Poor Intubations in EMS

[northernmedic]

VS I believe you are right about the 20 tube minimum being a CMA thing. We also had to have a min of 20 tubes in the OR but everyone in my class did at least 50 between OR and preceptorship.

[Ace844]

I would wager less than 10% of the paramedics on this forum would know what acronym LEMON stood for in airway evaluation (ooops, I just gave the 'E' away...).

As always I recommend "The manual of emergency airway management" by my friend and yours Dr. Ron Walls. Click on the Amazon thing on the main page and look for it (there ADMIN, now we're even ).

The book is awesome, I have had it for about a year and recommend it to anyone who sees it. It will truly give you a new perspective into the approach of all forms of airway management.

Peace.

WORD.... :wink: 8)

[AZCEP]

I will probably be repeating myself, but here I go anyway.

If you like the book that Dr. Walls wrote, take out the second mortgage and attend the conference that his group puts on. Yes it is pricey for the EMS folk, but it is worth every cent. Well, maybe not cents 48 and 975, but other than that well worth it.

You just can't get all the techniques/tricks down without actually putting blade to plastic with the experts guidance. The best part of the whole program was the BLS airway management. I'll probably burn in ALS hell for saying so, but it's too late now.

Most medical schools will occasionally offer up airway management labs/lectures, and these are good for the same purpose. Anyone that has any experience will have a slightly different take on how to do things. Listening to options makes for a good discussion, if only in your own mind.

[Ridryder 911]

Good discussion guys.. I hate to say, I right off hand don't know what LEMON stands for.. :oops: .. but yet again, ii might have been taught but I have never been the type to try to remember acronyms. ... ( I still have trouble with SOAP...lol)

From what I read this is a newer study, that is what my concern was. Second, my medical director also brought up the number thing... which must be the buzz word in ACEP and EMSP meetings these days. She never really pays much attention otherwise. So I know if she is NOW concern, there must have been a lot of talk & more discussion lately.

Even if the studies are not as represented, we still need to keep abreast of things, and at least make clarifications. We still need to become professional enough, to manage ourselves by enforcing a good thorough QI program. This as some have discussed should have skill retention and review as well. Again, this is OUR profession ans we should be responsible enough to police ourselves and correct our faults.

Professionally,

R/R 911

[ncmedic309]

It's the lack of continuing education in advanced airway management. The initial training for most paramedics is adequate, but in most places your AAM con-ed consists of tubing airway dummies, how helpful is that? There are services out there that require their paramedics to do so many successful intubations in an OR setting each year, but the number of services that actually require that are fairly slim. I'm willing to bet that the number of successful intubations in those services are much better than services that don't offer that type of con-ed experience. If there isn't more efficient training for paramedics, things like this will continue to happen. If it continues to head this direction, they are going to start teaching paramedics just to insert a BIAD and be happy with it, who wants that to happen?

[Ridryder 911]

I am trying to establish a quality management airway program in our service. I have approval from the Chief anesthesiologist, but the EMS is not directly related to the hospital, so working out administrative and malpractice insurance etc.. is giving me grief as well. I know that AHA has a recommended number set, or to use a BIAD. I am afraid more will go towards this in lieu of maintaining airway skills.

In all defense, I am not aware of any physician competency to do the same... non-excusable on our part, but the same should be true on all accountability.

R/R 911

[flight-lp]

It's the lack of continuing education in advanced airway management. The initial training for most paramedics is adequate, but in most places your AAM con-ed consists of tubing airway dummies, how helpful is that? There are services out there that require their paramedics to do so many successful intubations in an OR setting each year, but the number of services that actually require that are fairly slim. I'm willing to bet that the number of successful intubations in those services are much better than services that don't offer that type of con-ed experience. If there isn't more efficient training for paramedics, things like this will continue to happen. If it continues to head this direction, they are going to start teaching paramedics just to insert a BIAD and be happy with it, who wants that to happen?

This is really bugging me because I had read a study recently directly comparing this exact subject and now I can't find it..

The study showed that there is NOT and increase in success by getting OR time, but by continuing to maintain the knowledge base that should be utilized in each and every intubation i.e. proper positioning (if possible, lord knows it usually isn't!), proper evaluation, proper technique etc. I'll keep searching for it, hopefully I'll find it again.

Personally, OR rotations did nothing for me as far as field intubations go. Its like comparing apples to oranges. In the OR you get that perfect NPO patient in the perfect sniffing position that has been sedated or paralyzed in a controlled environment. We all know that the patient we are about to tube will probably have a case of beer and about 6 slices of pizza in him. Not to mention having to tube in awkward positions and having to definitively control the airway in a very uncontrolled environment. It just not the same.............................

[ncmedic309]

This is really bugging me because I had read a study recently directly comparing this exact subject and now I can't find it..

The study showed that there is NOT and increase in success by getting OR time, but by continuing to maintain the knowledge base that should be utilized in each and every intubation i.e. proper positioning (if possible, lord knows it usually isn't!), proper evaluation, proper technique etc. I'll keep searching for it, hopefully I'll find it again.

Personally, OR rotations did nothing for me as far as field intubations go. Its like comparing apples to oranges. In the OR you get that perfect NPO patient in the perfect sniffing position that has been sedated or paralyzed in a controlled environment. We all know that the patient we are about to tube will probably have a case of beer and about 6 slices of pizza in him. Not to mention having to tube in awkward positions and having to definitively control the airway in a very uncontrolled environment. It just not the same.............................

I agree, it's not the same, but it's a hundred times better than tubing a airway dummy, you can't deny that. The two biggest problems I see with AAM is patient positioning and proper use of the laryngoscope blade. Both of those can be properly addressed and taught in an OR rotation, your not going to find a much better con-ed environment anywhere else...

[Ridryder 911]

We can all agree that surgical/intubations is the best or "Gold Standard of intubation education and clinical studies. I assisted in one Paramedic class that we intubated cadavers.. when Oral Roberts had their medical school. There were so many donated bodies each student had their own to practice surgical airway and any other dissection they wanted to etc..

It was not as nice as surgical theater, but; definitely was better than mannequin and the surgical airway and chest etc.. was nice to be able to perform and demonstrate.

Has anyone else used cadavers before?

The other item is what is your satisfaction percentage for QI % for intubation ratios ? .. and how much performance is acceptable before re-education .. and procedures? One of newer Paramedics is modifying QI and our Medical Directors is supporting it.

I also question distance education programs, and some technical programs... do they routinely schedule O.R. rotations ? Our technical program allows observation, & if the physician feels comfortable or allows them too, that is great. Most are only getting exposed to very few ETI, an increase of LMA is now being used for short surgical procedures.

I am attempting to find out if NAMSE has a policy statement or accredit ion requires such..

R/R 911

[flight-lp]

We do cadavers yearly and I agree, they are great for skills maintenence. You are right on the money Rid, a quality QA/QI program with sound integrity in the numbers is key................