Poor Intubations in EMS

[JakeEMTP]

vs-eh, I didn't know what LEMON stood for as we haven't arrived at that part of our education yet. However, a little search with my best buddy Mr. Google came up with this,

L- Look externally

E- Evaluate 3-3-2 rule

M - Mellampati score

O - Obstruction

N - Neck Mobility

reference: http://www.templejc.edu/dept/ems/documents...%20part%202.ppt

Thanks for the tip, I appreciate it. :thumbleft:

[Dustdevil]

All medics in Fort Worth, Texas are given the opportunity for cadaver class annually. Not sure exactly who, if anybody, is required to attend or how many do. But it is very popular and even the FD first responder medics (of which there are many) attend.

[AZCEP]

Anyone in Dallas that doesn't take advantage of the yearly SLAM course is not to be considered professional.

I've made the trip for the last couple of courses, and it is well worth the bucks. Like I have said before, if the book is good, spending time with the people that write the book is that much better. This course also includes a pig trachea lab, and a cadaver dissection/procedure lab if you want.

Take the course. It will do nothing but help you.

If you can't be enthusiastic about airway management, then you shouldn't be doing patient care.

[hewittc4]

My $0.02.

EMS is broken. When I worked in a rural part of Arizona, I was the one that tubed every patient that needed it. Now that I am working in a city, I haven't gotten to tube anyone, nor will I get to. Why? Because here I respond with the fire department. I am competing with 2 fire medics and 2 fire EMT-Is. All 4 of them get a chance before I do. And if they can't get it, then I won't be allowed, because if a firefighter can't get the tube, then a private medic had better not because it will make the fire department look bad. Hell, I've only gotten to start, maybe 10 IVs in the last 6 months.

What departments were used in the study? I know that there are some good fire departments that provide excellent patient care and take EMS seriously, I just have never seen one myself. Kinda like space aliens, people claim they exist, but I haven't seen one yet.

Were the tubes actually bad or were they dislodged by the hospital? I have had patients that had a confirmed good field tube, that was dislodged when we got the patient to the ER. I actually had to tell a doctor that lifting the patient's head by the ETT might not be a good idea. Fortunately, he agreed.

What equipment was used? We just got CO2 monitors on some of our rides. The rest only have the litmus paper.

And finally, what training and retraining do the medics get? OR time is rare around here. The nearest cadaver lab is 100 miles away, and that is hard to get into.

[Brocktalk]

Dr.Bledsoe posted on Merginet.com that ETI should be stopped immediately based on recent findings. He cites a study that looked at 47? systems that were either large urban or rural with a high number of failure/misplacement /dislodged tubes. Where the study fails is in looking at systems that limit ETI providers in order to increase exposure/experience. It would also be interesting to review the QI/PI program of those services to see if their programs have an intensive research and improvment process. Working in New England for a high volume, hospital based,all paramedic service, we have been performing RSI for 6 years without a single misplacement or dislodged tube. Boston may have the right model in using a small number of medics to increase exposure and allow ED providersto be familiar with the small numbers. In Feb.05 I attended the "Gathering of Eagles" in Dallas and was amazed to hear that Houston has 350 medics and they average 1 ETI every 3 years. I have had shifts with 2-3 and perform on a frequent basis. Oversaturation of ALS, lack of oversight and education, and poorly conducted studies might result in changes. It is unfortunate that a medic isn't driving the bus and we find ourselves once again answering to studies we didn't initiate. It would be nice if "paramedics" started driving our industry and take control of this and many other issues. thanks

My $0.02.

EMS is broken. When I worked in a rural part of Arizona, I was the one that tubed every patient that needed it. Now that I am working in a city, I haven't gotten to tube anyone, nor will I get to. Why? Because here I respond with the fire department. I am competing with 2 fire medics and 2 fire EMT-Is. All 4 of them get a chance before I do. And if they can't get it, then I won't be allowed, because if a firefighter can't get the tube, then a private medic had better not because it will make the fire department look bad. Hell, I've only gotten to start, maybe 10 IVs in the last 6 months.

What departments were used in the study? I know that there are some good fire departments that provide excellent patient care and take EMS seriously, I just have never seen one myself. Kinda like space aliens, people claim they exist, but I haven't seen one yet.

Were the tubes actually bad or were they dislodged by the hospital? I have had patients that had a confirmed good field tube, that was dislodged when we got the patient to the ER. I actually had to tell a doctor that lifting the patient's head by the ETT might not be a good idea. Fortunately, he agreed.

What equipment was used? We just got CO2 monitors on some of our rides. The rest only have the litmus paper.

And finally, what training and retraining do the medics get? OR time is rare around here. The nearest cadaver lab is 100 miles away, and that is hard to get into.

[Ridryder 911]

Welcome to the City Brocktalk.I guess the amazement of the studies (either misplaced tube or even dislodged) is there is no reason for such. Since you have either clormetric or capnography for formal documetation and lung sounds for clinical judgement. Our new policy is runn a strip with EtCo2 wave form upon arrival at the ER before meovement and if possible after movement to ER bed. This is to show confirmation of ETT upon arrival. We decided this after reading an article were medics was acused of an esophageal intubations occuring. They had the capnograpy wave form and was able to prove their placement was valid. saving their butts, but also showing that tube displacement occured after arrival to the ER.

I highly suggest some form of documentation of confirmation upon arrival to ER's. As the old story goes they are going to blame someone...

I am amazed that Houston does not have that many required intubations. Although that is a lot of medics. Again, no contriol of the system and flooding the market, I now also wonder with that many, how difficult can the program be?

R/R 911

[flight-lp]

"I am amazed that Houston does not have that many required intubations. Although that is a lot of medics. Again, no contriol of the system and flooding the market, I now also wonder with that many, how difficult can the program be? "

Rid, this is HFD that we are talking about, so the statistics really do not surprise me!!!!!!!

[firemedic78]

I had the "pleasure" of working for a private ambulance service which consisted of 90% HFD part-timers. A situation comes to mind when I was on the truck with a former HFD paramedic when we came upon an accident with a work truck, minivan, and commercial box truck. The driver of the minivan attempted to flag us down while he was still in his car. My partner proceeded to drive on by. When I questioned him about it, he proceeded to tell me that in Texas we did not have a duty to act and besides, it was in city limits-a fire truck and ambulance would be there shortly.

Needless to say, I worked too hard for my certification to lose it and I quit.

[EmergencyMedicalTigger]

I had the "pleasure" of working for a private ambulance service which consisted of 90% HFD part-timers. A situation comes to mind when I was on the truck with a former HFD paramedic when we came upon an accident with a work truck, minivan, and commercial box truck. The driver of the minivan attempted to flag us down while he was still in his car. My partner proceeded to drive on by. When I questioned him about it, he proceeded to tell me that in Texas we did not have a duty to act and besides, it was in city limits-a fire truck and ambulance would be there shortly.

Needless to say, I worked too hard for my certification to lose it and I quit.

Grr, my husband is bad about signing out. I'm actually the one who made this comment.

[Dustdevil]

As much as I hate to admit it, the hosemonkey was correct. He had no duty to stop. And if you already had an assignment, he was more than correct to just keep going. Neither your freedom nor your certification was on the line.

Now, if you did not already have an assignment, and the accident looked serious, then he was probably just being a lazy burnout. But still, he was legally in the right. I suggest you actually study the laws that apply to your profession instead of just making assumptions. You left a job over an incorrect assumption.