The Great Airway Debate...

[VentMonkey]

I posted this in another thread, but again, Eric's book is an excellent resource for paramedics at any level wanting to learn more about prehospital ventilator management.

He breaks it down in paramedic lingo so it's fairly easy to follow. I just got the second edition, and have perused through it. It has some updates from the first, but the first is also still a good starting point.

http://www.barnesandnoble.com/mobil...oks_00000000&2sid=Google_&sourceId=PLGoP62465

 

[SeeNoMore]

I'd be curious to read this. I do advocate that all providers uss textbooks made for resp therapists and MDs/ critical care rns and are also are given quality education , clicnial time and testing. I think paramedics in particular should show that we are not second class providers through aggressive educational standards for ourselves.

 

[GMCmedic]

I hate to see it happen but I think i am in favor of taking RSI away. Just watched one hell of a crap show from one of our medics while I was on the fire side.

 

[Old Tracker]

I heard a rumor yesterday that Texas is considering doing away with RSI. Time will tell.

 

[TransportJockey]

I heard a rumor yesterday that Texas is considering doing away with RSI. Time will tell.

Unless there's major state law changes the whole state cant just get rid of it as a while.

 

[TransportJockey]

I am all in favour of making it a credentialed skill. Not every medic needs to be able to rsi. At my service only in charge certified paramedics and above can do it

 

[DrParasite]

I am all in favour of making it a credentialed skill. Not every medic needs to be able to rsi. At my service only in charge certified paramedics and above can do it

I'd hate to have my family member call 911 for a serious medical condition, and have the ambulance show up with a crew that wasn't able to RSI, and have my family member need to RSI.

In fact, if that happened, i would tell my lawyer that since RSI is the standard of care, the agency was negligent in not sending a fully capable ambulance crew. probably have a decent shot of winning.

 

[TransportJockey]

I'd hate to have my family member call 911 for a serious medical condition, and have the ambulance show up with a crew that wasn't able to RSI, and have my family member need to RSI.

In fact, if that happened, i would tell my lawyer that since RSI is the standard of care, the agency was negligent in not sending a fully capable ambulance crew. probably have a decent shot of winning.

There are entire states where RSI is not a ground paramedic skill.

 

[DesertMedic66]

I'd hate to have my family member call 911 for a serious medical condition, and have the ambulance show up with a crew that wasn't able to RSI, and have my family member need to RSI.

In fact, if that happened, i would tell my lawyer that since RSI is the standard of care, the agency was negligent in not sending a fully capable ambulance crew. probably have a decent shot of winning.

On the other hand how would you feel if you had a crew respond who butchered the RSI?

Unless that agency has RSI in its protocols for all paramedics to use it will be really hard to get away with a claim of “standard of care”. If they elect that they want to give only certain paramedics the RSI skill then it would be safe to say that no RSI is the standard.

 

[Carlos Danger]

I'd hate to have my family member call 911 for a serious medical condition, and have the ambulance show up with a crew that wasn't able to RSI, and have my family member need to RSI.

In fact, if that happened, i would tell my lawyer that since RSI is the standard of care, the agency was negligent in not sending a fully capable ambulance crew. probably have a decent shot of winning.

RSI is not the standard of care in EMS, and you would have no case at all on that basis.

 

[DrParasite]

RSI is not the standard of care in EMS, and you would have no case at all on that basis.

says you.... I know several agencies that do it..... that makes it the standard of care..... or at least I am pretty sure I can get a lawyer to make that case....

 

[DrParasite]

says you.... I know several agencies that do it..... that makes it the standard of care..... or at least I am pretty sure I can get a lawyer to make that case....

By the way, what is or is not the standard of care in anyone's opinion is irrelevant.... all that would become relevant is if an attorney could convince 12 people who weren't smart enough to get out of jury duty that it is the standard of care.... and I know enough shady lawyers who could pull that off.

 

[DesertMedic66]

says you.... I know several agencies that do it..... that makes it the standard of care..... or at least I am pretty sure I can get a lawyer to make that case....

It makes it the standard for that agency but not EMS as a whole. If the agency that responds does not have RSI or decides to limit it to only a select number of paramedics then it is not the standard..

 

[DrParasite]

sure, one agency doesn't meet the standard.... does 2? does 3? How do you define standard? if half the ALS agencies do RSI, does that make it the standard? Maybe that half meets the standard, and the other half is below standard?

Anytime you are cherry picking skills or treatment that am ambulance can perform (ambulance A can do it, but B can't, and it's pure luck if you get ambulance A or B), you are literally playing chance with patient's lives. if RSI would have no impact on the patient's outcome, and it wouldn't matter, than I could see your point.

But if I get ambulance B, and the patient dies, but if I had received ambulance A, who could have saved my loved one, well, I'm pretty sure I would have a pretty good negligence case. After all, I only need to prove these four elements, from http://injury.findlaw.com/accident-injury-law/proving-fault-what-is-negligence.html:

1. Duty - The defendant owed a legal duty to the plaintiff under the circumstances;
2. Breach - The defendant breached that legal duty by acting or failing to act in a certain way;
3. Causation - It was the defendant's actions (or inaction) that actually caused the plaintiff's injury; and
4. Damages - The plaintiff was harmed or injured as a result of the defendant's actions.

 

[DesertMedic66]

sure, one agency doesn't meet the standard.... does 2? does 3? How do you define standard? if half the ALS agencies do RSI, does that make it the standard? Maybe that half meets the standard, and the other half is below standard?

Anytime you are cherry picking skills or treatment that am ambulance can perform (ambulance A can do it, but B can't, and it's pure luck if you get ambulance A or B), you are literally playing chance with patient's lives. if RSI would have no impact on the patient's outcome, and it wouldn't matter, than I could see your point.

But if I get ambulance B, and the patient dies, but if I had received ambulance A, who could have saved my loved one, well, I'm pretty sure I would have a pretty good negligence case. After all, I only need to prove these four elements, from http://injury.findlaw.com/accident-injury-law/proving-fault-what-is-negligence.html:

1. Duty - The defendant owed a legal duty to the plaintiff under the circumstances;
2. Breach - The defendant breached that legal duty by acting or failing to act in a certain way;
3. Causation - It was the defendant's actions (or inaction) that actually caused the plaintiff's injury; and
4. Damages - The plaintiff was harmed or injured as a result of the defendant's actions.

Show me where it states that RSI is that standard of care.

If the medic is not able to RSI because they are not trained or not allowed by their system there is no duty to preform that skill and no breach of that duty.

 

[DrParasite]

show me where it states RSI is NOT the standard of care. And for the record, just because an agency doesn't do it isn't support that is isn't the standard of care, but rather support that that particular agency isn't meeting the standard of care.

As for your second statement, you're right, the individual has not..... the system/agency has. That is why standards exist, and if different ambulances (within the same system) can do different services, well, I would hate to get one of the ambulances that can't do a needed procedure out of dumb luck.

 

[DesertMedic66]

show me where it states RSI is NOT the standard of care. And for the record, just because an agency doesn't do it isn't support that is isn't the standard of care, but rather support that that particular agency isn't meeting the standard of care.

As for your second statement, you're right, the individual has not..... the system/agency has. That is why standards exist, and if different ambulances (within the same system) can do different services, well, I would hate to get one of the ambulances that can't do a needed procedure out of dumb luck.

Show me where open heart surgery is NOT the standard of care in EMS? You can’t just say show me where it’s not.

 

[Bullets]

@DrParasite id say your NJ is showing. I dont know of an agency here that isnt RSIing

 

[DrParasite]

Show me where open heart surgery is NOT the standard of care in EMS? You can’t just say show me where it’s not.

That's a strawman argument, and not a really good one, because I bet you can't show me any EMS system that is performing open heart surgery, so you have very little support to say that is in the standard of care.

I can show you an entire state that has every ALS capable unit is able to RSI (Thank you @Bullets )

You are missing the important part: if your entire agency says "we aren't doing RSI", than that is their decision. One could even argue that their "standard of care" is to not RSI.

But when you have different ambulance crews having different capabilities, within the same system, where some can RSI and some can't, and it's plain old dumb luck if you get an RSI capable ambulance or not, than your agency has made the standard of care RSI.

The individual medic isn't negligent; the agency is, because they failed to send an RSI capable ambulance to a patient that needed to be RSIed, and had they sent the appropriate ambulance with a crew meeting the agency's standard of care, no damages would have occurred.

Let me try to make this even clearer:

1. Duty - The defendant owed a legal duty to the plaintiff under the circumstances; As the EMS agency of the area, I, the plaintiff, called 911 requesting a fully qualified medical professional to treat my loved one who was suffering a life threatening emergency.
2. Breach - The defendant breached that legal duty by acting or failing to act in a certain way; EMS agency failed to send a RSI capable ambulance. They chose to send one that was not capable of RSI.
3. Causation - It was the defendant's actions (or inaction) that actually caused the plaintiff's injury; As a result of sending an ambulance that was unable to RSI, my sick family member was unable to receive the proper medical treatment. Had they sent a fully trained ambulance crew, one that was capable of RSI, they would have received the appropriate care
4. Damages - The plaintiff was harmed or injured as a result of the defendant's actions. and as a result, my family member is no longer with us or suffered harm.

That is why it's always better to have one standard, across the board. Either everyone at your agency can do it, or nobody; that's why it's the standard of care.

 

[MackTheKnife]

Show me where open heart surgery is NOT the standard of care in EMS? You can’t just say show me where it’s not.

Can't prove a negative!