a little enough for him to grasp it with the Magills. I can attest as he did, it was a tough pull and finally removed the object, while doing so the child went into cardiac arrest. We were fortunate enough, that resuscitation was successful.
This was approximately 10 months ago, and about 3 months ago, I had testify against the father.
I can assure you it was h*ll, against the defense attorney, even though the father admitted he forced the wipe into the child's mouth. Acquisitions was made that we forced the wipe down using the Magill forceps, and exactly what education and training did I receive to use such specialize equipment. I was even quizzed on the anatomy. Even though, I hold instructor levels in the Neonatal Resuscitation, PALS, PEPP, etc.. Why, didn't I just transport while doing BLS? Could I be 100% certain, I did not force the object further, or cause more damage?
I can assure you something, I would never want to go through again.
I wished I could say the outcome was good. Even after the ER physician testimony, and the blunt admission of guilt, the jury only awarded him a few months in jail, and worse, the time he had spent was allowed to be entered.
So, I feel my emotional response is valid. From one that has been cross examined and questioned using magill forceps, even though I have used them several times successfully, and have had been extensively trained and educated in using them still was placed on the hot seat. I can just imagine what would occur from those that did not have such education, training, experience as myself.
Here is a link to the story.. http://news-star.com/stories/051707/new_47824.shtml
R/r 911
Airwaygoddess
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Rid, all I have to say that that was one hell of a call from start to the end. You and the others that were there give that baby a fighting chance, I thank the heavens that she won. -_-
Thank you for sharing that story.
Now if you will pause for a moment and think/look back to the original post, your story and my post were not fully relevant.
What i was posting about is when we look into an airway, i always would verbalize "peek" when looking for a foreign object in the airway of a child. The protocol is to "Not Sweep" "Look" and "remove what we see".
What a splendid procedure, Now with "my fingers", I might just as well be doing a blind sweep, as i wouldn't see past my fingers in most instances., and that is why we do not do blind sweeps, we could just make matters worse.
Now maybe i should use a fish hook remover, Because there is such a strong consensus that a Magill is married to a laryngoscope .
Rid in your story you related that you went searching deep in the airway, as you didn't see an obstruction prior to pulling out the scope. There is a difference. I never intended that.
Now if you will pause for a moment and think/look back to the original post, your story and my post were not fully relevant.
What i was posting about is when we look into an airway, i always would verbalize "peek" when looking for a foreign object in the airway of a child. The protocol is to "Not Sweep" "Look" and "remove what we see".
What a splendid procedure, Now with "my fingers", I might just as well be doing a blind sweep, as i wouldn't see past my fingers in most instances., and that is why we do not do blind sweeps, we could just make matters worse.
Now maybe i should use a fish hook remover, Because there is such a strong consensus that a Magill is married to a laryngoscope .
Rid in your story you related that you went searching deep in the airway, as you didn't see an obstruction prior to pulling out the scope. There is a difference. I never intended that.
***bangs head on wall***
A fish hook wouldn't be recommended.............
Why not just do what your level of certification and training allows you to do and leave it at that? Despite RELEVANT depictions of how and why things WILL go wrong, you still insist that everyone else is incorrect in your search for self justification. This thread is going no where and is falling on deaf non believing ears. Lets just move on..............................
A fish hook wouldn't be recommended.............
Why not just do what your level of certification and training allows you to do and leave it at that? Despite RELEVANT depictions of how and why things WILL go wrong, you still insist that everyone else is incorrect in your search for self justification. This thread is going no where and is falling on deaf non believing ears. Lets just move on..............................
Even in a little kid...a newborn...if you don't need a laryngoscope to see the obstruction, then it's most likely going to be plenty high up enough in the airway that you can get to it with your fingers. Think about how the human body is put together and it starts to make sense, doesn't it?
If you need a laryngoscope...then you are almost gaurenteed to need magil's...which means that as a basic with no knowledge of the human anatomy, you are out of luck.
If you need a laryngoscope...then you are almost gaurenteed to need magil's...which means that as a basic with no knowledge of the human anatomy, you are out of luck.
What part of my training am I not following? "If i can see it, Remove it"
Please, where did you loose the "remover" part of my post?
Maybe you should refrain from getting your head so close to that wall?
Now I am not a beliver in evolution, from ape to man, but isin't using tools to preform simple task kind of where .....................................
Grady_emt
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I like to take some 4x4s and ball them up, pinch them in the Magill's and preform a self administered nostril cleaning.
BossyCow
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I'm big on analogies, and the one that comes to mind here is a kid, used to driving on Dad's lap down the driveway assuming he can drive a car. There are times he can drive, there are times when it works just fine, but that doesn't mean you buy him his own set of keys.
Just because there may be an instance where the forceps could be used instead of fingers to pull something out of an airway without negative consequence to the pt. doesn't negate the risk of causing a problem to a pt with the same tool. The risk outweighs the gain.
Bottom line, if you want to be trusted with an ALS tool, get an ALS certification.
Just because there may be an instance where the forceps could be used instead of fingers to pull something out of an airway without negative consequence to the pt. doesn't negate the risk of causing a problem to a pt with the same tool. The risk outweighs the gain.
Bottom line, if you want to be trusted with an ALS tool, get an ALS certification.
KEVD18
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and rtight there is the central theme of every thread regarding als tools at the bls level.
i've been told that many times myself and i got mighty tired of it. so you know
what i did? well, check my "current level" under my name....
Ridryder911
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Great analogy Bossy!
This is part of the problem with some lower level medical providers. Not all by any means; but it tends to be greater on those with lower training, because the lack of understanding of the risks, potential dangers, and litigation of using and playing with medical equipment that has to be authorized by a licensed physician.
Unfortunately, EMS suppliers are just too happy to sell oxygen cylinders, medications, IV supplies to about anyone. If not suppliers, medics carry such things off duty. Amazing, most EMT's and medics carry much more medical equipment than I have ever seen a licensed physician (that actual has authority to use it ) carry. Compare their little black bag to a jump kit of off duty EMT.
The difference between ignorance and stupidity is not being aware or unintentional action versus repeat offense or have been educated and refuse to change. All medical equipment has a label that reads... Federal Law prohibits the distribution and use of this device without proper prescription or orders of a licensed physician"..... With this said, cervical collars, IV's, etc..legally can only be carried by a physician order or one is technically is violating a Federal Law, with consequences of fine or prison. Oxygen is a medication in a gas form... period and unless you have a prescription to carry it or administer it, you are providing medication and practicing medicine without a license. The only way Rescue and EMS is able to do such is through licensing agencies, and qualified personal under protocols, while either representing the agency or on duty.
Remember, litigation can be based upon "standard of care". This means, what you were taught, certified or licensed in, as well as compared to those with the same license or certification would had done under protocols or direct medical control. Deviating away from such, is risky business, and one better be able to justify one's action well enough to do so without further harm to the patient. Even then, one can still be prosecuted for acting upon themselves and endangering the patient. i.e. defibrillating a patient in v-fib without license or certification, intubating a apneic patient without a cert to do so.. IV or any medication or tools, that one has not been taught or certified in. Just because there are surgical tools in the ER; does not allow me to use them... even though, I might do so sucessfully. I must know my limitations....
R/r 911
This is part of the problem with some lower level medical providers. Not all by any means; but it tends to be greater on those with lower training, because the lack of understanding of the risks, potential dangers, and litigation of using and playing with medical equipment that has to be authorized by a licensed physician.
Unfortunately, EMS suppliers are just too happy to sell oxygen cylinders, medications, IV supplies to about anyone. If not suppliers, medics carry such things off duty. Amazing, most EMT's and medics carry much more medical equipment than I have ever seen a licensed physician (that actual has authority to use it ) carry. Compare their little black bag to a jump kit of off duty EMT.
The difference between ignorance and stupidity is not being aware or unintentional action versus repeat offense or have been educated and refuse to change. All medical equipment has a label that reads... Federal Law prohibits the distribution and use of this device without proper prescription or orders of a licensed physician"..... With this said, cervical collars, IV's, etc..legally can only be carried by a physician order or one is technically is violating a Federal Law, with consequences of fine or prison. Oxygen is a medication in a gas form... period and unless you have a prescription to carry it or administer it, you are providing medication and practicing medicine without a license. The only way Rescue and EMS is able to do such is through licensing agencies, and qualified personal under protocols, while either representing the agency or on duty.
Remember, litigation can be based upon "standard of care". This means, what you were taught, certified or licensed in, as well as compared to those with the same license or certification would had done under protocols or direct medical control. Deviating away from such, is risky business, and one better be able to justify one's action well enough to do so without further harm to the patient. Even then, one can still be prosecuted for acting upon themselves and endangering the patient. i.e. defibrillating a patient in v-fib without license or certification, intubating a apneic patient without a cert to do so.. IV or any medication or tools, that one has not been taught or certified in. Just because there are surgical tools in the ER; does not allow me to use them... even though, I might do so sucessfully. I must know my limitations....
R/r 911
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