What are your RSI protocols?

[NYCEMS9115]

I currently work in an ICU, but when I did work in the field we used Versed + Morphine + Sux + Vec. There have been studies done that suggest that pre-hospital intubation is causing harm, so it is likely that intubation will be removed from the scope of practice of ground based Paramedics in the future & be replaced with blind insertion devices unless we increase provider education, improve provider airway assessment & intubation skills..

I agree and I have made it known; I am for increase Education for the Basic & Advance Providers. Including, increasing didactic and practical hours. In addition, Degree only Paramedics. But many are against this.

[croaker260]

Back on the original topic...

Here is our RSI/MAI protocol.

http://www.adaweb.net/LinkClick.aspx?fileticket=%2bAHDTKMw3B8%3d&tabid=798

[Quakefire]

Saskatchewan currently has no RSI protocol. To intubate the paramedic either has to have an apnic patient, or contact med control for the intubation (we can do nothing about loc or gag reflex) There is an MFI protocol in the works with versed and fentanyl but no paralytics.

EMTs and EMT-Advanced have King LTs (the EMT-a also has LMA and combitubes)

Medics have ETTs and above skills.

Medics are trained in surgical airways (needle and cric) but are unable to perform the skill

[HotelCo]

Southeast Michigan has no RSI protocol, but we have surgical crics pre-radio. Go figure.

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[usalsfyre]

Southeast Michigan has no RSI protocol, but we have surgical crics pre-radio. Go figure.

This is actually the way it should be in my mind if there's not a strong commitment to RSI. RSI is often a semi-elective procedure, but when you have to cric, nothing else will manage that airway. Edited May 7, 2011 by usalsfyre

[R0B]

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.

I'm a Paramedic in Texas, at the 2 companies I work at (both municipal 911 only) our paramedics can RSI via standing orders.

Protocols call for the consideration of Lidocaine and/or atropine obviously if indicated,

followed by etomidate and succinylcholine, unless they are contraindicated in which case we have the option to do versed or valium with vecuronium. Big fan of the Ronc as well, we dont have it, wish we did... Have a good one man! Rob

[UMSTUDENT]

I'm torn on RSI, but typically believe it should be something that is part of the "universal paramedic toolbox." Why? I've watched so many dumb things happen to patients who truly needed it and where it wasn't available, e.g. head injured, clenched patient who has three paramedics desperately trying to nasally intubate as saturations drop below 80% with poor BVM compliance (with NPA placed). No matter which way you shake it, this patient is going to die if airway access is not achieved relatively quickly.

We don't have RSI in my jurisdiction, but I have intubated both sedated (as part of routine clinicals) and non-sedated patients and can generally say that the paralyzed patient tends to be some of the easiest I've performed. It seems counterintuitive that we would ask our paramedics to intubate in a more difficult fashion and then hold them accountable for the success rates they receive in this austere, less than perfect situation. Then again, I don't personally see what all the "paramedics can't intubate" controversy is about. The advent of ETCO2 waveform capnography seems to have really limited the instances of unrecognized esophageal intubation and better education and fear mongering has really gotten most to realize the importance of confirming an airway.

Really, in my opinion, every jurisdiction should have a robust airway training program which includes hospital time quarterly. The only way, in my opinion, to get good at intubation is to do it a lot, particularly as a new paramedic. I felt like I received this during my first job in a high call volume environment, but many paramedics never receive this exposure, particularly in a rural environment. I feel that where states should get involved in EMS is in things like this. States should pass legislation mandating hospital participation in EMS training programs and provide subsidized premiums for anesthesiologists who allow paramedic intubation. A paramedic should intubate four times quarterly or BAM-automatic OR time.

Edited June 17, 2011 by UMSTUDENT