Endotracheal Tube or Combitube??

[hfdff422]

So, yes I agree, get down off your para-god pedestal and join us uneducated mortals in the real world.

How about you try to improve your level of care instead of being upset at others for trying to improve the effectiveness of EMS, or would that require too much time and effort?

[PRPGfirerescuetech]

How the heck did I miss this thread long enough to go past three pages. Shameful really.

EMTtut. Im a 7 year basic. Please take that into consideration when you read the rest of this.

There is absolutely no reason why you or I should be performing "Field" combi-tube intubations.

In EMS there is a distinct lack of education on all levels. One of the biggest problems stemming from this said lack of education is simply stated, there arent enough people in many areas to perform these skills.

Stepping back and looking at the bigger picture of medicine for a second, who is the most respected in the medical profession? Doctors right? Why do you think that is.

They have the most schoolin, yo.

Then, theres the RN's, and they have their own tiers of respect, based around....education.

Lets apply this theory to EMS.

One of the biggest reasons why we have such difficulty in this business is this. We are regarded as highly uneducated skill monkeys. For your 150 hour BLS program, you want to perform invasive skills?

Do you know what nurses go through, in clinical and didactic education for one simple invasive skill? Were talking education that is 4 or 5 times longer than the entire BLS program. This number does not include pathophysiology based education that provides the knowledge as to why your performing the skill.

So, why do you think they have to jump through that hoop, but yet we cant get a combi tube skill in a few nights out of a 150 hour course? Because no one cares about actually fixing the problems in EMS anymore. Everyone wants to apply a proverbial bandaid to the issues by giving BLS providers these advanced skills, instead of providing intensely increased education for not just the BLS, but ALS levels.

You've noticed the frustration levels of everyone on this board. That is because you are providing a great example of one of the biggest problems in EMS to this day. Under education skill monkeys. This is one of many things dragging down EMS from progressing into a profession.

XoXo

PRPG

[Nate]

I have to agree with the above statement, how did this get to three pages? I would also like to throw this out for people to chew on. How many times do you notice EMS crews who fail to use a BVM properly? I see it a lot, people seem to forget how important that "seal" is when bagging a patient. If you bag someone with a good seal, you should have a good SaO2 and CO2 numbers on most patients.

I understand that many EMT-B's wish to do more, and there is a way to do more. However; you have to go back to school, and I don't understand why so many people have a freaking problem with that. You might get lucky and win the lottery and get a new car with out earning the money, but that doesn't happen in EMS. You can't win some EMS lottery and gain the ability to intubate or start IV's.

[hfdff422]

In Indiana, most systems allow EMT-B's to intubate with the dual lumen airways. I, at a BLS level, will gladly utilize this device to provide a better airway if ALS is unavailable. However, I would much prefer using simple adjuncts and have the medic make the decision as to what kind of advanced airway to use- because when you are taught the A+P you have a greater understanding of the consequences of your actions. If you have ALS in a reasonably close response area, then BLS providers should not use combi-tubes :!:

[medic53226]

Hello, I'm a indiana paramedic and in the system I work now they use LMA for the EMT-B's, and that is new to me, but the other service I worked for allowed EMT-B to use a Combi-Tube, as well as the FD certified as Basic non transports, I had a basic emt on a run at a residence, before I could get to the truck he had used a combi-tube and the patient didn't have a airway we were in a small area and I had them bag the pt to the truck, which and been moved unknownlingly to me, so as I got my gear and headed to the truck the Emt Basic decide to Combi-Tube the pt before I got their which took a couple of Min's to find since they had moved my ambulance. When I arrived they were bagging this pt through a Combi-Tube, no problem they were on the ball, and that is good, however, as the tech was bagging this pt, he looked as though he was having trouble with a bowel movement he was bagging that hard, so I listened for lung sounds and couldn't get them but they had, and per our protocol I have the right to remove the tube, well he had left the ambulance and didn't see me pull the tube, and when he found out he went to my supervisor because the EMT also worked part-time for our ambulance service. Well word travels fast and I found out that he was mad. So, I was called to the office by my supervisor, and got a lecture, which my supervisor was a advance emt so I pointed out the protocol to him, My point is this I don't have a problem with EMT B's doing Combi-Tubes or LMA's, but I feel that problems like this arise, and it not because I didn't think he did a good job its that it wasn't doing the job and that was not being able to ventilate the pt. My EMT partner is what makes our shift run good and what makes runs go smooth I would have a basic partner over a paramedic partner any day.

[Dustdevil]

My EMT partner is what makes our shift run good and what makes runs go smooth I would have a basic partner over a paramedic partner any day.

Wow! I sure didn't see that one coming.

That was an awful strange way to end a rant where you just gave a perfect example of why having a basic partner sucks! :?

[Ridryder 911]

Ditto.. sounds like a true basic emerged.

R/r 911

[firefighter523]

I am sorry, but for the life of me, I just cant think of ONE good reason a basic should be allowed to combitube someone. An effective seal via BVM with good Cricoid pressure with an OPA is optimum right before an ET tube goes into someones trachea. Look at all of the trauma that trachea has gone through already between you and your basic putting tubes in, and taking them out.

Combitubes are meant to be a BACK-UP airway, when you cant get the ET.

[Spock]

The combitube and LMA should only be used by ALS providers and I'm still not convinced that the LMA is appropriate for prehospital use. I would like to see all providers master BVM with OP airway ventilations first because I routinely see paramedic students come to the OR for intubations and they can't mask the patient. We don't let them intubate if they can't mask ventilate. I might be able to make a case for the King LT-D for use by BLS providers but I'm thinking we need more experience with it. That's probably a change from what I've said previously.

Live long and prosper.

Spock

[ERDoc]

I think a lot of folks out there don't realize that Combitubes and LMAs are buck devices that are used until a definitive airway can be established. A definitive airway is a properly placed and secured ETT or a true surgical airway (Trach or cric, NOT a needle cric). It is only appropriate that if a basic has put a combitube in that the medic should attempt to get a definitive airway established. That EMT partner that was offended by it needs to realize that it is about proper pt care and not his precious little ego. I'm not sure about the role of LMAs in the prehospital setting, they seem to unstable to me. Like others have said, master proper BLS skills and there would not be a need for adjuncts, thus decreasing the risk to the pt (isn't this what it's all about?).