King LTS-D

[AZCEP]

Do the paramedics in the areas that are considering this procedure getting enough airway management practice to maintain their ability?

If they aren't, and most places don't, adding one more set of providers with an advanced skill that will not be practiced enough is not the answer. Educate the medics that need more practice so the EMT's won't need another add on skill.

[Spock]

Well, I agree with you on the first responder thing. I equate them with EMTs. No real difference to me. That's why BLS and EMT are not synonymous.

I equate BLS with anything that does not require a physicians order, regardless of who is applying it. After all, physicians, nurses, and paramedics apply BLS too.

I'm not saying EMTs cannot apply ALS. I'm saying that if it requires a physicians order, it is ALS, regardless of who is applying it. That is indisputable fact.

I think we are arguing over semantics. For instance: I arrive on scene of a cardiac arrest and start CPR and ALS interventions. I may talk to the doctor enroute to the hospital but I am not required to do so unless I want to call the code on scene. I never get a physicians order for any of my interventions because I am working under established protocols. Why can't the same hold true for EMT's using a King airway? Of course there has to be sufficient training and a close QI program to support it. We already have BLS protocols that apply to all EMS providers and I don't see why the King can't be added.

I do agree that it should only be used in the cardiac arrest patient.

Live long and prosper.

Spock

[Spock]

Do the paramedics in the areas that are considering this procedure getting enough airway management practice to maintain their ability?

If they aren't, and most places don't, adding one more set of providers with an advanced skill that will not be practiced enough is not the answer. Educate the medics that need more practice so the EMT's won't need another add on skill.

I couldn't agree more with this and it is a national problem. I'm not suggesting that if an EMT and a paramedic crew arrive on scene of an arrest the EMT should place a King instead of the medic intubating. I do think that a BLS ambulance or BLS first responder unit that arrives on scene before an ALS unit can start CPR, use an AED and place a King airway. When the ALS unit arrives they could change the King only if ventilations are inadequate.

Will this cut the number of intubations by medics? Most definitely yes in some systems. This may be in our patient's best interest because we know now how interruptions in CPR are to be avoided and ETI results in stopping CPR for an unacceptable amount of time. Many medics have poor intubation skills to begin with and asking them to hit a moving target really puts them behind the eight ball.

I realize that many of you work in systems that place a high emphasis on intubation and have good con ed and QI programs. Consider yourself lucky and thank your medical director because I run in an area that does none of these things.

Live long and prosper.

Spock

[Dustdevil]

I think we are arguing over semantics. For instance: I arrive on scene of a cardiac arrest and start CPR and ALS interventions. I may talk to the doctor enroute to the hospital but I am not required to do so unless I want to call the code on scene. I never get a physicians order for any of my interventions because I am working under established protocols. Why can't the same hold true for EMT's using a King airway?

Those established protocols are physicians orders. That's not mere semantics. That is a legal distinction. To purchase, possess, or utilise the device requires the order of a physician. Therefore, they are ADVANCED life support.

I didn't say anything about EMTs. Only you said anything about EMTs. I am saying that ANYBODY who drops a KING is performing ADVANCED life support.

[Amanduh]

I think that the King LT D's are great just saw them for the first time two weeks ago. They take less time than a combitube.

[afd1307]

Where I work, King LTD are protocol for EMT Basics. I find them very successful, with almost 0 failures, and if we as a BLS unit can establish them, then the paramedics or intermediates can place an ET tube with what we call a tube changer( skinny blue thing)

[reaper]

You can't change the tube with a bougie. The King airway is designed to go into the esophagus , not the trachea.

So changing the tube out would just place your ET tube in the esophagus!

[Dustdevil]

You can't change the tube with a bougie. The King airway is designed to go into the esophagus , not the trachea.

So changing the tube out would just place your ET tube in the esophagus!

pwn3d

Another crystal clear demonstration of why EMTs should not be practising with these ALS devices.

[AZCEP]

You can't change the tube with a bougie. The King airway is designed to go into the esophagus , not the trachea.

So changing the tube out would just place your ET tube in the esophagus!

You've obviously never actually seen one of the King devices then.

It occludes the esophagus, and has a "ramp" at the level of the glottic opening for the bougie to pass into the trachea when properly placed. It is really quite simple to exchange for an ETT if you so desire.

[afd1307]

reaper, do your research. It's one of the benefits of the King.

Dustdevil, you said that EMT's shouldnt use these ALS devices. So you mean that you shouldn't use them either?? Since last I checked the levels are EMT-Basic, EMT-Intermediate, and EMT-Paramedic???