RSI - High-risk EMS procedure gets a low level of oversight

[p3medic]

I believe the Lawrence system on the north shore of MA does as well.

The lack of education is a huge problem, however the art of intubation cannot be learned in a classroom. It is a manual skill that takes lots of repetition and lots of experience in different anatomy, i.e. fat people, skinny people, kids, neonates, teens with downs syndrome, traumatic airways, burned airways etc.... No University education on the planet can teach intubation better than actually doing it. Now, the pharm, patho, etc needs to be well understood, and I have no idea weather that was the case with the S.D. medics, but I do know that if you take the number of medics out there with the number of live intubations they do in a year, you will see they average about 2. You can have all the education in the world, but if you see 2 tubes a year, your gonna suck, plain and simple.

[Happiness]

Ya Rocken I was serious not that I would disagree with intibation but with my location and the majority of my calls it is not practical. I am pretty much 5 minutes away from the hospital. It would take that much time to do the intibation and I could be at the hospital before I would be finished and the Dr. can do it. In the 12 years I have been here I can honestly say there is not one time after a call I would say I wish I new how to intibate. I know a lot of you will jump all over this but what ever.

And I don't take offence of the comment its just the way it is here, please remember I am a part timmer and I don't get enough experience to keep up some skills that you get in the real world.

Be safe again

[tniuqs]

Ya Rocken I was serious not that I would disagree with intibation but with my location and the majority of my calls it is not practical. I am pretty much 5 minutes away from the hospital. It would take that much time to do the intibation and I could be at the hospital before I would be finished and the Dr. can do it. In the 12 years I have been here I can honestly say there is not one time after a call I would say I wish I new how to intibate. I know a lot of you will jump all over this but what ever.

And I don't take offence of the comment its just the way it is here, please remember I am a part timmer and I don't get enough experience to keep up some skills that you get in the real world.

Be safe again

So in 12 years none of your patients have aspirated ?

And none have suffered Hypoxic events ?

And your service area are always 5 minutes from the ER ?

Maybe just me reading your comments incorrectly but HOW can one have an educated opinion when one does not practice to this level of expertice ?

cheers

[Asysin2leads]

Ya Rocken I was serious not that I would disagree with intibation but with my location and the majority of my calls it is not practical. I am pretty much 5 minutes away from the hospital. It would take that much time to do the intibation and I could be at the hospital before I would be finished and the Dr. can do it. In the 12 years I have been here I can honestly say there is not one time after a call I would say I wish I new how to intibate. I know a lot of you will jump all over this but what ever.

And I don't take offence of the comment its just the way it is here, please remember I am a part timmer and I don't get enough experience to keep up some skills that you get in the real world.

Be safe again

Even with 5 minutes to the hospital, anyone with hypoxia that cannot be corrected by other interventions or an airway obstruction should still be immediately intubated. If you don't believe me, next time you get a 911 call, the moment it goes out, tie a plastic bag over your head, and don't remove it until you are laying supine on a bed in the ER with the airway kit prepped. You'll find 5 minutes to the hospital is a lot longer than your think.

(BTW, don't really tie a plastic bag over your head, its wrong, dangerous, and can kill you.)

[triemal04]

Happiness...since you're in Canada, what type of paramedic are you? Primary, advanced, or critical? I'm only asking because if the answer is what I think it is, you'll save yourself a lot of grief and ass chewing.

[tniuqs]

Happiness...since you're in Canada, what type of paramedic are you? Primary, advanced, or critical? I'm only asking because if the answer is what I think it is, you'll save yourself a lot of grief and ass chewing.

Quite unfortunately in the provice of BC ..... everyone calls themselves a "PARAMEDIC" there is no title protection.

[Happiness]

And as always You all have decided that I am not worthy of the word Paramedic. I am not god and I do the best I can and you all can't unstand that then well thats to bad. I have never gone over my training and have always followed my protocols and you know sometimes I am able to think out of the box.

Rocken the answers to your questions no,yes(i will explain after), and the closest er to me is in prince rupert a 35 to 45 min heli ride away. And where did I ever say I had an educated opinion all I said is that I was glad that all I could use was and airway and bag em. I think some of yas have educated the brains out of your selves and forgotten the basics.

Asys and rocken the only real airway issue i have had would be with seizures. This one pt was in grand mal for what would turn out to be days, (a very long case study the guy has only 5 lives left) and by the time I got to him he was blue o2 stats in the low 60,s. I was able to get an airway in only after being patient enough to wait for that one sec he may stop clenching his jaw long enough, he arrived at the hospital pink, o2 in the high 80's and still seizing. Now since im not educated enough to know about intabation im not to sure if your going to be able to do the intabation on this pt in the first place.

Tri well what kind of paramedic do you think I am. I am a paramedic that tries to look at the scene as a whole and decide what is the best for my pt and so you all know I also consult with my partner to make sure nothing is missed. As for grief and ass chewing they are not protocols I have listed on my license. But if you must know my license says PCP. And so you all know I worked very hard to get and maintain my license just like all of you have and I am proud of what experience has taught me in 12 years.

And to save the best for last squint im sorry you have such a bad attitude towards BC it almost makes me think that you tried out for our service and were turned away at the phyc test. I really don't understand why you can't understand that just because I am in BC I don't deserve to be called a paramedic. So in your opinion what should I be called. But before you answer that maybe you should take some time and think that maybe there are just some people in BC that are good at their job and because they choose to be here what gives you the right to call us down. I have never slammed someone because of where they live or what level they are but I have no problems slamming someone who thinks they are better then others because they have a higher level. Just remember were you started it wasn't at the top.

Well that should give you all a bad opinion of me but what do I know because Im not a paragod, I am a paramedic.

Still happy

[tniuqs]

The term Paramedic suggests Advanced Life Support, and over 14 years ago I actually voted with the Paramedics of Canada to adopt the "term" PCP, the premise was as the public was confused, so with title recognition then standards across Canada and National reciprocity could become a reality, with ALL the levels of Paramedical care.

BUT I have since changed my mind as this has now as this has confused the gerneral population at large, due to so many PCPs blowing smoke up butts ..... ps The Ontario PCP is exempt from this personal view BTW, as their educational process is far superior, the Triangle vs the inverted Triangle in the Educational process ..... BC should take a good look at this concept.

So Just download the protocols from all "across" Canada and you will find great discreptancies and generally speaking the BC "ALS" protocols ARE some of the least researched, seriousy lack of evidence based medicine in current practices and very limited within scope and allowance of the ACP to work "out of the box" that you so speak of ... factually your BCAS just "started" calling them guidelines last writing/ release.

Yes as we all know more education does kill people thats why MDs only take 8 years, and RNs take minimum of 3 years.... good grief you just lost so many points on the dust devil scale, that I am very embarrased for you.

What is truely interesting is your senario below is the EXACT situation where the patient would benefit from RSI, control the seizures AND provide a definative airway, your commenting in a forum world wide that you have without shadow of doubt proven a lack situational awareness. There are many many others in passing, ventilatory failure, CHF with flash PE, and the Polytrauma or Septic patients.

Good point YOU DONT KNOW WHY was he siezing high ICPs? Epilepsy? DTs? Hypoglycemia ? +++

You believe that Sats in the 80s is a good thing ? and somehow equates to "pink" ?

just FYI ps that roughly coorelates to PO2s of 50 and normals should be PO2s of 60 to 90 mmhg much more "homeostatic" in my world.

Then why are you calling yourself Paramedic as this IS a US based forum site it is assumed that you are an ACLS provider by listing qualifications "Paramedic" you are guilty of misprepresntation. (You also have read a great deal concerning these concepts) in passing.

On the other hand, I am just the village idiots helper, I have not misrepresented MY qualifications.

So you are proud that experiance with a modicum of education that this is also a good thing and educational advancement is not required to further your profession nor provide better care to the people you serve ?

Its not a BAD attitude it is intended to wake you BC guys up, open your eyes up that you are being dictated to by the old boys club ..... the BCAS union. Seriously, I could not work in the province of BC and not a phyc issue (your comment in intself could be misconstrewed as a personal attack) meh whatever, just an village idiot's helper here after all.

MY issue is that I would be so seriously limited by what I have done vs what I would be "limited" to do for my patients, I have a thing its called conviction.

I started when you were a sparkle in your daddys eye <edit> I am old, experianced and always looking for more Education.

Your commenting in a forum on subjects that you have no experiance, nor education, unknowingly you have presented a terriffic senario for the ability to RSI, a true situational irony.

cheers

[triemal04]

Happiness, the point of my question was that if you are a PCP (as you are and I figured you were) then some of your unintelligent, uneducated, drivel-like comments could be ignored and written off as the ramblings of someone who doesn't know any better because they've never learned it. In fact you might have even learned a few things.

But now...well...sorry girl, you just plain ignaent!

. I am pretty much 5 minutes away from the hospital.

the closest er to me is in prince rupert a 35 to 45 min heli ride away

Which is it? If it's the later, then even a basic here or a PCP without a brain in Canada should have been able (over 12 frickin years) to figure out why intubation would be a good thing. If it's the former...guess you are just living proof that the Canadian system of training it's lower level EMT's has problems too. Just remember, to intubate someone without paralytics takes nowhere near 5 minutes, and the benefits can be extraordinary. And while using paralytics takes longer, the benefits can be extraordinary. As well, if you walk into an ER with someone needing an RSI, how long will it take the docs and RN's to do it? As long as it would have taken in the field? Longer? Start thinking about that and brush up on the basics of how the body works. It'll be beneficial, trust me.

Your comments about seizures were already touched on...wow...do you really think that's acceptable?

You may want to note in your profile that you are a PCP...it'll help people from thinking that you actually have knowledge about any kind of advanced topic, and will keep them from thinking you are even more dense than your posts make you out to be.

[CBEMT]

Arlington: Short transportation times and the inability to train a large number of paramedics are cited by Cynthia Simmons, the local medical director for the city's ambulance provider, American Medical Response.

So that patient on the 20th floor will just hve to hold their breath, I guess.

Dallas: Paramedics in a large system don't have enough opportunities to sharpen their intubation skills, according to medical director Paul Pepe.

No, paramedics in systems where every hose monkey, truckie, squaddie, chief, fire alarm tech, mechanic, and garbageman is a paramedic don't have enough opportunities to practice their skills. Size of the system has nothing to do with it.