Non-vent trach transports

Sam Adams

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To teach an EMT a skill that they may or may not use or use very rarely and with no monitoring for competency, might be a little futile.

As non-confrontational as I can type this: Can I infer from this that you also believe EMT's should not be taught the Heimlich Maneuver? The Jaw Thrust? Tourniquets? Traction Splints? APGAR scores? The Rule Of Nines? ...

Essentially what this whole thing comes down to is a UNIVERSAL lack of legitimate CON-ED and for that matter ED in EMS. It absolutely amazes me. This topic in particular, airway management, should be beaten like a dead horse. Airway opening and positioning, BLS ajuncts (OPA's and NPA's), suctioning with the different catheters.... You can't get to the Breathing part of your patient until the Airway has been managed.

Getting back to the topic at hand, should non-emergent, non-vented trach transports go BLS? Yes. Are we as a profession there yet? Not even close.
 

VentMedic

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As non-confrontational as I can type this: Can I infer from this that you also believe EMT's should not be taught the Heimlich Maneuver? The Jaw Thrust? Tourniquets? Traction Splints? APGAR scores? The Rule Of Nines? ...

The Heimlich Maneuver and Jaw Thrust are part of CPR and must be renewed at least every 2 years. Tourniquets are controversial and not every service has implimented the protocols for them again or yet. Traction splints should still be part of EMT training as should APGAR scores and the Rule of Nines. However, there is just so much a 110 hour course can teach. I would like to see the education/training of the EMT raised to the length of what the U.S. Paramedic is now or more with at the bare minimum of 1 semester of college level A&P as a prerequisite to entry. But then, EMT and Paramedic courses should be taught at a college in the division of health professions if EMS wants to be part of healthcare.

We could also look at the "skills" of the Paramedic. Those who only intubate or start an IV once a year are not going to be as up on their skills if they are not reviewing and practicing on some other source. Thus, we now have some ALS EMS agencies moving away from ETI and using alternative airways.

I am all for teaching the EMT how to suction but if their scope of practice does not allow for it or there is not a system in place to monitor an invasive skill, who is to say they will remain proficient at this "skill"?

Also, just as a little curiousity poll, ask your co-workers to run through the APGAR score and the Rule of Nines just to see how much they remember from EMT school.

As a sidenote, I do teach my trach patients and those on a ventilator to be able to talk someone through their technology and procedures such as clearing their trach if they are able. Unfortunately, if a mucus plug strikes at the wrong time, they may not be able to do this.

EMT(P)s should also be familiar with speaking valves and know the difference between a laryngectomy patient with a tracheostomy stoma as well as those with a tracheotomy.
 
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bstone

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Non-vent trach calls have been a long-standing BLS transport when I worked in Chicago. We regularly would do IFTs on these pts. We used french suction catheters frequently and regularly.
 

firecoins

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The patient should be transported by a person who is best capable of taking care of that trach. If an EMT (or any health care professional) is not properly trained to take care of a trach, they have no business transporting or caring for that patient.
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Makes sense

Non-vent trach calls have been a long-standing BLS transport when I worked in Chicago. We regularly would do IFTs on these pts. We used french suction catheters frequently and regularly.

Same here.
 
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VentMedic

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We used french suction catheters

For a little clarification, French refers to the size of the catheter and not necessarily the type of catheter. Some semi-rigid (Coude, bronchitrac) and rigid catheters are also sized by the French (Fr) measurement as well as urinary catheters, feeding tubes, cardiac catheters and chest tubes.

French = Diameter in mm x 3

# French suction catheter

Since there are many types of suction catheters, you may hear a brand name such as Bard or Ballard used and the type such as inline, closed or red rubber (latex). Some are trying to break the habit of using brand names since it becomes a habit even when that brand is not being used. An example of this is using "Ambu" bag instead of just saying BVM or the specific type of bag and correct brand name.


By using the term "French" with the item, it is similar to using the measurement term "gauge" with needles. Gauge can also apply to many other items as well.

# gauge angiocath

# gauge hypodermic

Diameter = 1/gauge

However, the larger the gauge the smaller the diameter whereas for French as the number increases so does the diameter.
 

VentMedic

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I probably should explain why understanding what "French" is can be important.

As I already mentioned:

French = Diameter in mm x 3

ETTs and trachs are measured by diameter in mm.

7.0 ETT has a diameter of 7.0 mm.

For trachs the sizing can be a little odd but you will find the ID (inner diameter in mm) and OD (outer diameter in mm) written on the trach flange.

Now if we multiply the diameter of the ETT or ID of the trach by 2 we get a French size catheter that is 2/3 the inner diameter (or 2/3 the French conversion size) of the trach or tube. By the text book we would then choose one size smaller as the correct suction catheter or approximately 1/2 the inner diameter.
 
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Incyder38

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VentMedic, thanks for all the info. This is exactly why I started this in the first place. To get people to think about these pt's. I know for a fact that a lot of EMT-B's transport these pt's, and are lucky that something requiring an intervention doesn't happen. although it's in the Orange County BLS protocols, doesn't mean that everyone is prepared to handle these pt's.
 

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