Intubation FAIL

[VentMedic]

tnuigs,

Where did you that quote from?

Note A - Conclusion statement of cardiac arrest study "There was no improvement in the rate of survival with the use of advanced life support in any subgroup. The addition of advanced-life-support interventions did not improve the rate of survival after out-of-hospital cardiac arrest in a previously optimized emergency-medical-services system of rapid defibrillation. In order to save lives, health care planners should make cardiopulmonary resuscitation by citizens and rapid-defibrillation responses a priority for the resources of emergency-medical-services systems."

We are talking about the trauma studies done with OPALS.

Yes, it is flawed when comparing U.S. BLS to Canadian ALS but the rationale for the advanced procedures are the same. Again, it is the education to know when and when not to do a procedure or which procedure that improves outcomes.

Our State is trying to improve intubation results, everyone IE Medics must perform at least

12 tubes a year. I work for a private EMS, but the problem I see in the City is alot of medics

are getting lazy, one shot at the tube- then here comes the combi tube. I saw a truamatic arrest

come in the other night. Motercycle 70 MPH hit a cement wall. The medics stuck a OPA in bagged

him, did half ass CPR going in to the code room. No BB straps No C collar. needless to say the Docs

went apeshit when they brought him in BLS on a ALS rig. I foresee licensure getting yanked or suspeneded. But if you cant stand the heat-time to leave the kitchen./or burning building if your a fireman. be safe cheers.

It sounds like the guy was dead at scene.

If you have a traumatic arrest, how many shots at ETI do you want to try? Did they have RSI capability? What did they assess from that one shot? One shot is all I need to tell me I need to go to plan B but hopefully I can discover that with my assessment before the blade.

Did the medic also pull the CombiTube out? Was there trauma interfering with the placement?

The terms "BLS" and "ALS" need to seriously depart from EMS. I do "BLS" stuff in a high acuity ICU everyday.

Edited August 6, 2009 by VentMedic

[CBEMT]

I saw a truamatic arrest

come in the other night. Motercycle 70 MPH hit a cement wall. The medics stuck a OPA in bagged

him, did half ass CPR going in to the code room. No BB straps No C collar. needless to say the Docs

went apeshit when they brought him in BLS on a ALS rig. I foresee licensure getting yanked or suspeneded. But if you cant stand the heat-time to leave the kitchen./or burning building if your a fireman. be safe cheers.

Once you see CPR in progress (well, 3-4 compressions at a time anyway) on a patient inside a car undergoing mechanical extrication, 5 layers of sheets and blankets laid down on the backboard to prevent any blood from getting on it, and then 15 minutes of on-scene work in the back of the truck prior to transport 1 mile from the trauma center, nothing really gets you going anymore.

Edited August 7, 2009 by CBEMT

[Kiwiology]

I saw a truamatic arrest

come in the other night. Motercycle 70 MPH hit a cement wall. The medics stuck a OPA in bagged

him, did half ass CPR going in to the code room. No BB straps No C collar. needless to say the Docs

went apeshit when they brought him in BLS on a ALS rig. I foresee licensure getting yanked or suspeneded. But if you cant stand the heat-time to leave the kitchen./or burning building if your a fireman. be safe cheers.

Tell me you guys don't still transport arrests, let alone traumatic arrests.

Once you see CPR in progress (well, 3-4 compressions at a time anyway) on a patient inside a car undergoing mechanical extrication, 5 layers of sheets and blankets laid down on the backboard to prevent any blood from getting on it, and then 15 minutes of on-scene work in the back of the truck prior to transport 1 mile from the trauma center, nothing really gets you going anymore.

Yeah that's um, kind of bad .....

The terms "BLS" and "ALS" need to seriously depart from EMS

Let me plays devil's advocate for a moment. Given the current divisions between (in the US) what "basic" and "advanced" are I think there is a definite need to seperate the levels of intervention that can be provided. The media is not our friend here when it comes to portarying EMS as being staffed with "Paramedics".

I mean nothing personal y'all but I just shake my head and wonder when the US will come up with a system that isin't stuck in the dark ages of 1912 like the class divisions on the Titanic; where we have 120 hour "basics' who aren't even trusted to carry and administer nitro or take an ECG yet Paramedics who have 600 hours of education can potentially be out there doing rapid sequence intubation.

Personally I think it's sad.

[VentMedic]

Let me plays devil's advocate for a moment. Given the current divisions between (in the US) what "basic" and "advanced" are I think there is a definite need to seperate the levels of intervention that can be provided. The media is not our friend here when it comes to portarying EMS as being staffed with "Paramedics".

It is the way the terms ALS and BLS are used to justify a level of provider instead of addressing patient care. A patient should also not be classified by the level of the provider especially when they are going to a facility providing a higher level of care than "BLS". Even those that drive dialysis patient to the facility should realize that dialysis is an "advanced" procedure for all practical definitions even if the EMTs do very little for that patient which that in itself can be a topic. Patients sick enough for dialysis are not "BLS" in terms of medicine.

I could use the example of other professions to demonstrate how they perceive "medicine".

A school nurse RN is usually required to have a BSN instead of just the two year degree even though most of the work might be minor boo-boos, handing out meds already prescribed, record keeping and calling the parents or 911. The intervention is not emphasized but rather the responsibility is the issue.

Edited August 7, 2009 by VentMedic

[tniuqs]

Dear Ventmedic:

I known nothing about this hospital and their Flight RNs. However if you say the Canadian nurses are crap then maybe they need to look closer at improving. I can only speak for the Flight programs here in the U.S. and RNs I am aware of and they are definitely not idiots when it comes to providing quality medicine.

No, I did not even infer that all Canadian RNs were crap at all, this is an extrapulation but some are excellent RNs and some ARE idiots, as in every profession ... again it is dependent on the an individual motivation as this was my point (not as clear perhaps as I should have been) I am so not a fan of generalizations.

tnuigs,

Where did you that quote from?

<snip for brevity >

We are talking about the trauma studies done with OPALS.

The quote addresses the flaws of the first OPALS study and "Letterman" a past member of EMT city who lives in Ontario provided myself with his critique of the frist OPALS study, and has been discussed here in great depth and vigor. It basically concludes the faster CPR and defib are implemented the better the outcomes ... as a direct result the governments counter move was to put more AEDs and train FF in CPR not invest in the future of practice of Paramedicine give them an inch and they will take a mile (another note OPALs 1 was based on OLD CPR standards)

Dr. Keith Wesley raved about OPAL 2 "trauma study" in JEMS until we sat down and shared a Canadians perspective and ... and I quote: "What is this Canadian rotgut" bottom line these studies again are now very outdated and now more political past EMS history and did slow the transition/development to ALL ALS in Ontario.

It cost 12 million for these studies that yet again comparing apples to grapefruit (no RSI drugs) and only in "moderately populated metropolitan areas" the ONTARIO OPALS Trauma study excluded Hamilton and Toronto the largest population base.. "selected Hospitals" hmmm interesting.

OPALs 2 it WAS quoted by many a political bean counter(s) search OPALS on EMT city for extensive discussion if you wish, briefly: No rescue airways were implemented and there was only a factor of less than 1 % difference in those outcome studies "to door discharge" The demographic groups of the trauma ALS vs BLS if one really critically crunches the study, comparing grandpa falling down the stairs to an poly trauma MVC (the mean age group was older in the ALS capable group btw) .... do I need to really say more ?

Yes, it is flawed when comparing U.S. BLS to Canadian ALS but the rationale for the advanced procedures are the same. Again, it is the education to know when and when not to do a procedure or which procedure that improves outcomes.

Agree yes it was flawed US BLS vs CND ALS

Disagree ... if we jump the gun on this to remove/ replace or restrict ETI in any way then we are not being objective .. more study is needed as chbar advocates then again with funding issues these days who will provide the $$ to this .. it is notorious that EMS is underfunded in any area of research (speaking for north of the border ONLY)

Who has the cash in their pocket to do a good cross section of all providers in trauma (and what is inclusion criteria) the comparision's in success ratio, first attempt vs a definitive capture of airway, then based on type of service, level of education, current in-house Con Ed, capabilities of early intervention ie RSI drugs vs no RSI ... and a GOOD study in the ER's itself on MDs "first pass attempt" prove in my hood that GPs are more successful and I will ask why do the Rural Hospitals have Paramedics respond to hospital to "assist" in difficult airways ?

Ok did I read the this study in depth ? No not initially and I too fell into the Abstract Trap until page 2 then had a gander ... Point being that many Medical Directors the vast majority of REMT-P and EMT will take the abstracts at face value hence my "math application" for debate sake only ... very, very few in fact will actually take the time read an entire document and then come to their own conclusions.

The terms "BLS" and "ALS" need to seriously depart from EMS. I do "BLS" stuff in a high acuity ICU everyday.

Laughing I put on my BDU pants one leg at a time ... but I can wear a suit too !

NO WAY you have 2 concepts confused ALS and BLS services should be clearly be defined ... i.e just look to BC Ambulance where "Emergency Paramedic" is Government approved "placard" on every truck when only a small percentage are actually Advanced Life Support providers ... this becomes a huge issue with public perception expecting "Gage and Desoto" and getting buddy PCP part time that works at the corner store and has not had patient contact for 2 months just try's to explain to the family that NO he can't start an IV or even has a way to take the pain away for 2 hour transport, but he can give nitro ... sorry off topic.

Fact is 95 % of what I practice is considered basic skills as well, then explain to me why NICUs or Trauma Centers are classified different levels ? Why not call ALL of them Trauma Centers as well when some don't have an MD that can crack a chest and are limited to belly cutting ONLY and no neuro to speak of.

My Conclusion in this study er ... abstract presented by Dust is: In the "the the geographical area" that the research was done, THEY have a "real issue" OMG 12% unrecognized Esophageal intubation's ???? That needs to be addressed First IMHO, but please stop pointing fingers at the entire REMT-P population.

Unfortunately this is the way this study will be perceived by the general Medical Community ... just saying.

cheers

[FL_Medic]

There is more on this topic here:

(Click to view this embedded page in a new window)

[HERBIE1]

Dear Ventmedic:

No, I did not even infer that all Canadian RNs were crap at all, this is an extrapulation but some are excellent RNs and some ARE idiots, as in every profession ... again it is dependent on the an individual motivation as this was my point (not as clear perhaps as I should have been) I am so not a fan of generalizations.

The quote addresses the flaws of the first OPALS study and "Letterman" a past member of EMT city who lives in Ontario provided myself with his critique of the frist OPALS study, and has been discussed here in great depth and vigor. It basically concludes the faster CPR and defib are implemented the better the outcomes ... as a direct result the governments counter move was to put more AEDs and train FF in CPR not invest in the future of practice of Paramedicine give them an inch and they will take a mile (another note OPALs 1 was based on OLD CPR standards)

Dr. Keith Wesley raved about OPAL 2 "trauma study" in JEMS until we sat down and shared a Canadians perspective and ... and I quote: "What is this Canadian rotgut" bottom line these studies again are now very outdated and now more political past EMS history and did slow the transition/development to ALL ALS in Ontario.

It cost 12 million for these studies that yet again comparing apples to grapefruit (no RSI drugs) and only in "moderately populated metropolitan areas" the ONTARIO OPALS Trauma study excluded Hamilton and Toronto the largest population base.. "selected Hospitals" hmmm interesting.

OPALs 2 it WAS quoted by many a political bean counter(s) search OPALS on EMT city for extensive discussion if you wish, briefly: No rescue airways were implemented and there was only a factor of less than 1 % difference in those outcome studies "to door discharge" The demographic groups of the trauma ALS vs BLS if one really critically crunches the study, comparing grandpa falling down the stairs to an poly trauma MVC (the mean age group was older in the ALS capable group btw) .... do I need to really say more ?

Agree yes it was flawed US BLS vs CND ALS

Disagree ... if we jump the gun on this to remove/ replace or restrict ETI in any way then we are not being objective .. more study is needed as chbar advocates then again with funding issues these days who will provide the $ to this .. it is notorious that EMS is underfunded in any area of research (speaking for north of the border ONLY)

Who has the cash in their pocket to do a good cross section of all providers in trauma (and what is inclusion criteria) the comparision's in success ratio, first attempt vs a definitive capture of airway, then based on type of service, level of education, current in-house Con Ed, capabilities of early intervention ie RSI drugs vs no RSI ... and a GOOD study in the ER's itself on MDs "first pass attempt" prove in my hood that GPs are more successful and I will ask why do the Rural Hospitals have Paramedics respond to hospital to "assist" in difficult airways ?

Ok did I read the this study in depth ? No not initially and I too fell into the Abstract Trap until page 2 then had a gander ... Point being that many Medical Directors the vast majority of REMT-P and EMT will take the abstracts at face value hence my "math application" for debate sake only ... very, very few in fact will actually take the time read an entire document and then come to their own conclusions.

Laughing I put on my BDU pants one leg at a time ... but I can wear a suit too !

NO WAY you have 2 concepts confused ALS and BLS services should be clearly be defined ... i.e just look to BC Ambulance where "Emergency Paramedic" is Government approved "placard" on every truck when only a small percentage are actually Advanced Life Support providers ... this becomes a huge issue with public perception expecting "Gage and Desoto" and getting buddy PCP part time that works at the corner store and has not had patient contact for 2 months just try's to explain to the family that NO he can't start an IV or even has a way to take the pain away for 2 hour transport, but he can give nitro ... sorry off topic.

Fact is 95 % of what I practice is considered basic skills as well, then explain to me why NICUs or Trauma Centers are classified different levels ? Why not call ALL of them Trauma Centers as well when some don't have an MD that can crack a chest and are limited to belly cutting ONLY and no neuro to speak of.

My Conclusion in this study er ... abstract presented by Dust is: In the "the the geographical area" that the research was done, THEY have a "real issue" OMG 12% unrecognized Esophageal intubation's ???? That needs to be addressed First IMHO, but please stop pointing fingers at the entire REMT-P population.

Unfortunately this is the way this study will be perceived by the general Medical Community ... just saying.

cheers

Interesting points.

A few things...

I agree with your assessment of the studies. The results of any poll, study, etc are only as good as the questions that are asked. Numbers can be skewed, sample sizes may be insufficient, differing results may be statistically insufficient, the group conducting the research and asking the questions may have ulterior motives, etc. Who is sponsoring the study or stands to gain from the results? In other words, yes, simply reading an abstract or executive summary may not give you all the facts.

Hospitals need to meet certain criteria in order to keep their various accreditations. A Trauma center must do a certain volume to maintain their status. Why is it such a stretch to think that unless you practice a certain skill on a regular basis, you may not automatically be allowed to use it?

I guess the problem becomes, in some areas, which is better, a person who's skills may be a bit rusty vs having someone who's not even able to do any advanced techniques? Tough call.

[VentMedic]

No, I did not even infer that all Canadian RNs were crap at all, this is an extrapulation but some are excellent RNs and some ARE idiots, as in every profession ... again it is dependent on the an individual motivation as this was my point (not as clear perhaps as I should have been) I am so not a fan of generalizations.

Again, the LVN at a nursing home probably won't be applying to a Flight team. Get over you attitude about nurses. We've got just as many idiots in EMS and some are on this forum who can't get an original thought for themselves without feeling the need to bash another profession to make themselves look good.

The quote addresses the flaws of the first OPALS study and "Letterman" a past member of EMT city who lives in Ontario provided myself with his critique of the frist OPALS study, and has been discussed here in great depth and vigor. It basically concludes the faster CPR and defib are implemented the better the outcomes ... as a direct result the governments counter move was to put more AEDs and train FF in CPR not invest in the future of practice of Paramedicine give them an inch and they will take a mile (another note OPALs 1 was based on OLD CPR standards)

Dr. Keith Wesley raved about OPAL 2 "trauma study" in JEMS until we sat down and shared a Canadians perspective and ... and I quote: "What is this Canadian rotgut" bottom line these studies again are now very outdated and now more political past EMS history and did slow the transition/development to ALL ALS in Ontario.

It cost 12 million for these studies that yet again comparing apples to grapefruit (no RSI drugs) and only in "moderately populated metropolitan areas" the ONTARIO OPALS Trauma study excluded Hamilton and Toronto the largest population base.. "selected Hospitals" hmmm interesting.

OPALs 2 it WAS quoted by many a political bean counter(s) search OPALS on EMT city for extensive discussion if you wish, briefly: No rescue airways were implemented and there was only a factor of less than 1 % difference in those outcome studies "to door discharge" The demographic groups of the trauma ALS vs BLS if one really critically crunches the study, comparing grandpa falling down the stairs to an poly trauma MVC (the mean age group was older in the ALS capable group btw) .... do I need to really say more ?

How about some links instead of he said/she said? I also form my own opinions when reading what people have to say on an anonymous forum regardless of how high of an opinion you have of someone going by "Letterman".

Dr. Wesley also was trying to say the U.S. EMT-B and Canadian "BLS" were the same in his JEMS review.

Again, don't just refer to just the abstract. Read the full article.

Disagree ... if we jump the gun on this to remove/ replace or restrict ETI in any way then we are not being objective .. more study is needed as chbar advocates then again with funding issues these days who will provide the $$ to this .. it is notorious that EMS is underfunded in any area of research (speaking for north of the border ONLY)

Where did I ever state to take away all the ETI? I stated that it is time to reexamine how we do things and assess skills.

Who has the cash in their pocket to do a good cross section of all providers in trauma (and what is inclusion criteria) the comparision's in success ratio, first attempt vs a definitive capture of airway, then based on type of service, level of education, current in-house Con Ed, capabilities of early intervention ie RSI drugs vs no RSI ... and a GOOD study in the ER's itself on MDs "first pass attempt" prove in my hood that GPs are more successful and I will ask why do the Rural Hospitals have Paramedics respond to hospital to "assist" in difficult airways ?

Doctors have been studied as have RRTs, RNs, PAs, CRNA, and NPs. Again, trying to drag down another profession as an excuse to ignor what is happening in EMS is not the way to correct a situation or many situations. Is it really a good justification if you miss a tube to say "Ha, ha, Dr. Smith can't tube either. I saw him miss."? That is just juvenile to not take responsibility for one's own actiions.

NO WAY you have 2 concepts confused ALS and BLS services should be clearly be defined ... i.e just look to BC Ambulance where "Emergency Paramedic" is Government approved "placard" on every truck when only a small percentage are actually Advanced Life Support providers ... this becomes a huge issue with public perception expecting "Gage and Desoto" and getting buddy PCP part time that works at the corner store and has not had patient contact for 2 months just try's to explain to the family that NO he can't start an IV or even has a way to take the pain away for 2 hour transport, but he can give nitro ... sorry off topic.

Fact is 95 % of what I practice is considered basic skills as well, then explain to me why NICUs or Trauma Centers are classified different levels ? Why not call ALL of them Trauma Centers as well when some don't have an MD that can crack a chest and are limited to belly cutting ONLY and no neuro to speak of.

I'm glad you brought up NICUs and Trauma centers. If a NICU is rated Level 1, we DO NOT use nursing assistants instead of RNs. If the rating is Level 2, we DO NOT use LVNs and save the RNs for Level 3. They are all RNs. The doctors also have M.D. or D.O. behind their name. Their base education is all the same. PLEASE DO NOT say that the EMT-B with 120 hours of first-aid training counts as a "base" education. The skills in it are essentially the first week of most professional curriculums.

My Conclusion in this study er ... abstract presented by Dust is: In the "the the geographical area" that the research was done, THEY have a "real issue" OMG 12% unrecognized Esophageal intubation's ???? That needs to be addressed First IMHO, but please stop pointing fingers at the entire REMT-P population.

Unfortunately this is the way this study will be perceived by the general Medical Community ... just saying.

cheers

I'm also going to address FL_Medic's article here. The article clearly stated where the study was done. The article also clearly gave a background of Miami-Dade. Yes, FL_Medic, that is MIAMI-DADE and not just MIAMI. This department is the result of over 25 small municipalites merging in just the past few years. There are almost 72 stations. ETI or any other "skill" had not been an issue before this happened when there was excellent medical oversight of the smaller departments. Quite possibly the only way to get the attention of some is for the hospital to do a study since what happens in the field also affects what the patient will go through in the hospital. Hence the words "Trauma System". The area has now identified and made known its problems and can deal with it. People want some evidence there is a problem, they have it. They must address it or continue to make excuses and stick their heads up their butts to hide from the realities of patient care.

BTW, Dade county is no longer the retirement capitol it once was and hasn't been since the 1980s.

Seattle is not an entire county. They do many, many less calls. However, their studies have also gotten their share of scrutiny. There was also discussions about their procedures for RSI, intubation and central lines in that it is not always because they should but because they can. How many "skills" or procedures did they do to make their numbers look good on patients that may have also down well without advanced intervention?

Criticize all you want but you really should wait and see what steps will be taken in Miami-Dade for improvement. I think it will be a turning point. L.A. and other California counties as well as Washington DC or any other large metro FD can then take notes one these findings and the outcomes.

Edited August 7, 2009 by VentMedic

[tniuqs]

'VentMedic' date='Aug 7 2009, 01:07 PM' post='221050']

Get over you attitude about nurses.

I believe I wrote: (No, I did not even infer that all Canadian RNs were crap at all, this is an extrapulation but some are excellent RNs and some ARE idiots, as in every profession ... again it is dependent on the an individual motivation as this was my point (not as clear perhaps as I should have been) I am so not a fan of generalizations)

How about some links instead of he said/she said? I also form my own opinions when reading what people have to say on an anonymous forum regardless of how high of an opinion you have of someone going by "Letterman".

Um because "Letterman" was directly involved with the out of hosp resus study, very sorry I did not include a written by .... AND this was discussed in great depth over 2 years ago on EMT city.

Dr. Wesley also was trying to say the U.S. EMT-B and Canadian "BLS" were the same in his JEMS review.

NOT the Topic we discussed when we sat down and had a face to face chat over a drink, Wesley's opinion was his review of OPALS study in JEMs concerning ETI success rates in the Trauma study.

I have yet to review of Wesleys opinion a boot this BLS (Ontario) CND vs BLS (wherever) US was never discussed, but things got fuzzier after about 22:00hrs, the conversation drifted to other areas, his hot wife (OMG that was my outside voice again ... oops) ...

(and when I speak of Canadian Rotgut that was the hooch we were drinking.

Dust was an impartial and the only sober observer in that convo btw, I was locked and loaded to discuss his position ... just ask Dust !

Besides how one can compare entirely different health care system/funding/philosophy in the first place, well that beats the hell out of me

Again, don't just refer to just the abstract. Read the full article.

OPALS Trauma study is not the thread topic and you can bet that I read every word and used my calculator.

Where did I ever state to take away all the ETI? I stated that it is time to reexamine how we do things and assess skills.

Well trying to use logic ... so if the failure rate is unacceptable (wherever the study is done) one can easily forsee that a "replacement with Combi or LT King" besides, I bet I know who would fund that study, perhaps the deep pockets of the developer of the plastic monstrosities .... see Herbie's note.

Doctors have been studied as have RRTs, RNs, PAs, CRNA, and NPs. Again, trying to drag down another profession as an excuse to ignor what is happening in EMS is not the way to correct a situation or many situations. Is it really a good justification if you miss a tube to say "Ha, ha, Dr. Smith can't tube either. I saw him miss."? That is just juvenile to not take responsibility for one's own actiions.

No attempt at "dragging down at all" cant see how its juvenile to compare success rates in our ER to Field, as I believe this would be an excellent place to start AS A BASE LINE for non emotional comparison, first attempt and success ratios in ETI providing the same playing field with RSI drugs, ok, off topic but a study was done in Alberta .. and apparently REMT-P read 12 leads with more accuracy than our rural GPs ... just saying.

If you would so request I will post the entire OPALS Trauma Study in this thread ... no abstract.

http://www.google.ca/search?rlz=1C1CHNH_en...ls+trauma+study

Here is a goggle link to the search OPALS Trauma...... and all the conclusions and opinion and conjecture.

Your welcome.

I'm glad you brought up NICUs and Trauma centers. If a NICU is rated Level 1, we DO NOT use nursing assistants instead of RNs. If the rating is Level 2, we DO NOT use LVNs and save the RNs for Level 3. They are all RNs. The doctors also have M.D. or D.O. behind their name. Their base education is all the same. PLEASE DO NOT say that the EMT-B with 120 hours of first-aid training counts as a "base" education. The skills in it are essentially the first week of most professional curriculums.

I dunno Vent I believe I was suggesting that removal of the clear definition in Level of Care BLS vs ALS ... or clear definition in any area of health care is misleading .. LPN, RN, NP or PA ... please note the different Titles.

<snip>

Miami, Dade, Seattle .... I don't really care but address the issue in that area ...

My Point this study presented by Dust (oddly absent from comment) reflects more negatively on Paramedics GENERALLY speaking that just those of a "select" metropolitan study are, AND those with option/luxury of close Multiple Trauma Centers.

cheers

Bottom line I need ETI to do my job to provide the best possible patient care in my environment, I would prefer to field Trach than use the the reinvention of the EOA.

Edited August 8, 2009 by tniuqs

[VentMedic]

I believe I wrote: (No, I did not even infer that all Canadian RNs were crap at all, this is an extrapulation but some are excellent RNs and some ARE idiots, as in every profession ... again it is dependent on the an individual motivation as this was my point (not as clear perhaps as I should have been) I am so not a fan of generalizations)

What is with you and nurses?

Um because "Letterman" was directly involved with the out of hosp resus study, very sorry I did not include a written by .... AND this was discussed in great depth over 2 years ago on EMT city.

YOU mentioned some comment from an anonymous poster from over two years ago and YOU mentioned articles that were all opinion but tried to present them as facts. I also have a little more interest vested in this artilce than just living in the U.S. or Florida as you relate to your anonymous friend living in Canada.

NOT the Topic we discussed when we sat down and had a face to face chat over a drink, Wesley's opinion was his review of OPALS study in JEMs concerning ETI success rates in the Trauma study.

I have yet to review of Wesleys opinion a boot this BLS (Ontario) CND vs BLS (wherever) US was never discussed, but things got fuzzier after about 22:00hrs, and conversation drifted to other areas, his hot wife (OMG that was my outside voice again ... oops ... (as when I speak of Canadian Rotgut that was the hooch we were drinking.

Dust was an impartial sober observer in that convo btw, I was locked and loaded to discuss his position ... ask Dust !

Besides how one can compare entirely different health care system/funding/philosophy in the first place, well that beats the hell out of me

A drunken conversation is your evidence for argument? Now you are wasting my time.

OPALS Trauma study is not the thread topic and you can bet that I read every word and used my calculator.

YOU brought up the Canadian studies.

The article was a study from a trauma center. You presented some article about cardiac arrests in Canada that was also done as part of the OPALS. I simply wanted you to compare trauma to trauma.

Also, as I have already mentioned, you can not equally compare Canadian "BLS" with the American 120 hour EMT-B.

Well trying to use logic ... so if the failure rate is unacceptable (wherever the study is done) one can easily forsee that a "replacement with Combi or LT King" besides, I bet I know who would fund that study, perhaps the deep pockets of the developer of the plastic monstrosities .... see Herbie's note.

I bet you don't know who funded this study.

Could care less about Herbie.

Juvenile to compare success rates in our ER to Field would be an excellent place to start AS A BASE LINE for non emotional comparison, first attempt and success ratios in ETI providing the same playing field with RSI drugs, off topic but a study was done in Alberta .. and apparently REMT-P read 12 leads with more accuracy than our rural GPs (just saying)

If you read other journals you will find studies that have been done for flight RNs and RRTs intubating in the field. Air Med had ran a couple of articles. Paramedics are not the only ones that do transport and scene response. There are PHRNs as well. Do some reading.

And what do a GP in a small rural hospital missing a tube have to do with Paramedics intubating? Enough with the "he can't intubate either crap". That is not a valid excuse for why a Paramedic can't intubate since they are supposed to be trained in that skill whereas a GP is NOT. To compare a job that you are specifically trained to someone who has very little to no training in is just stupid. It is a sad statement that these hospitals do have to resort to using GPs as a substitute for an ED doctor.

I dunno Vent I believe I was suggesting that removal of the clear definition in Level of Care BLS vs ALS ... in any area in health care is misleading.

As far as the BLS, I seriously hope you don't think 120 hours of first-aid training is adequate. Do you not even understand why there is a concern with that? The discussion was about concerns in the U.S. since it stemmed from an article in the U.S.

Miami, Dade, Seattle .... don't really care but address the issue in that area ... My Point this study presented by Dust reflects on more negatively on Paramedics generally speaking that just those select metropolitan study area, those with option/luxury of close Multiple Trauma Centers.

If you had read the whole article and not just the abstract you would have known this article is about Paramedics from Miami-Dade specifically who work for a FD. Some of the delicate egos here have taken this study about one FD very personally. I have tried to tell you where, how and why this study was done which you would also have known if you read the whole article.

Bottom line I need ETI to do my job to provide the best possible patient care in my environment, I would prefer to field Trach than use the the reinvention of the EOA.

You don't work in the U.S. You probably haven't even been following the changes that will hopefully start to happen. If people carry on as if there is not problem, how can anyone or any system improve?

If you can intubate in Canada and have adequate education why are you so concerned? Is your position in jeopardy? Have you not gotten more than 3 ETIs this year? Are you a bad intubator and take this personally or have nothing to show you know what you are doing? Does your company not track your procedures?

While I have my roots with the FD in this area, I am not so blind that I don't see a problem. When you continue to argue that the EMS systems in the U.S. are perfect and there are no problems, nothing will change. FDs are taking over a large part of EMS and I don't agree with the way all of them are doing this. I do know FDs can do EMS very well given the resources and medical oversight. I don't argue blindly about a system in Canada that I know nothing about.