YIKES! Gut Tubed in Rhode Island x 12

[SandpitMedic]

Looking into the FB page of one of their EMT cardiac folks (wannabe medics) their level of incompetence is nothing compared to their level of arrogance. 12 patients are dead, transported with GUT tubes and they just don’t get it! One guy said “Doctors miss tubes too”
I’m baffled that this goes on in 2019 American EMS.

No one likes to admit they’re wrong. No one wants to make big changes. Even when it’s clear that it is needed. What a sad state of affairs.

 

[akflightmedic]

Posted by a Rhode Island EMS contributor....think this mentality is endemic in the area, leading to less Medics and more EMT-Cardiacs, which then leads to dumbing down of education and missed tubes?

 

[Summit]

Wow the comments in the article... the discussion on that FB page... wow

4% rate or unrecognized esophageal intubations... that is beyond appalling.

 

[Tigger]

Posted by a Rhode Island EMS contributor....think this mentality is endemic in the area, leading to less Medics and more EMT-Cardiacs, which then leads to dumbing down of education and missed tubes?

View attachment 4672

Just by the by, Steve Berry lives and works in Colorado and not Rhode Island. I use to work with him at a part time spot.

 

[VentMonkey]

Just by the by, Steve Berry lives and works in Colorado and not Rhode Island. I use to work with him at a part time spot.

Hmmm, Pridemark? I haven’t heard or seen his name is quite some time. Then again, I don’t read or subscribe to Jems any longer.

 

[Tigger]

Hmmm, Pridemark? I haven’t heard or seen his name is quite some time. Then again, I don’t read or subscribe to Jems any longer.

No he's worked at the same, small rural service for decades.

 

[Summit]

He gave a decent lecture at EMSAC this year

 

[akflightmedic]

Just by the by, Steve Berry lives and works in Colorado and not Rhode Island. I use to work with him at a part time spot.

Aware....my comment was this was posted (shared) by a RI individual. Just saying....drawing relevance to the thought process of the topic at hand.

 

[Tigger]

Aware....my comment was this was posted (shared) by a RI individual. Just saying....drawing relevance to the thought process of the topic at hand.

Gotcha I misunderstood.

That state really disdains paramedics. I believe you can bill ALS with EMT-Cs onboard, which is going to delay the change as well. Why put someone that you have to pay more on the truck when you get reimbursed the same? I'd like to think it's because folks see the value in paramedics, but man, the comments from those sitting in oversight positions make you think that's not the case.

 

[SandpitMedic]

The memes online against Rhode Island EMS are nothing short of spectacular.

 

[Summit]

The memes online against Rhode Island EMS are nothing short of spectacular.

OK I wish to enjoy this... where do I find them?

 

[SandpitMedic]

OK I wish to enjoy this... where do I find them?

There’s a FB page called “Hittin’ it hard from the ambulance barn”....
Hilarious! You will love it, Summit.

PSA: If you’re sensitive—- you know how I feel about your sensitivities so don’t go “reporting” the funnies okay...

 

[Summit]

There’s a FB page called “Hittin’ it hard from the ambulance barn”....
Hilarious! You will love it, Summit.

PSA: If you’re sensitive—- you know how I feel about your sensitivities so don’t go “reporting” the funnies okay...

My wife was wondering what I kept laughing at

Fav:

 

[DrParasite]

To clarify- These are not Paramedics who were doing this. This is giving all of EMS and all Paramedics a bad rap and requires very clear public statements and illustrations. They are EMT-Cardiacs; a unique construct by Rhode Island fire departments.

So I guess New York State's EMT-CC doesn't exist? nor Virginia's Advanced EMTs? or North Carolina's EMT Intermediates?

using the term "EMT-Cardiac" might be unique to Rhode Island, however they are far from the only state that has an EMT level that is sort of ALS, but not a full paramedic.

That all being said, the sheer number of unidentified esophageal intubations is appalling. ETCO2 is the standard to verify that the tube is in the right place; why wasn't this used? I could see mistakes when listening for lung sounds and belly sounds; but ETCO2 is an objective assessment tool... was it never checked?

Just because the providers in question are firefighters or not full paramedics is really irrelevant; the fact that this was never checked showed a serious systemwide failure on the QA side, a failure at the state level mandating ETCO2 for all intubations, and a failure on the provider for not even bothering to check.

 

[E tank]

That all being said, the sheer number of unidentified esophageal intubations is appalling. ETCO2 is the standard to verify that the tube is in the right place; why wasn't this used? I could see mistakes when listening for lung sounds and belly sounds; but ETCO2 is an objective assessment tool... was it never checked?

ETCO2 is an indicator of, not verification for endotracheal intubation. The only practical ways to "verify" placement is direct visualization of the upper esophagus and glottis via DL or a chest XR.

Breath sounds, ETCO2, "gastric auscultation" all fail and are only as good as the individuals being able to contextualize them to the whole picture. No substitute for training and experience and when things get technically difficult, those kinds of chops are not possible to have in a great many settings.

 

[SandpitMedic]

So I guess New York State's EMT-CC doesn't exist? nor Virginia's Advanced EMTs? or North Carolina's EMT Intermediates?

using the term "EMT-Cardiac" might be unique to Rhode Island, however they are far from the only state that has an EMT level that is sort of ALS, but not a full paramedic.

That all being said, the sheer number of unidentified esophageal intubations is appalling. ETCO2 is the standard to verify that the tube is in the right place; why wasn't this used? I could see mistakes when listening for lung sounds and belly sounds; but ETCO2 is an objective assessment tool... was it never checked?

Just because the providers in question are firefighters or not full paramedics is really irrelevant; the fact that this was never checked showed a serious systemwide failure on the QA side, a failure at the state level mandating ETCO2 for all intubations, and a failure on the provider for not even bothering to check.

I’m not getting into another beef with you.
It is what it is.

It matters very much that they were firefighters because it was the fire union who lobbied to perpetuate the process and keep the status quo instead of allowing changes such as ETCO2 and video laryngoscopy. And then they doubled down on the whole thing by not acknowledging their failure.

Secondly, it is very relevant that they are not “full” paramedics when this story will be used as a argument for potentially removing intubation from the scope nationwide. (What is not full” paramedic- you either are one or you are not one- there are no fractional paramedics???)

Also, advanced EMTs, EMT- Cardiacs, and Intermediates et al. are not “Advanced Life Support.” They are Intermediate Life Support. It doesn’t matter that they exist elsewhere; what matters is that no other jurisdictions allow intubation by ILS. ILS folks get supraglottic airway devices- not intubation.

The only thing we agree on is it was appalling. Don’t worry, we aren’t bashing them because they are firemen.

 

[DrParasite]

I’m not getting into another beef with you.
You don’t know what you don’t know and you routinely display that with seething arrogance.

dude, you made ANOTHER ignorant statement and got called on it. stop making BS claims and you won't be called out on it. get it? good.

It matters very much that they were firefighters because it was the fire union who lobbied to perpetuate the process and keep the status quo instead of allowing changes such as ETCO2 and video laryngoscopy. And then they doubled down on the whole thing by not acknowledging their failure.

you mean the EMT-cardiac's can't do ETC02? i would imagine than an EMT cardiac can obtain a 12 lead.... unless your saying the RI lifepak's are special and they removed the ETCO2 feature.....

Secondly, it is very relevant that they are not “full” paramedics when this story will be used as a argument for potentially removing intubation from the scope nationwide. (What is not full” paramedic- you either are one or you are not one- there are no fractional paramedics???)

do you honestly think the state won't be looking at any other studies (esp the ones from SoCal) that show any other instances where fully certified paramedics miss intubations?

Also, advanced EMTs, EMT- Cardiacs, and Intermediates et al. are not “Advanced Life Support.” They are Intermediate Life Support. It doesn’t matter that they exist elsewhere; what matter is that no other jurisdictions allow intubation by ILS. ILS folks get supraglottic airway devices- not intubation.

ok, now I know you have no idea what you are talking about.... plenty of jurisdictions allow ILS folks to intubate. Maybe when you actually do some research you will find out how you really should stop making stuff up to make yourself sound smart. a simple google search would show you how wrong you are

Here, I decided to do some work for you: here is the NC EMS airway protocol: https://www.ncems.org/protocols/AR 1 Adult Airway Protocol Final 2017 Editable.pdf look at who can do intubation..... hint it, it doesn't start at the paramedic level. you're welcome for the education.

 

[SandpitMedic]

dude, you made ANOTHER ignorant statement and got called on it. stop making BS claims and you won't be called out on it. get it? good.
you mean the EMT-cardiac's can't do ETC02? i would imagine than an EMT cardiac can obtain a 12 lead.... unless your saying the RI lifepak's are special and they removed the ETCO2 feature.....
do you honestly think the state won't be looking at any other studies (esp the ones from SoCal) that show any other instances where fully certified paramedics miss intubations?
ok, now I know you have no idea what you are talking about.... plenty of jurisdictions allow ILS folks to intubate. Maybe when you actually do some research you will find out how you really should stop making stuff up to make yourself sound smart. a simple google search would show you how wrong you are

Here, I decided to do some work for you: here is the NC EMS airway protocol: https://www.ncems.org/protocols/AR 1 Adult Airway Protocol Final 2017 Editable.pdf look at who can do intubation..... hint it, it doesn't start at the paramedic level. you're welcome for the education.

Here you go bud. From NREMT.org and EMS.gov

https://www.ems.gov/education/EMSScope.pdf

Advanced Emergency Medical Technicians | National Registry of Emergency Medical Technicians

The primary focus of the Advanced Emergency Medical Technician is to provide basic and limited advanced emergency medical care and transportation for critical and emergent patients who access the emergency medical system.

www.nremt.org

Again- it does not matter that they exist. It is not a national standard of care for any level under that of paramedic to perform endotracheal intubation. Is that clear enough for you?

Yes- They should be doing continuous ETCO2 capnography. CAN they- I guess they can’t or they wouldn’t be having this issue. You ranting about the capabilities of a Lifepak is not germane to the conversation. The point is it is the standard of care.

 

[VentMonkey]

For two highly educated providers, this is getting ridiculous. I’m out.

 

[SandpitMedic]

For two highly educated providers, this is getting ridiculous. I’m out.

We get heated, but I’d have a beer with him.