EMT's Performing Selected ALS?

[1EMT-P]

Did any of you happen to see the University of Pittsburgh Study on EMT-Basics performing limited ALS during cardiac arrests?

The researchers developed a three hour training module to train EMT-Basics in the use of both LMAs & EZ-IO. Following the training they divided the EMT's into teams of two & conducted simulated V-Fib cardiac arrests. According to the study they found that EMT-Basics were able to insert an LMA 78% of the time with a mean of two attempts and that they were able to insert an IO using the EZ-IO 94% of the time on the first attempt. They concluded that EMT-Basics were moderately successful in performing ALS interventions during cardiac arrest.

Gyette Fx.Rittenberger JC.Platt T.Suffoletto B.Hostler D.Wang HE "Feasibility of basic emergency medical technicians to perform selected advanced life support interventions." Prehospital Emergency Care.2006,10(4):518-521

[vs-eh?]

Do it...

And extrapolating this from a purely procedure vs. education issue (EMT-B vs. PCP).

PCP's should probably be able to do everything an EMT-P or CCEMT-P does...At least procedure wise...

And then ACP's should be able to do what a doctor can do (anything that is simply a physical procedure).

CCP? Perhaps Jesus could weigh in?

A line has to be drawn somewhere.

Jesus?

[akroeze]

And also, just because they can do it does not mean that the pt outcome has been changed.

Besides, I would bet that with some time you could train a monkey to effectively insert an LMA or EZ-IO

[vs-eh?]

Now with the poll up...

Those who think they should, be them basic's or paramedic's...please voice your opinion. A poll means NOTHING without a response to it.

A 3 hour CME? Good Lord!

A solid 120 + 3 (OR DARE I SAY 6) hours has EMT's doing a scope of practice which ALS PARAMEDICS here would be scoffed at for suggesting? Yes, I know that PCP's place LMA's here (rarely, and in all honesty it's not that difficult, even under an anesthetist's concerned eye). PCP's have near ONE THOUSAND hours of JUST DIDACTIC not including clinical and precepting. Let me repeat 800-1000 hours DOES NOT include ambulance time (350-500 hours).

However...

You have to draw a line.

I think the line drawn even at your 120 hours is far beyond the thin red.

[BEorP]

78% of the time is good enough... right guys?

[vs-eh?]

Hmmmm...

Ok...This poll (as of right this minute is 3/3 50%/50%)

Now considering I haven't voted and I assume my Ontario friends are of the "Nye" vote, and I will assume the OP is too...

Those who are in favour please voice your opinion...

Because as far as I am considered it's 100% NO.

Express your opinion...

[JPINFV]

I voted no because having the training with out the education is going to lead to abuse of the skills and equipment. EMTs shouldn't be allowed to play with anything that has a motor besides the electric suction.

That said, time to play devils advocate.

1. The patient is in cardiac arrest, i.e. dead. You can't hurt dead people (but you can make it harder to get them back).

2. LMA specific. LMA=secured airway (not the best, but better than OPA/NPAs)=non-stopped CPR=better perfusion=better chance at a successful defibrillation.

[vs-eh?]

1. The patient is in cardiac arrest, i.e. dead. You can't hurt dead people (but you can make it harder to get them back).

2. LMA specific. LMA=secured airway (not the best, but better than OPA/NPAs)=non-stopped CPR=better perfusion=better chance at a successful defibrillation.

Sorry man...

LMA is not a "secured airway" (an endotracheal tube is). In a can't intubate/pseudo can ventilate situation I am sure that 2 nasal's and an oral is just as good with good manual airway management as an LMA.

An LMA doesn't require pauses in CPR? I.e. 30:2? I find that hard to believe...

And apaprently it doesn't... http://circ.ahajournals.org/cgi/content/fu.../24_suppl/IV-12

Healthcare providers should deliver cycles of compressions and ventilations during CPR when there is no advanced airway (eg, endotracheal tube, laryngeal mask airway [LMA], or esophageal-tracheal combitube [Combitube]) in place. Once an advanced airway is in place for infant, child, or adult victims, 2 rescuers no longer deliver "cycles" of compressions interrupted with pauses for ventilation. Instead, the compressing rescuer should deliver 100 compressions per minute continuously, without pauses for ventilation. The rescuer delivering the ventilations should give 8 to 10 breaths per minute and should be careful to avoid delivering an excessive number of ventilations. The 2 rescuers should change compressor and ventilator roles approximately every 2 minutes to prevent compressor fatigue and deterioration in quality and rate of chest compressions. When multiple rescuers are present, they should rotate the compressor role about every 2 minutes. The switch should be accomplished as quickly as possible (ideally in less than 5 seconds) to minimize interruptions in chest compressions.

Hmmm... I guess an argument could be made that most/all out-of-hsopital cardiac arrests do not have an empty stomach but...

[Asysin2leads]

Sure, give 'em the EZ IO drill. Then they can buy a patch that says "IO Certified". I think 123 hours of training is enough to allow invasive surgical procedures. Why not.

[vs-eh?]