JEMS article regarding Medics and intubation

[p3medic]

What the San Diego study "proved" was how poorly trained the medics were, not weather prehospital intubation for TBI resulted in worse outcomes. They were set up to fail from the beggining. The training was inadequate, the real life intubation training was non existant and the average medic got 2 prehospital tubes!

[fiznat]

These studies don't say anything about the REASON the results are what they are, nor do they attempt to suggest what actions we should take to correct these problems. They can't say either of those things because the data they collected could not possibly support such conclusions.

I'm not saying any of these things, either. I'm not saying paramedics shouldn't intubate. I'm not saying we don't have enough education. I'm saying hey, reliable data suggests the way we do things now doesn't seem to be working very well. Perhaps this offers a bit of insight as to the original topic, which questioned why prehospital RSI may be frowned upon by most doctors.

...And don't take things so personally! These studies aren't saying we're not "good" at intubation, they're saying that prehospitally intubated patients generally have a poorer prognosis. Maybe that is physiological, who knows. We don't have to get our hackles up like this because someone might take away one of our "skillz." Let's look at what matters MOST: are we helping our patients. In the face of all this research, and even amongst whatever "yeah, buts" you can come up with, can you really say intubation makes a difference for your patients? How can you support such a conclusion?

[p3medic]

I'm not taking it personally, no worries there. I just get a bit worked up when these studies suggest we are causing harm, when they are flawed by design. Yes, the San Diego patients intubated prehospitally did worse, but the degree of "training" set them up to fail. Take 50 EM residents and put them through the same training, and let them intubate 2 patients a year and see how they do. EMS systems need to insure that their medics get the education and experience they need, and the medical directors (physicians) heading these systems (and collecting a paycheck to boot) need to make arrangents with the anesthesia staff to get their folks into the OR to manage airways if they are not getting enough tubes in the field. What is enough? Don't know, thats debatable, but I can assure you 2 isn't it.

[fiznat]

True enough. ...Although I did post seven studies. Are ALL of those medics undertrained?

I do agree with you though. I get about 8-10 tubes a year and I know full well I am not nearly as proficient at ETI as I could be. I have unlimited access to mannequins but that really isn't the same, and access the OR is tough when you have to compete with medical students/residents. Even then, intubation of a prepped patient on propofol in the OR is not the same as one with a vomit-filled airway in a dimly lit bathroom on the fifth floor with no elevator...

[spenac]

Our patients should not be punished because of the poor outcomes caused by those that that choose not to excel. The area I work in you can not just rush to the hospital for the doctor to save the day. Your actions or inactions determine the final outcomes of the few real patients that are seen. To not provide an advanced airway in a patient with compromised airway would be sure death. Just because a bunch of lazy slobs can not stay up with their education and skills should not make a blanket change warranted. Take away the patch if the person wearing it does not deserve it.

[Dustdevil]

These studies don't say anything about the REASON the results are what they are, nor do they attempt to suggest what actions we should take to correct these problems. They can't say either of those things because the data they collected could not possibly support such conclusions.

That was a good bit of my point. However, Wang himself is known to further such theories publicly, based upon his study findings.

[fiznat]

To not provide an advanced airway in a patient with compromised airway would be sure death.

What evidence do you have to back up this statement?

Just because a bunch of lazy slobs can not stay up with their education and skills should not make a blanket change warranted. Take away the patch if the person wearing it does not deserve it.

Careful, you're talking about thousands of paramedics here. I posted seven studies, some of which are quite large. Are ALL of those paramedics slobs? What are the chances each of these studies managed to find only the dysfunctional paramedics?

[Dustdevil]

What evidence do you have to back up this statement?

Put a plastic bag over your face for the next ten minutes, then get back to us.

Or not.

[tniuqs]

Our patients should not be punished because of the poor outcomes caused by those that that choose not to excel. The area I work in you can not just rush to the hospital for the doctor to save the day. Your actions or inactions determine the final outcomes of the few real patients that are seen. To not provide an advanced airway in a patient with compromised airway would be sure death. Just because a bunch of lazy slobs can not stay up with their education and skills should not make a blanket change warranted. Take away the patch if the person wearing it does not deserve it.

Zactly: Correct the underlying "root cause" do not punish the patients, I like the way you explain that concept.

Badges pfft ... take away the registration #

[fiznat]

Put a plastic bag over your face for the next ten minutes, then get back to us.

It isn't ETI-or-nothing. Come on.

BVM me. Give me a combi-tube, or an LMA, or a king. High flow O2 as well.

That kind of black and white thinking gets us in trouble. Where is the research (the evidence) that an intubated patient is better off than a bagged or rescue-airway'ed one? I just posted seven studies that suggest that patient might actually be WORSE with a tube in his throat.