Fire Medics

[FormerEMSLT297]

Havent been on in a while so i appologize for that...

Is it me, or have the level of training and professionalism in this business degraded over the past 15-20 years ????

So, I go on this call the other day. Female stabbed in the chest, with absent lung sounds on the injured side..

Fire based ground unit does a good job and decompresses the chest, even sedated the patient first... sooo cudos for that..

Now the weird part, they advise this is a critical airway and they want us to RSI the Pt.

Only problem, the patient is like a class 4 airway, and she is about 250 lbs. Also she is concsious, breathing, talking, and ohh yeah good BP good pulses, and her O2 Sat is 98%.

I just do not know how paramedics get such tunnel vision..

OK RANT OVER

Edited June 24, 2010 by FormerEMSLT297

[BushyFromOz]

Sorry mate, i don't get where your going, is this a generalised frustration at tunnel vision or is at a stab at the fire establishment?

[Kiwiology]

<TONGUE IN CHEEK>

Lets see .... sounds like this guy needs the works

• Fentanyl 100mcg

• Ketamine 150mg

• Suxamethonium 150mg

• Vecuronium 10mg

Somebody want to get me a 20ml syringe?

</TONGUE IN CHEEK>

[tskstorm]

<TONGUE IN CHEEK>

Lets see .... sounds like this guy needs the works

• Fentanyl 100mcg

• Ketamine 150mg

• Suxamethonium 150mg

• Vecuronium 10mg

Somebody want to get me a 20ml syringe?

</TONGUE IN CHEEK>

Kiwi that would equal a dead patient ..

A class 4 airway is not an easy tube by any means. Essentially the tongue is blocking everything accept the hard pallet. So if someone with a difficult airway is sating well and talking fine .. why bother risk it ?

[HERBIE1]

Havent been on in a while so i appologize for that...

Is it me, or have the level of training and professionalism in this business degraded over the past 15-20 years ????

So, I go on this call the other day. Female stabbed in the chest, with absent lung sounds on the injured side..

Fire based ground unit does a good job and decompresses the chest, even sedated the patient first... sooo cudos for that..

Now the weird part, they advise this is a critical airway and they want us to RSI the Pt.

Only problem, the patient is like a class 4 airway, and she is about 250 lbs. Also she is concsious, breathing, talking, and ohh yeah good BP good pulses, and her O2 Sat is 98%.

I just do not know how paramedics get such tunnel vision..

OK RANT OVER

Critical airway? Wow.

The only thing this person needs is a chest tube because of being decompressed. Barring unknown internal injuries, this person is pretty darned stable.

RSI? How about malpractice?

[scubanurse]

Havent been on in a while so i appologize for that...

Is it me, or have the level of training and professionalism in this business degraded over the past 15-20 years ????

So, I go on this call the other day. Female stabbed in the chest, with absent lung sounds on the injured side..

Fire based ground unit does a good job and decompresses the chest, even sedated the patient first... sooo cudos for that..

Now the weird part, they advise this is a critical airway and they want us to RSI the Pt.

Only problem, the patient is like a class 4 airway, and she is about 250 lbs. Also she is concsious, breathing, talking, and ohh yeah good BP good pulses, and her O2 Sat is 98%.

I just do not know how paramedics get such tunnel vision..

OK RANT OVER

Was this in Maryland? As far as I know MSP Medics were the only ones allowed to RSI?

[uglyEMT]

NJ has started using RSI also. Was wierd seeing it for the first time, wasnt expecting the siezure like shaking.

[Kiwiology]

NJ has started using RSI also. Was wierd seeing it for the first time, wasnt expecting the siezure like shaking.

You get that coz suxamethonium is a defasiculating neuromuscular blockes whereas some others are not but I am not sure whcich ones ... from memory its vecuronium and the likes

[firemedic37]

It seems to me that the ground crew thought that since the patient had a tension pneumothorax that it required the pt to be RSI. It doesn't surprise me. I had a EMT that just finished his Paramedic course and he wanted to bag a pediatric patient with a tension pneumothorax that had a respiratory rate of 34 - 38 per minute with decreased SpO2 levels even with a NRB at 15 lpm. He thought that giving more O2 and tidal volume would improve the patients SpO2 level. Instead I simply said "Let's fix the problem". He just looked at me. So I needle decompressed the patient and the patient became stable and was talking and alert. Continued transport to a Level III Trauma Center. Pt was admitted and discharged a week later.

I think sometimes new and experienced providers just want to do everything because they can and they forget what is in the patients best interestsd.

It is interesting to see that RSI is very limited across the US. Seems that it is usually reserved for HEMS. It is becoming very common for ground units to do RSI. I work for two ALS ground services one hospital based and the other private, both have the same medical director so we all have the same protocols for each service. And it includes RSI for all patients with a compromised airway. We always have the following airway devices and back-up airways; BVM, Suction, Airtrach, Flexable Introducer, Quick-Trach, King LT Airway, Combitube and Oral/Nasal Airways.

I feel that when RSI is correctly used it is a HUGE benefit to EMS, but when used incorrectly it causes great harm to the patient. Every patient that is critical is evaluated for RSI and if it is deemed neccessary it is carried out in the most controlled situation that is possible in EMS. Every crew member must know their job when undertaking this task. No one should have to think about what to do next when something doesn't go the way that they had planned.

As with anything else RSI is a skill that is intended to save patient's airway and not to take ia away.

[FormerEMSLT297]

Maryland State is not the only unit to do RSI, there are even ground providers in the both Maryland and Va. that do RSI... no i am not going to tell you where this occurred, not trying to embarrass anyone, and not this was not a slam on Fire Dept. Medics, it was just a question about why i go to soo many scenes and immediately the ground provider wants me to RSI... There are a ton of good medics in this area, it is just that sometimes they get tunnel vision and I think they even get mad at me when i tell them either this is not a candidate for RSI, or RSI, is not the answer to the problem.... No I have no problem sedating a patient if it is:

A. Medicallt necessary and

B. within Protocols, Heck I've even called for orders to sedate a combative pt, but I just do not see how you want to RSI someone with a Tension Pneumothorax, WHEN YOU ALREAY FIXED THE PROBLEM, as someone else previously stated and cited the Pediatric patient as an example...