Rsi

Nice. Hoping to head that direction eventually. Know any good systems to start out over there running 911 as a new medic? I looked into NC and Virginia. Just tryin to not go back to my private in WA or get too stuck in the midwest.
 
Natren said:
WTEngel,
Do they RSI there in Fort Worth? Curious what its like down there...I don't know much about the Texas systems but have heard they are good! :)
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MedStar allows a small pool, a few other systems in the area also allow it. It varies throughout the state how common it is.
 
n7lxi said:
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.
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As you said, it's all down to comfort and most preceptors just do not get enough time with a student in actual critical calls to validate a student doing it (in my opinion). Now, if it's just the intubation aspect of the call, and they've already proven to me that they can get the tube in the hole, ok. But at my current agency, we're allowed a single shot at the tube, and I truly do not want to waste my one shot on a critical patient that's paralyzed without their own ventilatory ability to fall on a student that's probably never done a tube, let alone in a situation as the one presented.


My first ever RSI was also my first ever field intubation, and I got it first try. I know I'm awesome and all, but even you normal people can do that! :lol:


Natren said:
Do they RSI there in Fort Worth? Curious what its like down there...I don't know much about the Texas systems but have heard they are good! :)
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Yes, it's done in Ft Worth. Besides the physicians that show up on scene who obviously can do it, also the APPs (Advanced Practice Paramedics) and the more senior/experienced Paramedics all go through a crash airway course and extensive airway control classes before being allowed to do it. The average truck Paramedic doesn't have it, but there's someone within 10 minutes driving that does if you call for them.
 
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It isn't that uncommon to find systems with RSI around North Texas, but it is implemented a bit differently.

Like Linuss said, in Fort Worth, the system is tiered. It isn't uncommon to have physician medical directors or advanced practice paramedics show up to the higher acuity calls where the need for additional hands on deck with more advanced capabilities is likely. The advanced practice paramedic is a designation specific to MedStar in Fort Worth though, and not a level recognized by the state. It is simply a small pool of up-skilled paramedics authorized by the medical director to have a few more tricks up their sleeve.

The nice thing about that type of system is that it is easier to track and assure quality in a smaller pool of providers.

There are also a handful of smaller cities that are under the medical direction of a pretty well known medical director in the area that for the most part all have RSI capability. The nice thing is that these small cities are compartmentalized and generally have a pretty active EMS command to help track and control quality.

Now, as for the city of Dallas, the EMS is run by Dallas Fire Department, and they do not have RSI, should not have RSI, and I hope to God never get RSI. They actually no longer carry ET tubes to my understanding, and run with only king airways...I could be wrong, but that is the last I heard.

All of the systems in between these two extremes have PAI for the most part, which seems to work really well for them. The fact that most are not any more than 10-15 minutes from the hospital ever makes PAI a reasonable alternative.

Additionally, we have a number of critical care services that have RSI capability and beyond...but that accounts for a handful of a handful of medics in the area, and typically they are rolling with a nurse and a RT...

EMS in Texas is pretty diverse. I personally believe we have some of the best EMS systems in the world here in Texas, along with some of the most underperforming systems.
 
WTEngel said:
There are also a handful of smaller cities that are under the medical direction of a pretty well known medical director in the area that for the most part all have RSI capability. The nice thing is that these small cities are compartmentalized and generally have a pretty active EMS command to help track and control quality.
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Having ridden with a couple of those departments and seen them work, I'm still on the fence on if they should have the ability. Dr Yamada is really well respected, but those agencies... ehh.

Now, as for the city of Dallas, the EMS is run by Dallas Fire Department, and they do not have RSI, should not have RSI, and I hope to God never get RSI. They actually no longer carry ET tubes to my understanding, and run with only king airways...I could be wrong, but that is the last I heard.
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Last I heard they also didn't have narcotics for pain control.

But that was also about the time that they were being investigated federally for illegal billing practices and rumors were rampant that they were going to pull out of EMS for AMR to take over. Ha.
 
Thanks for the insight. I'm learning a lot being out of WA. I have a list of possible places I'd like to ride/apply. Fort Worth is on my list as well as some places on the East Coast. But I think I will end up heading to Kansas City for my ride time since it seems to be the least difficult for us to get a contract with at our school and they are really busy from what I hear...
All in all I think I will just have to see how the whole RSI thing will work out. I am nervous not have it since I have seen many pt's benefit from it...but the Fort Worth system sounds like they have a great support system. Some places I know don't have that. I guess its an arguement of what the best pt care really is and there are lots of perspectives. ;)
 
WTEngel said:
Now, as for the city of Dallas, the EMS is run by Dallas Fire Department, and they do not have RSI, should not have RSI, and I hope to God never get RSI.
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Amen and hallelujah

WTEngel said:
They actually no longer carry ET tubes to my understanding, and run with only king airways...I could be wrong, but that is the last I heard. .
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This would explain why the last couple of times I've done a field ETT I've gotten a strange look and "you did a real tube?"
 
The trick to healthcare on every single level is not knowing what to do and being able to do it. The trick here is being able to to do something and knowing when and when NOT to do it. My advise is to take care of your pt whether you have RSI oor not. Managing the airway and intubating are not necessarily the same thing.
 
Not to be critical, but Linuss, you've only been a medic just a little longer than me. Are you precepting students?

Here, only FTOs can have paramedic students, and the FTO process requires a significant amount of education and experience. You're not eligible to even apply until you've been working in the system for 4 years. And here, students are not allowed to participate in the RSI procedure.

RSI in Delaware is at the Medical Director's discretion. There's a "certification process" that involves classes, a written test, a long crash airway skill test on the SimMan and an interview with the medical directors.

Even then, we still require two medics be part of every RSI.
 
n7lxi said:
Not to be critical, but Linuss, you've only been a medic just a little longer than me. Are you precepting students?
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I did at my last agency a few times. Just ask usal how they delegate student, haha.


Didn't you get your medic in '11? I don't know, everyone getting their medics confuses me.


You're not eligible to even apply until you've been working in the system for 4 years. And here, students are not allowed to participate in the RSI procedure.
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To be fair, we've established that I'm just awesome ^_^

I plan to go for my FTO at my new agency in the coming months where they start Paramedic FTOs training EMTs and Intermediates at first, then move on up to medics.
 
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Hahah. Yeah, I'm only 6'1". And I didn't mean any disrespect... I know you're awesome. :)
 
Wait....Linuss you left MedStar?
We don't have RSI in New Mexico, unless online medical control authorizes. My AMR operation also sends the on duty supervisor in a truck to high acuity calls, which is a help.
NM as a state is pretty backwards on airway management, but we do have full ETI .

How's the job market in DFW?
 
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