Intubation FAIL

[VentMedic]

I think thats a bit over the top with gross generalization there Vent, I know of many RNs with a deer in the headlights look myself .. Thats not MY job .... anyway.

Are you really that insulting of our flight nurses? The LVNs from the nursing homes usually do not apply for a flight or Specialty position. Those that we get to apply are well educated and have an average of 5-10 years in ICUs. Those that want those jobs have no problem stepping up to the requirements.

We could also talk about the Paramedic that only does BLS transfers for many years without intubating or starting a line and then finally gets hired by a 911 service. Or one that has flipped burgers for several years with his Paramedic cert while waiting to get picked up by a FD. Or the Paramedic that does only 5 calls a month.

I do agree more time should be spent with all levels of providers in the use of BVM .. as for butered airways I have seen way more as an RRT from MD residents than Paras, to that end I present a paper by a good friend Dr. Peter Brindley an Assosiate Professor in Intensive Care Medicine. The issue of "in house" for failed intubations by resident Mds on code teams, no real records keep on failure rates oddly enough, as I have said in past I would LOVE to see a good study on ER MDs and GPs in rural areas ... nuff said.

It is too bad that your hospitals do not have more QA stanards than to allow your RRTs and MDs butcher airways in the hospital. If we butchered an airway or misplaced a tube as an RRT, you can bet we would be removed from the patient care areas until the hospital attorneys and the state decided our fate. In CA, one RCP did the unthinkable and now all the RCPs in that state feel the consequences. Nurses are also feeling the effects of the actions of a very few. Yet, when something happens in the world of EMS, how may examine their own abilities or protocols to see if they are covered? Instead, some would rather cry foul without seeing what they can do to improve their system for the benefit of the patient.

It is unfortunate that some hospitals must rely on GPs to intubate. They are not allowed in any of the areas I am familar with and I do know of some ED physicians from the rural areas that come to our intubation classes and ORs for more experience.

How many RNs when they miss an IV say there are studies that show Paramedics miss IVs also as an excuse? How many RRTs would be able to get away with saying that about missed intubations?

Again, trying to show fault with others does not give Paramedics the "right" to not be accountable for their abilities.

Edited August 5, 2009 by VentMedic

[HERBIE1]

Critics? Everyone is picking on EMS..boo hoo. Did one happen to think about the environment you work in?

Hospitals may also change out lines from other hospitals or those done in an emergency situation or under less than idea conditions even if it is in their hospital and done by one of their doctors. If a line is set up with an open port, the whole line is changed. Meds from another hospital are changed out. Florida is even changing the wording in one of it statutes to have the rec'g physician determining what needs to be done for interfacility transport rather then the referring. Enough with this "oh woe is me the poor picked on Paramedic". There is a patient involved and whatever can be done to prevent an infection will be done.

Are you hard-wired to be a d**k or is it something you need to practice?

I was agreeing with you.

Yes, CRITICS. Like some nurses who still live in the past and resent us for our autonomy. Like old school docs who went to medical school in the 1800's. They are certainly not as abundant as they used to be, but they are not gone yet. You can't change someone's opinion, but you can certainly keep from giving them ammunition by doing your job professionally. Do it right, do it by the numbers, and do what's best for the patient.

[CBEMT]

Here it is. 1 infected pre-hospital IV, 4 in-hospital. Evaluated as statistically negligible on both counts.

http://cat.inist.fr/?aModele=afficheN&cpsidt=3492647

Edited August 5, 2009 by CBEMT

[VentMedic]

Are you hard-wired to be a d**k or is it something you need to practice?

I was agreeing with you.

Yes, CRITICS. Like some nurses who still live in the past and resent us for our autonomy. Like old school docs who went to medical school in the 1800's. They are certainly not as abundant as they used to be, but they are not gone yet. You can't change someone's opinion, but you can certainly keep from giving them ammunition by doing your job professionally. Do it right, do it by the numbers, and do what's best for the patient.

This is what I wrote in case you missed it the first time.

Critics? Everyone is picking on EMS..boo hoo. Did one happen to think about the environment you work in?

Hospitals may also change out lines from other hospitals or those done in an emergency situation or under less than idea conditions even if it is in their hospital and done by one of their doctors. If a line is set up with an open port, the whole line is changed. Meds from another hospital are changed out. Florida is even changing the wording in one of it statutes to have the rec'g physician determining what needs to be done for interfacility transport rather then the referring. Enough with this "oh woe is me the poor picked on Paramedic". There is a patient involved and whatever can be done to prevent an infection will be done.

I disagreed with your remarks about critics.

Why must you resort to such ludicrous arguments such as the nurses are just jealous or resentful? Is this the 2nd grade?

No, nurses are not just out to criticize EMS and considering nurses have many more protocols that they can initiate when out of the hospital situation (and inhospital also), I doubt anyone feels threatened by Paramedics. Doctors are also now held accountable for their actions and if they fail, there will be someone to remind them now with the changes in the way a hospital gets reimbursed. You essentially restated what I was disagreeing with you.

The hospitals have already analyzed their areas that need improving. For once why can't EMS do the same instead of blasting people that do point out situations that may need some improvement?

Read the posts before you start with the name calling. It is amazing that some must resort to name calling when they fail with having an appropriate argument.

[medic82942003]

not to get off the subject, but when I started intubating people 14 years ago, your average person

who dropped from a cardiac was 70 kilos and they had a normal airway. Now when I do tubes in

Detroit- the folks are around 300 pounds more with the necks the size of one of my thighs. EMS

has to address this and teach accordingly. Be safe.

[VentMedic]

not to get off the subject, but when I started intubating people 14 years ago, your average person

who dropped from a cardiac was 70 kilos and they had a normal airway. Now when I do tubes in

Detroit- the folks are around 300 pounds more with the necks the size of one of my thighs. EMS

has to address this and teach accordingly. Be safe.

You are not off topic but rather right on the subject.

Many spend time practicing on a manikin that simulates a 70 kilo patient.

Too few are taught to assess difficult airways.

Too many pick their one favorite blade and fail to learn where the other blades can be useful.

Some use the "BLS" and "ALS" crap to guide their way whether they use an alternative airway. "Only EMT-Bs use King tubes or BVMs...not real Paramedics".

Maybe there should be closer monitors for those that don't get at least 2 tubes per year.

Maybe there should be fly cars with an experienced Paramedic to do all the "advanced" stuff and then turn the patient over to the other medics to monitor on the way to the hospital.

Maybe there should be more mandatory retraining periodically.

Maybe there should be a time limit one can hold a Paramedic cert if not employed with an ALS agency without repeating certain parts of the curriculum.

[Just Plain Ruff]

QUOTE (spenac @ Aug 1 2009, 03:59 PM)

OK here is the most practical and simple solution. Remove the CRNA's and have the Paramedics come in and do all intubation and ventilation in the OR. This saves hospitals money and allows all Paramedics to maintain their skills.

Ok, Spenac, I disagree on this one. As a patient I'd much rather have a CRNA who has been to many many more hours or years of schooling intubate me in the OR than a paramedic with a 1000 hours of school, of which only 24 - 36 hours of schooling was focused on respiratory. And then a yearly lab on the manikan and maybe 5-10 or so codes or intubations under their belt.

I'll take that CRNA over the medic any day.

[HERBIE1]

This is what I wrote in case you missed it the first time.

I disagreed with your remarks about critics.

Why must you resort to such ludicrous arguments such as the nurses are just jealous or resentful? Is this the 2nd grade?

Either you are new to this game or your area is far more progressive than mine. I've worked in hospitals for 20+ years and have been in EMS for around 30. I assure you what I said is true for this area and every area I have been involved with. Again, that adverserial attitude is MUCH better than it was, but is not completely gone yet.

No, nurses are not just out to criticize EMS and considering nurses have many more protocols that they can initiate when out of the hospital situation (and inhospital also), I doubt anyone feels threatened by Paramedics. Doctors are also now held accountable for their actions and if they fail, there will be someone to remind them now with the changes in the way a hospital gets reimbursed. You essentially restated what I was disagreeing with you.

Strawman. Read what I said above.

The hospitals have already analyzed their areas that need improving. For once why can't EMS do the same instead of blasting people that do point out situations that may need some improvement?

Again. Read what I said instead of pontificating. Evidence based QA and QI is vital to the future of EMS. Never said they were not.

Read the posts before you start with the name calling. It is amazing that some must resort to name calling when they fail with having an appropriate argument.

Right back at ya. If you have something constructive to say, by all means say it, but lose the attitude. It does not help your argument. Bullying and intimidation may work with the young ones, but not with me.

[spenac]

QUOTE (spenac @ Aug 1 2009, 03:59 PM)

OK here is the most practical and simple solution. Remove the CRNA's and have the Paramedics come in and do all intubation and ventilation in the OR. This saves hospitals money and allows all Paramedics to maintain their skills.

Ok, Spenac, I disagree on this one. As a patient I'd much rather have a CRNA who has been to many many more hours or years of schooling intubate me in the OR than a paramedic with a 1000 hours of school, of which only 24 - 36 hours of schooling was focused on respiratory. And then a yearly lab on the manikan and maybe 5-10 or so codes or intubations under their belt.

I'll take that CRNA over the medic any day.

LOL. Did I forget the sarcastic smiley? Sorry about that.

[VentMedic]

Either you are new to this game or your area is far more progressive than mine. I've worked in hospitals for 20+ years and have been in EMS for around 30. I assure you what I said is true for this area and every area I have been involved with. Again, that adverserial attitude is MUCH better than it was, but is not completely gone yet.

20 years and you seem to have no respect for nurses and MDs? That must have been a rough 20 years for you and those that had to work with you. The one thing that working in a hospital has taught me is teamwork with many different professionals as well as respect for their abilities and education. If you see yourself as being constantly criticized by RNs and MDs, then maybe you have some security issues of your own or you are giving them a reason to criticize you. I do realize that some who have the lesser certs and lesser education do feel "picked on" but you must realize those with the higher credentials and education are not the ones holding you back. When you stop blaming others, you can move forward.

Right back at ya. If you have something constructive to say, by all means say it, but lose the attitude. It does not help your argument. Bullying and intimidation may work with the young ones, but not with me.

Who started the name calling? Were my posts intimidating to you? Bullying you? Gee whiz...

Move on and stop blaming nurses and doctors for any shortcomings you have or for the shape of EMS around you.

Edited August 5, 2009 by VentMedic