He even posts here once in a while. He seems to have a detector for whenever we talk about him.
It's called "Google Alerts," an indispensable tool for narcissistic EMS speakers and writers.
The title "Ambulance Driver" is satirical, yes.
As for the bevel-down technique, there's a learning curve to using it, but I've found it to work well for me after I got the trick. Using shielded catheters that way does require some serious finagling, though.
At the least, it's a useful trick to pull out of the bag on those rare occasions.
Use a steeper angle when inserting, just to pierce the skin, and pull greater skin traction. If you *****foot around with it, yes, it will probably hurt more and tear the skin. If you make a decisive stick, however, it works pretty well. The trick is learning how to be decisive and delicate at the same time.
I didn't come up with the technique. It was taught to me by a grizzled old peds nurse in a PALS class years ago, and used to be a commonly taught trick.
I would object to the notion that needles are expressly designed to be inserted bevel-up, however. They may work well that way, but that's not necessarily a function of design.
A lot of things we do have their roots in tradition, and have no legitimate application any more. For instance, we were all taught never to withdraw the needle from the cath and then re-advance it, right?
The stated reason for not doing that was the danger of catheter shear and resulting embolus. Y'all try that some time: TRY to shear off a piece of catheter that way. It may bugger up the cath, and cause a little more trauma when you D/C the IV, but it is damned near IMPOSSIBLE to shear off a piece of the catheter.
To do it, you have to poke the stylet through the side of the catheter, hold it against the cutting bevel of the needle, and then rotate it 360 degrees to shear off anything. And supposedly, we're supposed to be at risk of doing this ACCIDENTALLY, while INSIDE a vein? Not gonna happen.
That caveat was a holdover from the days of THROUGH-the-needle catheters, and do not apply to modern over-the-needle catheters. Yet it still gets taught as gospel every day.
Why? Because your instructors were taught that way, that's why. As were their instructors, and their instructors... and no one ever bothered to question why.
ALWAYS question, especially when the rationale doesn't make sense, whether it comes from your medical director, your EMT instructor, me or some other dude with a laptop and Powerpoint presentation.
That's how we discard the dogma in our profession.
