Pediatric intubation

[cdcmj]

All of the "hot-topic" controversial issues in EMS right now come back to one thing, and thats education. Improve education and real CE and most of this stuff will go away. OOH anything can be done if it is approached in a responsible and effective way.

[sportygirl]

cdcmj

All of the "hot-topic" controversial issues in EMS right now come back to one thing, and thats education. Improve education and real CE and most of this stuff will go away. OOH anything can be done if it is approached in a responsible and effective way.

So are you all saying that if as EMT-B's and MEDIC's if we had better schooling and training/practice in more skills that it would make patient care allot better?

For example the nabiorgh girl across the street she knows CPR but has never used it and a bout a month ago she came to me because she almost had to use those skills and she was scared that she didn't have enough practice with it and was scared that she wouldn't know/rember what to do. But if she had more practice she would be able to do it better? That would make scene. And this would apply to many things for both EMT's and MEDIC's.

[chbare]

So are you all saying that if as EMT-B's and MEDIC's if we had better schooling and training/practice in more skills that it would make patient care allot better?

For example the nabiorgh girl across the street she knows CPR but has never used it and a bout a month ago she came to me because she almost had to use those skills and she was scared that she didn't have enough practice with it and was scared that she wouldn't know/rember what to do. But if she had more practice she would be able to do it better? That would make scene. And this would apply to many things for both EMT's and MEDIC's.

Actually, we are saying the opposite. Why add more skills when it appears that we may be contributing to bad outcomes when we utilize our current skill set?

How can we advocate for more skills when people still do not even understand basic concepts? I see EMT-B's going through intubation classes who can tube patient's all day long; however, these providers cannot even explain simple concepts such as explain how carbon dioxide is transported or how PH changes effect hemoglobin/oxygen affinity.

Take care,

chbare.

[cdcmj]

sportygirl::So are you all saying that if as EMT-B's and MEDIC's if we had better schooling and training/practice in more skills that it would make patient care allot better?"

Better schooling/training/EDUCATION and continued education/CME has nothing to do with more skills. I never said that. All I mentioned was EDUCATION as it pertains to the scope we as Medic's have now, which as already mentioned, is being stripped away due to incompetency and lack of EDUCATION.

[FL_Medic]

Ok, the education thing is obvious.

Paramedics poor at intubation? Improve training, don't pull the skill. This starts at the beginning. We see every type of patient an ER does, and we are the decision maker and healthcare provider on scene. We have to make the same decisions a physician does for his emergent patients. Yet, we have less schooling than an RN. This is why members of our profession lack proficiency, and in turn we don't get the respect deserved.

The school where I teach wants us to pass everyone. If our fail rate increases, we get punished. This is ridiculous. I'm not saying we shouldn't be accountable, but my instructor passed 15 of us out of 75 students. He taught, but he didn't give breaks. That's how it should be, this is a serioous profession with some not-so-serious individuals getting in to it.

[VentMedic]

Ok, the education thing is obvious.

Paramedics poor at intubation? Improve training, don't pull the skill. This starts at the beginning. We see every type of patient an ER does, and we are the decision maker and healthcare provider on scene. We have to make the same decisions a physician does for his emergent patients. Yet, we have less schooling than an RN. This is why members of our profession lack proficiency, and in turn we don't get the respect deserved.

That is not a good comparison since an RN can do much more than most Paramedics in similar circumstances and this can include intubaton. This is the reason they are essential on Flight, Specialty and CCT. The difference is they know when they need to acquire more education and are more accustomed to profiency monitoring. If an RN has intubation responsibilty on Pedi or Neo teams, they know the importance of maintaining not only the skill but also having the proper educational foundation for airway management and maintenance. There is little or no chance this "skill" will be removed from their protocols for these reasons. Paramedics often believe the "skill" itself is the beginning and end to all.

The school where I teach wants us to pass everyone. If our fail rate increases, we get punished. This is ridiculous. I'm not saying we shouldn't be accountable, but my instructor passed 15 of us out of 75 students. He taught, but he didn't give breaks. That's how it should be, this is a serioous profession with some not-so-serious individuals getting in to it.

Was this instructor instructing or educating? If he was educating, the failure rate should not have been that high unless this was a class that had nothing but wannabes for the wrong reasons. The object is not to see how many students you can fail. Thus, we can get into an instructor vs educator debate. EMS needs more educators who are trained to teach.

Did this class have any prerequisites? If the Paramedic programs were to make a few prerequisites mandatory, that would eliminate more from even applying to a Paramedic program unless they were interested medicine.

Look at the examples in Florida where ETI for adults is now in question. How can you respect an education system that allows medic mills to push through students who may only use mannequins for their intubation checkoffs with no live intubations? How many students are even getting a chance at doing a pedi intubation? If you also look at the reasons people are going through the medic mills, you will find it is not about the medicine. We recently had the FD hiring events for a couple of major south Florida FDs. It was astounding at the number of applicants who were Paramedics but had never worked in EMS or even on an ambulance and will not work in EMS until they get a FD job. You will also find this in other states like California.

Edited April 7, 2009 by VentMedic

[backinboston]

Taking away pediatric intrubations would be a really poor move. There is really no true justification to do it.

Anyone that has access to a tube should know when and where to intubate. I agree that intubating a pedi should be a last resort but at just that, without that last resort we may see an increse in motality.

Anyone that says we need to take away ETT due to lack of tubes is looking as lazy people. If you dont tube atleast 10 people a year, you should be talking to your medical director about getting into the OR to re-up your skills. We need to take it upon ourselves to keep up our skills, as this is a very important one. Many people have been saved by this procedure.

[brentoli]

But..but...but... dad.....

When you save a kids life in a really dramatic "Rescue 911" way you ALWAYS get to be the grand marshal of the 4th of July parade!

[chbare]

Taking away pediatric intrubations would be a really poor move. There is really no true justification to do it.

You could argue that there is not much justification for pediatric intubation.

Unfortunately, the burden is now on us to provide evidence that we can safely and effectively intubate, while contributing to positive outcomes.

Take care,

chbare.

[VentMedic]

Taking away pediatric intrubations would be a really poor move. There is really no true justification to do it.

**********************************

We need to take it upon ourselves to keep up our skills, as this is a very important one. Many people have been saved by this procedure.

The same things were said about intracardiac epi, subclavian central lines, pericardiocentesis, chest tubes and retrograde intubation which were skills commonly used by most Paramedics many years ago. You could also include the MAST into that list and there are some EMT(P)s that still do not want to part with it because it is one less "skill" to list dispite the evidence based literature that does not suppport it.

Edited April 7, 2009 by VentMedic