Newbie EMT here!

[spenac]

However, because of some Paramedics lacking the ability to intubate or not knowing when to stop trying and use an alternative airway or just bag, we are seeing many more swollen and bloodied airways that require the big tools to come out of the closet such as the fiber optic scopes to assist with intubation in the ED. We have definitiely seen a great increase in traumatized airways over the past 5 years. Combi-Tubes have also been part of the problem as some are just not mindful of what they are doing when the ram a tube that large into the throat and inflate cuffs that can do some serious damage if in the wrong place. There are now several pieces of literature being published on this new traumatic trend. Thus, some EDs have beefed up their intubation tools. Many of these patients may require traching if the throat does not heal in 7 - 10 days or if the ETT will further irritate a throat and cords already damaged.

So it is no picnic for those of us in the ED when these botched airways come in. It definitely is not much fun for the patient who may have to adjust to a trach tube for awhile or learn a different way of communicating. The lack of education and proper training of prehospital personnel has a profound affect on the healing process if there are complications of a traumatized airway and aspiration as well as the initial complaint.

My doctors are spoiled was said in fun. I agree with your comments as well though. I have also seen doctors, CRNA's, etc screw up and not know when to back away. I have also seen hospitals request certain Paramedics to come intubate for them. So while there are many bad in EMS we do have some that airway specialists.

One day when education improves though this will not even have to be a discussion.

[VentMedic]

One day when education improves though this will not even have to be a discussion.

I feel rather lucky to have taken my EMT-B and Paramedic training when I did. The 2 year degree was being encouraged for the Paramedic and the EMT-B was stated for what it was, a first-aid course for ambulance drivers. Your medical director was supporting you and your education because the profession had something to prove. The standards were high and the skills were perfected. There was also a pride in doing a few special skills in a very different environment with the trust of your medical director. It also didn't matter what uniform you wore...at least not in the beginning. Back then, the FDs were very selective as to who was chosen to go through Paramedic training.

Of course, as times have changed, even the hospitals I am associated with now will no longer support intubation for Paramedic training within their walls. The ED is barely tolerating the IV training for the medic mill students. They have also been banned from L&D and NICU. PICU will still allow them in but at a distance. This is a shame but the hospitals have a reputation to maintain and if the schools will not screen and instruct their students better on just proper etiquette, not to mention basic procedures, the hospital will have to make the decision for restrictions in favor of their patients. It is a shame a few bad apples from less than reputable schools have forced the hospitals to place these restrictions. The students from other healthcare programs always have their own preceptors, approved by the hospital, monitoring them so any problem is dealt with quickly.

Edited May 26, 2009 by VentMedic

[spenac]

I feel rather lucky to have taken my EMT-B and Paramedic training when I did. The 2 year degree was being encouraged for the Paramedic and the EMT-B was stated for what it was, a first-aid course for ambulance drivers. Your medical director was supporting you and your education because the profession had something to prove. The standards were high and the skills were perfected. There was also a pride in doing a few special skills in a very different environment with the trust of your medical director. It also didn't matter what uniform you wore...at least not in the beginning. Back then, the FDs were very selective as to who was chosen to go through Paramedic training.

Of course, as times have changed, even the hospitals I am associated with now will no longer support intubation for Paramedic training within their walls. The ED is barely tolerating the IV training for the medic mill students. They have also been banned from L&D and NICU. PICU will still allow them in but at a distance. This is a shame but the hospitals have a reputation to maintain and if the schools will not screen and instruct their students better on just proper etiquette, not to mention basic procedures, the hospital will have to make the decision for restrictions in favor of their patients. It is a shame a few bad apples from less than reputable schools have forced the hospitals to place these restrictions. The students from other healthcare programs always have their own preceptors, approved by the hospital, monitoring them so any problem is dealt with quickly.

Glad my school has a good rep. I have been allowed all over the hospitals. Of course while in OR 2 other students from another school were there and they were not allowed to do more than watch. I intubated. Helped adjust vent equipment. Established another IV during ne of the surgerys when they deciided they needed more access. Delivered 2 babys but I do that all the time. ICU had me doing all kinds of care. All the while students from a college program with a well not as ..................... were watching from the sidelines. That would suck to only observe and not be able to do.