EMS Research

[Spock]

Those are some good points guys and I think I need to clarify something. 97% of our patients that had an intubation attempt were eventually intubated. I've been looking at first time success rates. My theory is that if there are multiple attempts something else isn't getting done and since most of these patients are cardiac arrests what isn't getting done is probably compressions which we know is more important.

We don't have a true RSI and PA just approved etomidate only assisted intubation. I doubt our medical command system will allow it and I wouldn't let most of our paramedics any where near the drug. Most of the airway evaluation techniques have never been validated scientifically. The best measure of airway evaluation I have seen is the straight edge rule. Take any straight object (such as a pencil) and if the nose, lips and chin don't all touch the straight edge you will have difficulty intubating. A corollary is if the patient can't bite his upper lip you will also have problems. Try it.

I'm not yet at the point where I think medics shouldn't intubate but I can see why some doctors think so and if people don't put more emphasis on airway management it may come to pass.

I would mention that I almost never intubate in the ambulance until someone else has tried. I don't want to take tubes from those that need to perform the skill but after one miss I can't justify not taking over.

Live long and prosper.

Spock.

[Ridryder 911]

I believe you actually found the reason the successful intubation rate has dropped. It is the attitude and stubborness of most medics. Even as one that been intubating for over thirty years, I would welcome any type of education and possible improvement. I admit I have been lucky to probably hit about 95% on the first time, but there is still the 5% I would like to improve upon.

I believe we have lost teaching among Paramedics the emphasis of skill retention and understanding that one has to continuoulsy improve. I have as of yet met any Paramedic (or any other license) is "the all there is and plus some". I have to admit, I met many with that attitude..

R/r 911

[Jinketsu]

Yes.

• 1. Care includes assessment. Without an advanced education, you are not qualified nor capable of competently assessing what level of care your patient needs. Consequently, all emergency patients need a paramedic.

2. The public expects EMS to be capable of responding to the needs of the worst case scenario, not the lowest common denominator. Anybody who staffs their system based upon what minimum they can get by with on most patients is an idiot.

so far i have read several of your replies and you seem nothing more than a cocky medic who thinks their god.get off your high horse and remember your basics and stop thinking you are the best because you can push a couple of drugs.i bet if you had a real trauma job you would wet yourself and calling for bls because you forgot how to put on a band aid

a minute in the street and then you continue your assesment en route.if the pt is critical enough then you get the hell off the scene and call the hsp ahead of time with what you got so this way they can prepare better to treat the pt. ALS=always losing seconds BLS= best life savers thats why you have to be a emt BEFORE you become a paramedic and even then you guys are useless until we get someone who is in arrest.any good trained emt can handle anything and get their pt to the hsp WITHOUT the need of ALS every time.maybe you guys should be better trained out there like we are where i am

[DwayneEMTP]

Perhaps they should add spelling and grammar to your stellar education...

Oh, and I say this so rarely it's difficult to type...

You are an idiot.

Dwayne

[JPINFV]

so far i have read several of your replies and you seem nothing more than a cocky medic who thinks their god.get off your high horse and remember your basics and stop thinking you are the best because you can push a couple of drugs.i bet if you had a real trauma job you would wet yourself and calling for bls because you forgot how to put on a band aid

a minute in the street and then you continue your assesment en route.if the pt is critical enough then you get the hell off the scene and call the hsp ahead of time with what you got so this way they can prepare better to treat the pt. ALS=always losing seconds BLS= best life savers thats why you have to be a emt BEFORE you become a paramedic and even then you guys are useless until we get someone who is in arrest.any good trained emt can handle anything and get their pt to the hsp WITHOUT the need of ALS every time.maybe you guys should be better trained out there like we are where i am

A couple of quick and hard lessons.

1. There is no such thing as ALS or BLS in medicine outside of EMS. It's simply called patient care. There aren't ALS doctors and BLS doctors. The emergency room isn't going to wait to see if oxygen stabilizes a patients condition if it's obvious that the patient needs to be intubated.

2. Ad hominem attacks are looked down upon. The only people who resort to them are people who are grasping for straws. It's better to not post at all then to post a personal attack.

3. The person you are attacking is a well respected member of the forum with numerous years of experience in several different care settings. Unfortunately you are not David of Biblical fame.

4. There is no 4.

5. A witty saying proves nothing (BLS before ALS, ALS=Always losing seconds, etc).

6. A cab driver can get 90% of patients to the hospital just as easy as any EMS provider. EMS is about patient care AND transportation, not just transportation.

7. Basic before Paramedic has been debunked. Simply put, if that system was so great then how come nursing and medical schools haven't adopted it?

8. EMS does not save cardiac arrests. EMS prevents people from going into cardiac arrest. Simply put, paramedics have much more tools and assessment options over basics to obtain that goal.

[Scaramedic]

so far i have read several of your replies and you seem nothing more than a cocky medic who thinks their god.get off your high horse and remember your basics and stop thinking you are the best because you can push a couple of drugs.i bet if you had a real trauma job you would wet yourself and calling for bls because you forgot how to put on a band aid

Umm Dust just got back from Iraq scooter. Have you been to Iraq. I seriously doubt you've stepped outside Mooseknuckle County.

a minute in the street

I'm sure that's not the only that takes you a minute!

and then you continue your assesment en route.if the pt is critical enough then you get the hell off the scene and call the hsp ahead of time with what you got so this way they can prepare better to treat the pt. ALS=always losing seconds BLS= best life savers

I'm sure they are in Mooseknuckle County, especially when Cooter is not working on the Duke boys car and can respond to calls.

thats why you have to be a emt BEFORE you become a paramedic

No you don't.

and even then you guys are useless until we get someone who is in arrest.any good trained emt can handle anything and get their pt to the hsp WITHOUT the need of ALS every time.

No you can't.

maybe you guys should be better trained out there like we are where i am

Hell maybe we should. I mean I've never ran a patient hot for an hour on a squirrel bite, minute man. :wink:

[BVESBC]

Yea, I think everyone else covered the most appropriate responses to your post Get a EDUCATION! I dont think anyone mentioned that.

[tniuqs]

quote=dustdevil

But you do appear to be a little slow on the uptake in matters that threaten your status as a basic provider.[/quote]

Thats fairly applicable, yet what the hell would I know? I am just the village idiots helper. CALLING THE VILLAGE IDIOT where the hell are you, man "we have invading cavemen"

All 4000 posts ++++++ ??? I seriously doubt THAT ! BTW that little number is the current body count from IRAQ reported today!Someone has disrespected a veteran of numerous "little conflicts" and my FRIEND! I have placed my cross hairs on cerbral cotex, its a very small target in passing, I charge you with being an UN American and unsupportive of the very people that support the troops trying to keep that count DOWN! and a HICK.

I accuse you of being "conceptual challenged" in regards to the very word RESEARCH.

You fail miserably.

So looking for intelligent feedback on topics of ETT success rates, Hypertonic saline studies, and how to do EMS research to find when I opened up my links for "EMS research" to find Shyt again ! Thats after I had my morning DUMP, AND my DUMPS are smarter than this stupid head ! GO AWAY you have nothing to contribute.

You are clearly a moron AND not anywhere close to being a trusted EMT basic.

I accuse YOU of disrespecting ALL the GREAT basics in this EMT community, shame shame shame, are you following ? ..... or ...... should ....... I .......... type ........slower ?

ps not checked for spelling cause it just don't matter Jinketsu

SOMEONE CANT FUKIN READ.

Time to keel haul your dumb ass cause its green as grass it is crystal clear. You have again Fuked up a thread / topic that is obviously beyond your peas sized brain ... AGAIN AARGH!

I charge you with a being a repeat offender therfore immediate incarceration, no bail and shared accomodations with BUBA .... he so likes the VIRGINS.

ps not checked for spelling cause it just don't matter Jinketsu YOU CAN'T READ.

SEE SQUINT .... SEE SQUINT HIT , GO AWAY, Useless Fossil / Funeral Driver (s) are Not Welcome, piss off !

ps admin please forgive me but I have just had enough, I will send you a plant because it will grow great with this continuing crap ! Please MODERATE this, it is bringing the site to its knees.

squint #@!%#@! OUT!

[Jinketsu]

i notice that you people bitch about little things in an attempt to justify your answers.ill bet my certification that most of you people work in small cities that wouldnt know what to do with themselves is more than 10 people were hurt all at one time.your hospitals would shit themselves.any good ems provider knows that you should not take forever to asses a pt and get off scene to the hospital like we do here but then again i guess thats why my EMS system is ranked No.1 and thats including the private hospitals and if you dont belive me then look it up in Jems.

[Dustdevil]

Number 1 in what?

And why don't you just tell us where this EMS mecca is, Mr. Anonymous?