RSI - High-risk EMS procedure gets a low level of oversight

[mediccjh]

God forbid we would actually expect to educate our providers, instead of taking things away.

That's it!! Scrap the system and start over.

I hate it when idiot providers make it harder for us who actually know what they're doing.

[jmp6753]

In my area in Washington, we use RSI with great success. We use Sux, Etomidate and Vec. We are required to to attend an "advanced airway" class once every cert period (3 years) and also do an OR rotation. The class covers RSI and if you are unable to secure the airway, you are expected to perform a cric so that procudure is covered with a hands on lab using sheep tracheas. If you have a missed sux tube, you earn a meeting with the MPD and then get to do an additional OR rotation.

[FormerEMSLT297]

RSI in Maryland State as an Optional protocol. MSP Aviation, USPP Aviation, and MedSTAR are using it.

As far as ground providers, I know that Anne Arundel Co. is using it, limited to experienced medics and supervisors.

Alexandria City Fire and several other VA depts. are using it as well.

[Mateo_1387]

Are there statistics that measure if RSI is improving survival rates of patients who qualify for it in the field vs those that do no receive RSI?

[Spock]

Are there statistics that measure if RSI is improving survival rates of patients who qualify for it in the field vs those that do no receive RSI?

Now that is one darn good question. There are a number of studies out but I don't think any of them really answer the question. The San Diego study is frequently mentioned as a reason why medics should not use RSI but the study had serious flaws in my view. We do need research on this and the services that use RSI should think about publishing results. Retrospective to be sure but it would be a start. A double blind study would be difficult since no placebo can mimic the effects of etomidate and suxs.

Live long and prosper.

Spock

[Dustdevil]

San Diego paramedics are a mixed bag. On the positive side, they have many single-role medics and a couple of quality educational institutions there. On the negative sides, the majority of medics in the system are firemonkeys who went to the shortest school they could possibly find, and have a sorely inadequate educational foundation in pharmacology and pathophysiology. Consequently, the results of the study -- and San Diego EMS in general -- gets dumbed down to the lowest common denominator.

If somebody wants to do a study that is actually helpful, why not go do a meta-analysis of all these previous studies, and break down the results by education? Let me know what percentage of the FAILURES (whether it be RSI, intubation, 12-lead interpretation, or whatever) were medic mill monkeys and what percentage were degreed medics. Then we might start to get somewhere. Right now all we know is that they are medics of dubious quality, with a two-day merit badge in RSI.

[ccmedoc]

If somebody wants to do a study that is actually helpful, why not go do a meta-analysis of all these previous studies, and break down the results by education? Let me know what percentage of the FAILURES (whether it be RSI, intubation, 12-lead interpretation, or whatever) were medic mill monkeys and what percentage were degreed medics. Then we might start to get somewhere.

This would be a study I would be very interested in. I think the only way to quell the ranting about taking intubation off of the streets may be this type of study, broken down by educational backgrounds. This may also give a kick in the keister to increasing the educational requirements...period!

At the risk of being overly pessimistic, I may have to look into this in the coming months..

I will take any studies or reference to studies if you want to send them to me..This may be a way to burn off some angst by the pool..

[Happiness]

Im just so glad all I can do is an oral airway and bag em.

Play Safe :wav:

[rock_shoes]

Im just so glad all I can do is an oral airway and bag em.

Play Safe :wav:

Why are you satisfied with an OPA? Please tell me you're kidding. Intubation ,provided the requisite education has been received by the caregiver, is a far superior method of securing an airway. I realize intubation opens up a pretty big can of legal worms but the fact of the matter is we aren't lawyers. Our concern should be for our patients.

Please don't take this as an attack. That isn't the intention. I just believe that improving the standard of care to the highest level possible is the best course of action.

[CBEMT]

CT, I have no idea who's doing it other than Lifestar (HEMS), but I have been told that American Ambulance in Norwich has an Etomidate/Versed protocol.

MA, Lifeflight and Medflight both have it, as well as Boston EMS, Worcester EMS, and I think the Lowell hospital medics. New Bedford EMS is trying to get the special project waiver for it. P3 would know anyone else that has it.

RI, the RIH Lifeguard truck does it, but they also have a doctor on board at all times so I think the rules are a little different.