I'm originally from WA state where we RSI patients when needed. I am a Paramedic student currently out of state and am understanding how much different this concept/skill is not utilized in other EMS systems. I'm wondering if anyone has any advice for me about this when I go into my field rotations. I have the opportunity to ride at some places where they RSI but are not as busy as a big city that doesn't. Wondering what some seasoned Medics think about being a student and the importance of learning this skill in the field as a student is? And how you might deal with a pt who would benefit from RSI but it may not fall under the protocols of your service? And if there are any good places to look into as far as field time besides places in WA that practice this skill that take students?
Rsi
- Thread starter Natren
- Start date
- 5,018
- 1,356
- 113
Go with the busier system for your clinical time*. There is much more to being a paramedic than RSI. If you run across a patient in the field that needs RSI, and you can't give it to them (not in your protocols), then call med control if you have the appropriate meds available, or drive fast.
*Assuming the busier system is still decent and just doesn't have RSI
*Assuming the busier system is still decent and just doesn't have RSI
i agree RSI is a nifty trick but not an integral part of being a paramedic that you should base your internship decision on. Patient assessments of course are the key in becoming a good paramedic and therefore the system that will provide you with more patient contacts will be the most beneficial to participate in.
lightsandsirens5
Forum Deputy Chief
- 3,970
- 19
- 38
Exactly. For example Memorial Herman Life Flight is one of the most high speed flight services in the country, and as far as I know, they don't RSI.
Aidey
Community Leader Emeritus
- 4,800
- 11
- 38
Nifty trick...:blink::blink::blink:
While I don't know for sure, I would be DUMBSTRUCK if this were actually the case.
Very simply, it's a dangerous, possibly over utilized and usually under prepared for skill set that your "average" paramedic has no business performing.
abckidsmom
Dances with Patients
- 3,380
- 5
- 36
Quoted for truth.
I know a medic who "ghetto RSIs" with versed and fentanyl and a Benadryl chaser. He apparently does this quite frequently, and off protocol.
It's dangerous, and if we got RSI he would be even more dangerous. I would like to see more people actually knowing when the airway is ok to be managed bls rather than jumping the gun and tubing everyone.
med51fl
Forum Lieutenant
- 114
- 0
- 0
This is very true. Just because you can do something doesn't mean you should.
It's all about the ego. I've seen some peers sit in the bay of the trauma center trying to RSI, with the trauma surgeon staring at them through the window, tapping his foot.
lightsandsirens5
Forum Deputy Chief
- 3,970
- 19
- 38
One of my best friends is a flight medic with them. Now....I know they have been talking about getting it, so they may have by now. That info is about a year old.
Or were you talking about being dumbstruck if Memorial was actually high speed?
Shishkabob
Forum Chief
- 8,264
- 32
- 48
I did 2 RSIs in a rural system in 10 months. I've assisted on one in a busy urban system in the same time. While I think RSI should be available everywhere, it's more likely to be needed in a rural system due to the length of transport. (Having said that, if I need to RSI someone in a hospital ambulance bay, I will). On top of that, hate to break it to ya, but with RSIs being so rare, complicated and dangerous, I'm not letting my student do it.
As I said, I believe it should be available in every system, rural, urban or suburban, as when it's needed, trust me, it's needed. It's beneficial to a multitude of patients in a multitude of situations, and infact is beneficial/needed more than a few of the medications we carry.
Instead of not allowing the skill to be done, just don't allow those you don't trust to do it not practice as medics in your system.
As I said, I believe it should be available in every system, rural, urban or suburban, as when it's needed, trust me, it's needed. It's beneficial to a multitude of patients in a multitude of situations, and infact is beneficial/needed more than a few of the medications we carry.
Instead of not allowing the skill to be done, just don't allow those you don't trust to do it not practice as medics in your system.
NomadicMedic
I know a guy who knows a guy.
- 12,190
- 6,953
- 113
That's a shame. I performed several RSIs in the field as a paramedic student, under the watchful eye of my preceptor. And what do you know; I was a paramedic student in Washington.
Of course, the skills you practice will be directly proportionate to your preceptor’s comfort level. I will say I was glad I had the opportunity to practice with a preceptor before I did my first one in the field alone. We have RSI at my current service and due to our long transport times and frequent helo fly outs, we RSI quite frequently and we’re very good at it. Having said that, ONE bad RSI can spoil the entire program. We practice, practice, practice. We are expected to make frequent visits to the OR for Pedi and Adult tubes. And we follow very tightly defined protocols and run through exhaustive QI on every RSI. Subsequently, we continue to have an awesome success rate and every RSI has been deemed appropriate by medical directors and the QI division.
Should every service be allowed RSI? No. Should well trained paramedics who use the skill often have it? Absolutely.
- 680
- 10
- 18
I have worked in systems with RSI, and I have worked in systems without it.
I didn't really miss it when I didn't have it, and I had a high degree of respect and humility when I did have it.
Most patients can be managed quite effectively with PAI and don't require a paralytic. I have mixed feelings on the issue, but all in all, this has been my experience.
I think the real goal should be to build the skills that keep you from getting to the point of needing RSI, and you will be better off.
As far as people saying they do this as a field intern, I have some reservations about that... Most medic students can barely bumble through a good field interview with a patient, much less walk the tightrope that is RSI... I don't fault them for this, they are students and they are learning, but you also must crawl before you walk... doing RSI in field internship is not crawling before you walk.
I didn't really miss it when I didn't have it, and I had a high degree of respect and humility when I did have it.
Most patients can be managed quite effectively with PAI and don't require a paralytic. I have mixed feelings on the issue, but all in all, this has been my experience.
I think the real goal should be to build the skills that keep you from getting to the point of needing RSI, and you will be better off.
As far as people saying they do this as a field intern, I have some reservations about that... Most medic students can barely bumble through a good field interview with a patient, much less walk the tightrope that is RSI... I don't fault them for this, they are students and they are learning, but you also must crawl before you walk... doing RSI in field internship is not crawling before you walk.
NomadicMedic
I know a guy who knows a guy.
- 12,190
- 6,953
- 113
Agreed on all points.
As for students not performing RSI, when is it ok? After they pass national registry?
Every student is different, and while not every student should be allowed to perform advanced procedures, in much of Washington, RSI was a regular paramedic skill, the same as any non drug assisted intubation or any other skill that new medics learn. To become proficient, you have to practice. I know that RSI is a dangerous procedure, and I know that I am nervous every time I push the drugs... But I have had opportunity to practice. Much more so than many of the other medics that frequent this forum. That's not bragging, it's just a simple fact. If you infrequently intubate, then a drug assisted intubation will be even more of a high pressure situation. If you have opportunity to intubate frequently, if you practice and have a clearly defined protocol for intubation and a back up plan B and C and maybe even D for failed intubations, then a drug assisted intubation is just another tube.
To be fair, there were some students in my class that were not given the opportunity to practice advanced skills. But the high performers in my program, of which I was one, were encouraged to learn and gain experience and practice skills in the field that I'd guess many medics have never seen.
As for crawling before you walk, you know as well as I do that some students are far more skilled than others. It should be at the preceptors discretion as to what skills those students should be able to practice when in their field internship. Just because a student is cleared to put a laryngoscope into someone's mouth doesn't mean they should be intubating. Conversely, an exceptional student who has skills that are potentially far more developed than other students should not be held back from opportunities to practice in the field simply because he is a "paramedic intern".
- 680
- 10
- 18
Fair enough. The USA is a big place...what's right for Washington may not be right in my neck of the woods.
As far as when paramedic students or newly certified paramedics should practice, this is just my opinion, it should be after they have become certified and ridden as first assist for at least 6 months...incrementally getting more experience during that time period.
Granted, I know this isn't always possible, but unfortunately we live in a country where some systems are just fine putting a newly certified paramedic on critical care transfer calls simply to make a dollar.
I have digressed a bit, and I am definitely not trying to imply that anyone posting here is working in a system like that...but it is that type of system where a mistake is just waiting to happen.
A lot of the backlash that medics have been getting for years regarding intubation and advanced procedures, or the taking away of those privileges, has come from poorly managed systems that had RSI in place without responsible oversight of that skill.
I always found it frustrating to hear the ego trip that some people get on touting how they have RSId "x number of people in the last x months" or whatever. Again, I am not accusing anyone here of doing this, just simply stating.
I guess I always like to get on a little soap box during discussions like this because, as nearly 100% of the people posting on this forum have recognized, RSI is a skill that almost every paramedic thinks they can handle, yet very few can actually hack it...they have simply been getting lucky thus far...
Any paramedic worth their grit knows it is only a matter of time before the call that is going to bite you in the rear comes out over the radio. The good paramedic accepts this fact and begins to learn his enemy so that he can defend himself and protect his patient should the need arise...the novice paramedic rests on his laurels and fools himself into thinking that enemy would never dare confront him because he is just such a dang hotshot...woefully ignorant of his previous good fortune.
One of those paramedics is right, and the other is wrong...
As far as when paramedic students or newly certified paramedics should practice, this is just my opinion, it should be after they have become certified and ridden as first assist for at least 6 months...incrementally getting more experience during that time period.
Granted, I know this isn't always possible, but unfortunately we live in a country where some systems are just fine putting a newly certified paramedic on critical care transfer calls simply to make a dollar.
I have digressed a bit, and I am definitely not trying to imply that anyone posting here is working in a system like that...but it is that type of system where a mistake is just waiting to happen.
A lot of the backlash that medics have been getting for years regarding intubation and advanced procedures, or the taking away of those privileges, has come from poorly managed systems that had RSI in place without responsible oversight of that skill.
I always found it frustrating to hear the ego trip that some people get on touting how they have RSId "x number of people in the last x months" or whatever. Again, I am not accusing anyone here of doing this, just simply stating.
I guess I always like to get on a little soap box during discussions like this because, as nearly 100% of the people posting on this forum have recognized, RSI is a skill that almost every paramedic thinks they can handle, yet very few can actually hack it...they have simply been getting lucky thus far...
Any paramedic worth their grit knows it is only a matter of time before the call that is going to bite you in the rear comes out over the radio. The good paramedic accepts this fact and begins to learn his enemy so that he can defend himself and protect his patient should the need arise...the novice paramedic rests on his laurels and fools himself into thinking that enemy would never dare confront him because he is just such a dang hotshot...woefully ignorant of his previous good fortune.
One of those paramedics is right, and the other is wrong...
Thank you all for your in put! I was an EMT in a high call volume service in which you were expected to be assistant to the paramedic and I had a lot of confidence MOST of the medics who RSIed in WA. All the students that came to work for us were taught it as a skill in school and we def had "red button" protocol that you were never to RSI as a single medic unless a supervisor was present or at least enroute. I can honestly say I have seen very few unsuccessful RSI intubations where I'm from. I feel as though it is highly respected there and not taken lightly at all.
All that being said, I do agree that I would rather learn as a student than be put in a situation as a paramedic where I there might be an expectation of me when I don't have the skill set not learned as a student. Being busy tho however I know should be my priority. Such is my dilemma currently! I know there is A LOT more to being a paramedic than just focusing on that skill, but its a difficult thing for me to understand coming from a system after 4 years that does this skill.
I feel like they have skimmed over it in school because they don't believe in it too much in the state I'm in currently. Which frustrates me a little because I feel like we should be educated thoroughly about HOW dangerous it is, but how we do need to be good at intubating and be prepared for the worse since many students in my program have NO prior EMS experience.
So new question....let's say you have a pt who does have a swelling airway (burn/anaphylaxsis, etc) what do you do when you can't RSI this pt? I have seen both as an EMT and I just don't know that any other option would have been available left over except surgical airway had we not been able to RSI this pt...being 20 min or so from the hospital.
I know I'm a student, I'm def very familiar with the dangers of this skill. But I want to know if I don't have it, what do I do?
All that being said, I do agree that I would rather learn as a student than be put in a situation as a paramedic where I there might be an expectation of me when I don't have the skill set not learned as a student. Being busy tho however I know should be my priority. Such is my dilemma currently! I know there is A LOT more to being a paramedic than just focusing on that skill, but its a difficult thing for me to understand coming from a system after 4 years that does this skill.
I feel like they have skimmed over it in school because they don't believe in it too much in the state I'm in currently. Which frustrates me a little because I feel like we should be educated thoroughly about HOW dangerous it is, but how we do need to be good at intubating and be prepared for the worse since many students in my program have NO prior EMS experience.
So new question....let's say you have a pt who does have a swelling airway (burn/anaphylaxsis, etc) what do you do when you can't RSI this pt? I have seen both as an EMT and I just don't know that any other option would have been available left over except surgical airway had we not been able to RSI this pt...being 20 min or so from the hospital.
I know I'm a student, I'm def very familiar with the dangers of this skill. But I want to know if I don't have it, what do I do?
NomadicMedic
I know a guy who knows a guy.
- 12,190
- 6,953
- 113
Negative. I'm on the east coast.