YIKES! Gut Tubed in Rhode Island x 12

SandpitMedic

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@DrParasite its correct that NC has AEMTs that can intubate.
They do not require that they can intubate as a skill, only that they allow for certain medical direction to allow for it at certain agencies. You would know better than I how often it is to see an AEMT intubating as you live there and I don’t.

For paramedics it is a required skill.
It is also a requirement to utilize continuous ETCO2 monitoring.

You are correct about NC, thank you for the education. Some ILS systems allow for intubation- I still say it is not the national standard, and the standard educational curriculum of AEMTs (screen shotted above) would suggest that as well.

We must not digress too much- these EMT Cardiacs are not AEMTs, so our side debate is really of little value to the conversation. Also- I was actually retracting/editing my initial opening statement towards you because I realized it was inflammatory, and I wanted to avoid an interweb dual. But you saw it just too soon.
 
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DrParasite

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Some ILS systems allow for intubation- I still say it is not the national standard, and the standard educational curriculum of AEMTs (screen shotted above) would suggest that as well.
you'd be surprised (or likely not) how many EMS systems don't follow the so called "national standard." I think I read on here that Colorado EMTs could intubate, if they have a little extra training and got an endorsement from their medical director (but I could be wrong, I'm not sure)? and last I heard, texas EMTs can do whatever they want, provided their medical director says they can (again, based on what I read on emt life). And I'm sure there are other states that still have AEMTs or EMT-I's, but it's not as uncommon as you might think.
We must not digress too much- these EMT Cardiacs are not AEMTs, so our side debate is really of little value to the conversation.
So if the EMT Cardiacs aren't AEMTS, what are they? After checking out https://www.rapidsafety.com/rhode-island-cardiac-ric, which was the first site the showed up on a web search, this is how they describe the program:
Rhode Island Cardiac: RIC
Rhode Island Cardiac: RIC (Pre-requisite: AEMT)
This is the entry level Advanced Life Support (ALS) course that is unique to the state of Rhode Island. It incorporates additional training in emergency cardiac pharmacology, electrophysiology and trauma management. The curriculum, although based on the national AEMT model, is uniquely incorporated by the State of Rhode Island. The minimum course hours for classroom are approximately 160 hours. National EMS Institute has adopted a 220 hour curriculum before pre-hospital patient contact requirements. The candidate will have to master ECG monitoring and treatment, patient assessment advanced skills and many other areas of study. National EMS Institute delivers the Rhode Island Cardiac course as a stand-alone course for those seeking licensure in Rhode Island and as a combination of AEMT/Cardiac.
I have no first hand knowledge about this, and can only go off what I find on the Net.

it's bad that this happened, that it wasn't checked, and it looks like there is some education that was lacking or QA that failed in these 12 situations. And a massive systemic failure if this was an accepted practice.
 

silver

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That’s one of the most obvious and public displays of the Dunning-Kruger effect that I’ve ever seen.
Yes!! When ego, the desire to feel heroic, and the glorification of intubating completely blinds multiple groups of people.
As Ronnie Coleman said "Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-*** weights." Everyone wants to tube but not put in the education and training to become an expert on airway management.


Do you really only have to be successful on 8 manikins to be approved by the state? https://www.ri.gov/SOS/businessassistant/tasks/business_tasks/4ee2548cbd2a52341e000d1f/get/EMTOrotrachealEndotrachealIntubation.pdf
 
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KingCountyMedic

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This Doc in the article found this over a 2-3 year period. How long has this really been going on, and how many patients have really died I wonder?!? I know I come from the land of "You cough in front of me I'm tubing you" but at least we are pretty good at it. I've missed a tube every now and again over the years but even in the old days before ETCO2 we had proper training and a stethoscope, the ESO Bulb syringe detector and the color change ETCO2 thing. We would never be guilty of transporting a gut tube. It just doesn't happen when you have people that are Physician Trained and practice/know what they're doing. The claims of these morons that "they are the experts" or that they think these patients were accidently extubated and the tube went into the gut after transferring the patient to the hospital bed is just absolutely ridiculous. I have seen tubes pulled accidentally over the years but for 12 cuffed tubes to be pulled and then accidentally reinserted into the esophagus...........Like I said: note to self, never go to RI, EVER.

They should pull charts from at least the last 10 years and investigate this further. People should probably lose their jobs and elected officials should probably get fired as well. Possibly even charges filed. If it was a family member of mine I'd get a bad *** Lawyer immediately.
 

SandpitMedic

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Yup, everyone seems to be on the same page- except those in RI.

Funny how their online description says nothing about intubation in their skill set, yet they intubate (poorly). It says they follow/base it on the national AEMT curriculum with additional cardiac related training, so what gives???

I have never been a real big fan of lawyers, but I too hope there are going to be some subpoenas going out for years of records.
 

SandpitMedic

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Summit

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This Doc in the article found this over a 2-3 year period. How long has this really been going on, and how many patients have really died I wonder?!?
...
They should pull charts from at least the last 10 years and investigate this further. People should probably lose their jobs and elected officials should probably get fired as well. Possibly even charges filed.
Filing charges is a ****ty way to go. Firing people over malpractice from 10 years ago isn't going to engender reporting. The ENTIRE system is broken. Reporting and education need to be coupled with responsibility and consequences.

RI clearly has a ****ed up system perpetuated by stupid people invested in, and made by, that ****ed up system.

Sure, I agree they should do a retrospective quality review... but why? Why bother?

RI just had plenty of evidence for change and the reaction was to circle the wagon and kick anyone supporting change out of the decision process.
 

SandpitMedic

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RI just had plenty of evidence for change and the reaction was to circle the wagon and kick anyone supporting change out of the decision process.
To me, you answered your own question. If they won’t change on their own- bring in the lawyers and legal system. It is clear that Rogue Island EMS and FD are not going to police themselves.

It will be interesting to see if this story just goes away like so many do, or if additional investigations or overhaul will be pursued.
 

E tank

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To me, you answered your own question. If they won’t change on their own- bring in the lawyers and legal system. It is clear that Rogue Island EMS and FD are not going to police themselves.

It will be interesting to see if this story just goes away like so many do, or if additional investigations or overhaul will be pursued.
Legal system? Like lawyers? How about some doctors sacking up and doing something? WTF do lawyers have to do with this?
 
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KingCountyMedic

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I'm by no means a fan of lawyers... BUT

If you have a system so screwed up and supposedly it has been for years if not decades, and the folks running it have zero desire for change or improvement, what then? It sounds as if Physicians are almost run out of town if they speak up on behalf of patient care. 11 "gut tubes" with fatal outcomes in less than 3 years. If I had the attorney card I'd be looking for cases from the last 10 years or more and be looking into class action stuff.
 

SandpitMedic

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Legal system? Like lawyers? How about some doctors sacking up and doing something? WTF do lawyers have to do with this?
I believe the doctors tried, but they can’t get past the fire unions. Like we’ve pointed out- they have doubled down on how they do business and their “capabilities.”

Let’s start getting some negligence investigations going. Let’s get some legal injunctions and investigations; let’s see if it’s more than just the few noted in the news. Let’s get some folks on the record. Let’s start punishing these hacks for allowing this to happen.

You can get a lawyer to chase an ambulance for a fender bender or a slip and fall... I’d say the lawyers can have a lot TF to do with it at this point. Med control failed, QA failed, EMS failed, and the FD has the balls to say they are smarter than everyone else and everything is fine.

Survivable codes negated by malpractice. Burn it down.
 

Lo2w

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I think I read on here that Colorado EMTs could intubate, if they have a little extra training and got an endorsement from their medical director (but I could be wrong, I'm not sure)?
Not sure about the mountains but out of the protocols I looked at while job hunting on the front range I don't recall seeing anything about ETs for EMTS. IIRC I seem to remember supraglotic is the primary airway. At least for my vollie protocols and the service I'm hoping to get hired on.

Colorado does allow IVs for EMTs with an additional class and some of the more rural services allow a broader range of medications at the EMT scope with the med director waiver.
 

Summit

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No intubation by EMT or AEMT in CO. We do have IVs for EMTs with a state compliant class (48+hr course with clinical). Because of this we have almost no AEMT courses or demand for them.

CO still has some leftover EMT-I/99 that kept up their state certs. They can intubate in some systems.

From what I can Google, RI EMT Cardiac is a 150 hour course over EMT
 

Lo2w

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No intubation by EMT or AEMT in CO. We do have IVs for EMTs with a state compliant class (48+hr course with clinical). Because of this we have almost no AEMT courses or demand for them.

CO still has some leftover EMT-I that were Nremt I99s and kept up their state certs. They can intubate in some systems.
PCC is doing an AEMT this coming semester in Pueblo but that's all I could find.
 

Ensihoitaja

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Red Rocks has an AEMT program, as well. They market it more as a “paramedic prep” course, though.
 
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DrParasite

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No intubation by EMT or AEMT in CO. We do have IVs for EMTs with a state compliant class (48+hr course with clinical). Because of this we have almost no AEMT courses or demand for them.
I stand corrected. I knew they could do something that started with I with a class; it was IV only, not Intubation.
From what I can Google, RI EMT Cardiac is a 150 hour course over EMT
Considering the NC EMT class is 200+ hours, I'm pretty shocked that RI has a kinda AEMT course that is only 150 hours. And after reviewing the state protocols for RI (found at http://health.ri.gov/publications/protocols/StatewideEmergencyMedicalServices.pdf) it looks like they use the AEMT and EMT-C pretty interchangeably.

That's, ummmm, well, I'm glad I don't live in RI... that's pretty scary. even the NYS EMT-CC was about 300-400 hours on top of the initial EMT training.
 

Bullets

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This Doc in the article found this over a 2-3 year period. How long has this really been going on, and how many patients have really died I wonder?!?
And he wasnt even looking for it, he was looking for data about scene times in cardiac arrests and HAPPENED upon these 11 cases. Imagine if he was looking

@DrParasite i think Maine or NH has AEMTs. When i went to NH for my NRP psychomotor there were a bunch of AEMTs testing out too and they were from that region.
 

SandpitMedic

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