Endotracheal Tube or Combitube??

[JPINFV]

The term "skilled hands" in relations to a basic, as a general rule, should not be used in the same sentence. Any monkey can place a combitube, just as any monkey can hook up a pulse ox. It takes education and understanding (things some medics and most basics lack) to understand the what/when/how and limits of what is being done.

And if you think that basics are, in general, not lacking in education or understanding, I dare you to ask the majority of your basics what oxygen does. Afterall, it is our (me=EMT- main drug. Or do you hold basics to a different standard then medics? Would you accept a medic that doesn't know how lidocaine works (I picked lidocaine because it has a relatively easy mechanism when dealing with the nervious system)?

[Ridryder 911]

If you were the Code Blue patient, would you rather be "worked on" with a simple BVM, or a combitube that was properly placed with skilled hands. Tough choice...

Actually, I would prefer a Paramedic, than having a system make excuses for itself! It is a shame the citizens of this country cannot at least have a person educated in ALS procedures. One would think after 40 years, the EMS system would quit "justifying" half -ass classes because communities, administration cares so little for human kind to at least give them someone that can administer medications (please not a few or limited) If people REALLY cared there would be only one level... period.

Call me para-god, holier than thou.. I don't care! I know at least the patient(s) I attend to can and is able to get what the medication(s), emergency procedures when and if they need it.. If you don' t like it then change it.. go to school, receive an education, pass the boards, get experience and then change the system! One thing about EMS, that has never changed... a bunch of whiners and full of people who want to take the easy way out... don't believe me... look at how many acronyms there are after the letter EMT, or how many First-Aid, BLS, Half-way Paramedic units there are out there. Don't the patients at least deserve a chance?

R/r 911

[chbare]

The problem I see is that people think combitubes are effective as primary airway devices. A properly placed ETT is the golden standard period. Sure the combitube is better than bag mask ventilations. However, the combitube is a BACKUP/RESCUE device that the paramedic can use as an option that may keep him/her from taking out a blade and cutting someones throat. We allow lesser trained people to use the combitube as a primary airway device and we do not give the patient a chance to receive the golden standard of care. Do not fool your self into thinking that you can provide paramedic level care because you know how to cram a combitube down your patients throat.

PS I am not a paramedic so do not pull that paragod thing on me.

Take care,

chbare.

[Dustdevil]

Combitubes have no place in the hands of anyone under the education level of a paramedic? Are you kidding me? I'm not sure how you guys do things where you're from, but it sounds like you're allowing a "Para-God" complex to take over your thoughts!

You would do well to spend a LOT more time here before embarrassing yourself with such ridiculous accusations.

A combitube is FAR better thans simple BVM ventilations. When placed and inflated correctly (not the full cc amount, but until resistance is felt) the combitube DOES prevent aspiration and DOES protect the patient's airway.

Thank you. You just proved my point. I don't know what your level of training is, but it is obviously inadequate to provide you with enough understanding of the Combitube to be utilising it. I hope your school is teaching better than that.

In "my neck of the woods", EMT-Intermediates are allowed to intubate with an ET tube... only EMT-Bs can use combitubes. Endotracheal intubation in an artform, definitely, but so it the placement of a combitube. If you were the Code Blue patient, would you rather be "worked on" with a simple BVM, or a combitube that was properly placed with skilled hands.

Educated hands are much more important than skilled hands. Back to school with you.

[BEorP]

If you were the Code Blue patient, would you rather be "worked on" with a simple BVM, or a combitube that was properly placed with skilled hands. Tough choice...

If I were VSA and you were working on me I'd want you using proper BLS adjuncts and maneuvers. Jaw thrust, head tilt-chin lift, OPA, NPA, proper bagging including a good face mask seal... ever heard of any of that? Maybe they didn't have time for that in your 200 hour class. Idealy if I were VSA I would want an ETT placed by skilled hands, but yours are not skilled and there's a lot more to EMS than "skilled hands."Do not take this as an insult, I am halfway through my PCP program and I do not claim to have skilled hands or know everything... but I also understand why BLS providers can't use advanced airway devicdes.

[Ridryder 911]

I believe that BLS providers can use advanced airways but should not. Part of being properly educated is knowing what you are capable of knowing and performing and doing those well, as well as knowing your limitations.

There are several procedures and methodologies, I am sure I could perform or muddle through, however I realize that I have not been properly educated nor should I even consider attempting, because there is a reason it is not within my scope of education. Again, we have allowed piss poor reasoning and rational to mandate specialized certification and accreditation's. Excuses of not having enough personnel, and poor funding is not valid. Can one imagine allowing "special trained" physician assistants to perform cardiac by-pass or heart transplants because there is a shortage of cardiac surgeons? No, nor should we had considered allowing lower levels to ever perform advanced procedures. One of major flaws and blunders that occurred and continues to propagate, instead of the full level of ALS, in which it was to promote.

Unfortunately, EMS will not mature, it can't. Various members and administrators will not allow it to. Obtaining a thorough knowledge is barely visible and unfortunately "training " has been widely accepted as the norm in lieu of education. If you do not know the difference, there is part of the problem.

Be safe,

R/r 911

[1EMT-P]

The Combitube was not designed as a replacement for the ET Tube, it was designed as an adjunct airway to be used when an ET Tube could not be placed or when a trained provider was not available.

In short if an EMT completes an airway course, along with a practical and written exam then yes he or she should be able to place a CBT.

[emttut]

I just want to start off by stating that since I started coming to this sight, I have found most of the discussions to be extremely interesting and informative. However, after reading all of the responses left on this one topic, I have become almost outraged!

Yes, in an IDEAL world every person would receive care from a paramedic. However, we do NOT live in an ideal world. You state that there should be no excuses for needing people that are trained at any level below paramedic, but do you live in or deal with many small rural communities that inhabit our great nation? Most of these communities are fortunate to have caring individuals that give up their time to help support and protect their friends, neighbors, and families. Most of these people do this and hold down another full time job. Yes, some of them may be unfortunately not as "educated" as they should be, but by your comments you have seriously disrespected them. Did you ever think that help of any kind is better than no help. I personally live in an area where they had to shut down the ambulance service of a local community because unfortunately they could no longer staff it. Now they have to wait at least 20 minutes for a paramedic unit to arrive from a larger town. Tell me, what good will the patient receive from the use of that ET tube after receiving no care at all for 20 minutes? If they still had their basic unit, at least the patient would be receiving some care, and as in most cases, they would have intercepted with the paramedic unit in major cases allowing for ALS treatment.

Secondly, I personally take offense at the way you talk about the Basic level. You talk as if all EMT-B's are nothing but ignorant, bumbling idiots. I will have you know that I am not. Yes, I will agree that the level of training in some areas of the country may not be up to par with the way things should be, but I feel that I have not only been trained well but have continued to take that base level training and expand my knowledge base. Furthermore, if the individual does not continue to learn and improve himself after receiving their training, it doesn't matter if they received training as a basic or a paramedic. A paramedic can be just as ignorant as a basic, AND you give them more things to use. One of the reasons I started coming to this website was to further my knowledge and information base. However, if all you want to do is generalize, downgrade and disrespect people, I might have to rethink my decision.

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

[Dustdevil]

I just want to start off by stating that since I started coming to this sight' date=' I have found most of the discussions to be extremely interesting and informative.[/quote']

I just want to start off by saying that your grammar and spelling is much better than most basics! But the word is "site."

And you are lazy and/or selfish enough to accept that instead of helping to change it?

No, I didn't. I hope your medical skills are better than your reading comprehension. It sucks.

Yes, for longer than you have even been alive.

Bull. They do it for their own selfish thrills. If they cared, they would either get an education or, better yet, demand that their community provide adequately educated, full-time professionals instead of thrill seeking hobbyists of questionable intellect and motives.

Yep. And they are the reason that a professional cannot get the EMS job full-time. I wish somebody would go do their full-time job for free and see how they like unemployment.

They have done nothing to earn anybody's respect.

Yep. But there is zero justification for "no help."

Wrong. They could staff it. They just refused to pay for it because they knew people like you would do it for free.

And not a single person in the community is smart enough to hold their elected officials responsible? That's their problem.

Uhhh... this is what I was talking about regarding reading comprehension. Obviously you have misinterpreted this entire thread, genius. This isn't about basics versus medics. This is about basics performing paramedic skills. I have no problem with basics performing BLS care until the arrival of paramedics. I think it's wonderful. That's what they are for. The point here is that they should not be pushing the envelope of their training by attempting to take on ALS skills a la carte in an attempt to do without paramedics.

Boo hoo. Grow some thicker skin if the truth hurts.

Well then this doesn't apply to you then, does it? So what is the problem?

I don't care if you have a doctorate in physiology. After all is said and done, you still can't do anything more for your patient than any other EMT, which is very little.

That very point is made by me everyday on this board. I don't like idiot paramedics anymore than I like any other idiot. Less, in fact.

If people's opinions affect your desire to learn, then you're not cut out for EMS anyhow. Good riddance.

Bite me, bandaid boy.

[chbare]

Emttut, I understand your point and I agree that in rural areas there are no paramedic level services. I also want to point out that in no way do I think EMT Basics or BLS providers are "ignorant, bumbling idiots." The problem is a matter of education, you can teach anybody to perform a skill, but we are talking about education and not just training. The EMT B NSC is designed to be about 110 hours long, the course may be longer depending on where you train. Unfortunately, the curriculum does not provide a solid enough foundation in anatomy, physiology, and pathophysiology for people to fully appreciate what they are doing to their patient when they perform advanced procedures. You are correct that in the real world things are not ideal, but that does not mean that people in EMS have to accept this fact. We need to push for higher standards and accept nothing less than the highest standard of care. I understand that there is a lack of paramedics, but if a community wants adequate EMS coverage, they have the resources to make it happen. We all pay taxes (well most of us) and we all know that allot of that money goes to support worthless crap, come on expecting a higher standard of care is not impossible. We may have to accept changes that we do not like, heck even I would, because if paramedic level care was the standard, my job as a transport nurse may come to a sudden end. I am willing to accept that for the trade of having high quality EMS care available to all. Again, I am not basic bashing, heck I am not even paramedic, and Nurasgod complex does even sound cool. And finally, do not forget how important good BLS skills are. There are allot of people coming back from a pretty rough sandbox alive because of good BLS.

Take care,

chbare.