Scope Expanded to Combitube

[AMF]

To the Paramedics who browse the BLS forum,
EMTs in my area (Dallas) recently became able to use combitubes and ET Intubation (and maybe King's?). Do you recommend learning these (I'm a student) or will paramedics mostly take care of this? Also, do people in your profession have some sort of problem with EMTs performing advanced airway interventions? Do you think it's something requires the basic-science background/high clinical exposure you must have?

 

[usalsfyre]

To the Paramedics who browse the BLS forum,
EMTs in my area (Dallas) recently became able to use combitubes and ET Intubation (and maybe King's?). Do you recommend learning these (I'm a student) or will paramedics mostly take care of this? Also, do people in your profession have some sort of problem with EMTs performing advanced airway interventions? Do you think it's something requires the basic-science background/high clinical exposure you must have?

opcorn:

Considering there's probably close to 100 ambulance services in the Metroplex, I highly doubt it's the whole area, unless theres a move afoot in the Texas EMS culture I don't know about.

To answer you original question, supraglotic airways are fine (think super OPA) but considering how poor paramedics are at ET intubation, no, I don't think basics need to be anywhere near the business end of a laryngoscope.

I really think though, based on the MASSIVE number of threads covering this...:nosoupfortroll:

 

[AMF]

opcorn:

Considering there's probably close to 100 ambulance services in the Metroplex, I highly doubt it's the whole area, unless theres a move afoot in the Texas EMS culture I don't know about.

To answer you original question, supraglotic airways are fine (think super OPA) but considering how poor paramedics are at ET intubation, no, I don't think basics need to be anywhere near the business end of a laryngoscope.

I really think though, based on the MASSIVE number of threads covering this...:nosoupfortroll:

I was not aware that his was a trolling topic. And no, this is just Parkland IFT as far as I am aware.

 

[Veneficus]

In a handful of places, I know basics can place supraglotic airways in arrest patients.

When I got my original EMT cert, the EOA was the standard arrest airway for EMT-Bs to use in an arrest.

Given the ease of use for combitubes, how bad could it really be to let somebody insert one in a dead person?

If you are working in IFT I suspect many of those patients are DNR or DNI, so they won't be used much anyway.

 

[Firemanfred55]

Combitubes are a great tool, don’t be in a rush to get sued.

 

[TransportJockey]

I've been using combitubes as a basic since I was certified (in Jan 08 in NM). I know my service ot here in W. Tx our EMT-Bs are allowed to use MLAs.

 

[Veneficus]

Combitubes are a great tool, don’t be in a rush to get sued.

get sued by who and for what?

 

[STXmedic]

We don't have combitubes, but all the basics in our system are authorized to place Kings (which are currently on my **** list, along with some of the providers placing them)

 

[usafmedic45]

Do you recommend learning these (I'm a student) or will paramedics mostly take care of this? Also, do people in your profession have some sort of problem with EMTs performing advanced airway interventions? Do you think it's something requires the basic-science background/high clinical exposure you must have?

Non-visualized airways (Combitube and King) aren't rocket science. Any professional EMS provider should have it as an option (I was taught the Combitube as a first responder).

As for ETI....honestly I have reservations with letting paramedics intubate, let alone EMT-Bs.

You show me an EMS provider of any level with "the basic-science background/high clinical exposure you must have" and I'll show you someone who either came into the field with a lot of prior education or has gone beyond their EMS training.

 

[usalsfyre]

We don't have combitubes, but all the basics in our system are authorized to place Kings (which are currently on my **** list, along with some of the providers placing them)

Care to elaborate? I'd rather a half-@ssed provider place a supraglotic device than muck up an intubation.

 

[usafmedic45]

(which are currently on my **** list, along with some of the providers placing them)

Yeah, please elaborate.

I'd rather a half-@ssed provider place a supraglotic device than muck up an intubation.

....or trying to maintain an airway with an OPA or NPA and a BVM.

 

[usalsfyre]

To clarify my earlier post, I think basics placing Kings, Combis and LMAs is fine. It kind of read like I thought they should be limited to OPAs, but what I meant are these devices are kinda like OPAs on steroids.

Now ET intubation...a good percentage of my paramedic coworkers don't need to be doing ETTs, I'll leave it at that.

 

[Firemanfred55]

get sued by who and for what?

WOW! Joke made on the fact that the more you know and attempt the higher the liability.

 

[Shishkabob]

I was not aware that his was a trolling topic. And no, this is just Parkland IFT as far as I am aware.

By "Parkland IFT", do you mean Parkland hospital? They don't have their own IFT, and AMR holds the contract with Parkland.... and unless something changed recently, AMR wouldn't allow EMTs to do ETT, especially since the Medics don't get enough attempts at it themselves.


I'm fine with EMTs doing supraglottic airways... and while it's technically legal for EMTs to do ETT if their med control allows... I know of no place that allows it in the Metroplex.

 

[Martyn]

We are taught OPA & NPA along with the combitube here I'm Florida

 

[Handsome Robb]

I learned the Combitube as a B in Colorado. Then KING and ETT as an I in Nevada. But Washoe county doesn't allow I's to intubate, since the medics don't get enough tubes just like everyone else said.

 

[fast65]

Basics in Oregon are taught to use supraglottic airways, however, ETT is reserved for paramedics.

I am a bit unsure though, did the OP say that basics were actually being given the privilege to intubate?

 

[AMF]

Yeah, it's actually part of the NREMT-B curriculum, I believe.

 

[usafmedic45]

Yeah, it's actually part of the NREMT-B curriculum, I believe.

For all intents and purposes once you get past testing, the "national standards" and "curriculum" mean next to nothing.

 

[fast65]

Yeah, it's actually part of the NREMT-B curriculum, I believe.

I think you're confusing ET intubation with the placement of supraglottic airways (i.e. Combitube or King)