What are your RSI protocols?

[usalsfyre]

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.

I worked for the City, and it was an online order (there's no EMS supervisors per say over there). Alexandria can also RSI, or at least could when I left several years ago. Arlington and RSI is a new thing, and they took what's probably the correct approach. It needs to be a limited pool of experienced and well educated paramedics with good oversight.

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.

I would say the state of Maine blows this guys argument out of the water...

Edited April 15, 2011 by usalsfyre

[Kiwiology]

RSI here in New Zealand is restricted to select Intensive Care Paramedics and Ambulance (PRIME) Doctors. It's fairly new in that we have had it since 2006 here in Metro Auckland and it is now being expanded nationwide, hence the selectiveness.

In time RSI should be expanded to all Intensive Care Paramedics as it matures.

We use fentanyl, ketamine, suxamethonium and vecuronium.

Our success rate is near 97%

[tcripp]

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

RSI is in our protocols - paramedics push the drugs and intermediates can do the intubation. Drugs include lidocaine, atropine, fentanyl, etomidate, succinylcholine, vecuronium and versed.

[usalsfyre]

Who here is doing awake intubation with a topical and/or dissociative for suspected difficult airway?

[mobey]

Who here is doing awake intubation with a topical and/or dissociative for suspected difficult airway?

We use Ketamine.

I would give more info, but the OP did not respond when I asked him what exactly he wanted.

I am not going to type out our whole protocols

[9OrangeLetters]

Hi, I think this might be my first post (ah, memories to be created...) and how fitting of a topic, but RSI! I'm operating as a Paramedic in Pennsylvania, specifically Eastern. There is no RSI protocol here, per se, but a "sedation-assisted intubation" protocol, which allows for the use of Etomidate or Benzos. We're specifically prohibited from using fentanyl as an induction agent for intubation by protocol, and command physicians are prohbitied from ordering it.

So no paralytics, no narcotics, only a hypnotic or a sedative. Talk about making us work from behind the 8-ball... next thing they're going to give us is a 3 stooges-esque hammer for RSI...

[usalsfyre]

There is no RSI protocol here, per se, but a "sedation-assisted intubation" protocol, which allows for the use of Etomidate or Benzos.

Whoever is writing your protocols needs to do some serious evaluation of the system. Either your medics are good enough to use drugs to intubate, or they aren't. Half assed stuff like this just sets you up to have an obtunded, non-breathing patient with trismus and active regurgitation.

We're specifically prohibited from using fentanyl as an induction agent for intubation by protocol, and command physicians are prohbitied from ordering it.

I am baffled why an opiate would be excluded from the drug sequence...

Edited April 16, 2011 by usalsfyre

[Paramagic]

^^^^^^What he said^^^^^^^

It either needs to be done properly, or not at all.

[Emtpbill]

In PA. It is medication assisted intubation, no paralytics. Versed 5-10mg and only if , and a big if, there are 2 paramedics treating the patient. I wish we had succ. or Vec.

[NYCEMS9115]

Then NYC is way behind. I've sent letters and emails to NYC REMSCO regarding RSI and admitting it into the Training and Protocol. I have not heard anything; I been at this for over a year...