What are your RSI protocols?

[2Rude4MyOwnGood]

Just trying to get an idea of what protocols are for RSI in some other agencies outside of my area.

I was able to assist/observe in an RSI during my last shift and it was all very fascinating to me. Seeing the Succinylcholine go to work was an interesting experience.

In my agency, I's and P's can perform RSI's, but only under the supervision of the EMS Supervisor. The drugs used (Etomidate, Succinylcholine, Vecuronium, etc) arent carried on the medic units, but only in the supervisor's drug box. I only know of one nearby agency that allows their P's to RSI without supervision.

Just looking for some insight into other protocols. Thanks.

[FireMedicChick164]

NY EMT-CC here! RSI is not in protocol here..although my agency does carry valium, versed, and morphine in an electronic safe on the ambulance. They are in protocol for severe pain and seizures. Although we have only been carrying narcs for about a year now and are one of the very few services in the county to do so.

[Bieber]

Nonexistent, though we used to be able to (before my time).

Your agency is seriously allowing EMT-I's to perform RSI? Really? That's shocking, and not in a good way.

[mobey]

What specifically do you want?

[usalsfyre]

Brutane and tincture of fractured teeth... :D

Actually, fentanyl for premeditation, Amidate for sedative/hypnotic and roccuronium (no more MH or K+ concerns for us) for paralysis. As for the actual procedure, look up the national emergency airway algorhytms. Replace "1.5-2mgs/kg of succinylcholine" with "1mg/kg of roccuronium". You now have our RSI protocol.

Edited April 15, 2011 by usalsfyre

[2Rude4MyOwnGood]

Thanks for the replies!

@Bieber, our I's operate almost the same as our P's here in Northern VA. When it comes to RSI, both levels of ALS provider can only push the drugs under the supervision of the EMS Supervisor, but intubation is a skill shared by I' and P's here.

The only difference between I's and P's here is a better understanding of advanced pathophysiology, and surgical airways...i think. There might be something else that im missing but thats all i can think of off the top of my head. Im not saying its right, but its what we've got to work with here. I know that its a touchy subject around here and i completely understand. Our SOP is very broad compared to I's in many states/agencies.

[usalsfyre]

It's easy to forget how farking insane the setup in VA is...

That said, I was only aware of two agencies in Northern VA that performed RSI, I worked for one and did clinicals at the other, both had less than 6 units and I's and P's operated completely interchangably at both (at least when I left). Has some one else added RSI?

[2Rude4MyOwnGood]

It's easy to forget how farking insane the setup in VA is...

That said, I was only aware of two agencies in Northern VA that performed RSI, I worked for one and did clinicals at the other, both had less than 6 units and I's and P's operated completely interchangably at both (at least when I left). Has some one else added RSI?

Arlington is the agency that i was referring to in my original post. I know that Fairfax City does RSI as well, the rest of Fairfax County does not though. From what ive heard, P's in Fairfax City can perform RSI without supervision.

[Paramagic]

Brutane and tincture of fractured teeth... :D.

Haha! I've never met a jaw stronger than my arm or teeth stronger than a laryngoscope wielded in anger!

Fentanyl, versed, then sux (would prefer roc, but I use what I have), morphine and versed for ongoing sedation/pain relief, pancuronium for ongoing paralysis if required (not always, or even that often)

[Bieber]

Thanks for the replies!

@Bieber, our I's operate almost the same as our P's here in Northern VA. When it comes to RSI, both levels of ALS provider can only push the drugs under the supervision of the EMS Supervisor, but intubation is a skill shared by I' and P's here.

The only difference between I's and P's here is a better understanding of advanced pathophysiology, and surgical airways...i think. There might be something else that im missing but thats all i can think of off the top of my head. Im not saying its right, but its what we've got to work with here. I know that its a touchy subject around here and i completely understand. Our SOP is very broad compared to I's in many states/agencies.

It is a touchy subject, and please don't take it personal because I have nothing against you but to be honest paramedics in this country have appalling educational standards, and I say this even with regards to the few places like my state where it's a two year degree, and the idea that someone can start performing RSI or even doing half of the things paramedics do with only two semesters of education is just bad medicine, in my humble opinion.

You're in school to become a paramedic, so I know that increasing your education is important to you--and I applaud you for it. I just can't believe the backwards systems that we have in this country, and trust me it's not unique to Virginia. It's all over, and it keeps our profession down in the gutters when we could be elevating ourselves to truly professional and truly noble heights. I only hope you will be a force for positive change in your system and be one of the few that demands higher standards, rather than one of the many who either calls for a reduction of EMTs and paramedics to mere skill monkeys, or one of those defeatists who call to simply strip EMS down because either "we can't learn" or "there'll always be idiots who aren't capable of treating a dog, let alone a person". Just the other day I encountered someone who was against selective spinal immobilization and C-spine clearance in the field for everyone, because there are too many folks who will screw it up. Educate them, and if they're still too stupid to do it correctly, fire them, is all I have to say on that matter. We need to quit holding ourselves down for the sake of fools and simply give those who are unwilling or incapable of learning or advancing beyond the status quo the boot.

Edited April 15, 2011 by Bieber