EMT's Performing Selected ALS?

[Asysin2leads]

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.

Answers

1: No greater benefit has been shown for a cardiac arrest victim with an additional hole in them. An EMT can't give medications. What's the point of an IV if you're not going to give any meds through it in the field? Giving the ER a helping hand?

2. An LMA + untrained, unskilled provider = broken trachea

VS, I heard they had good buds in Canada, but I had nooooo idea.

[vs-eh?]

2. An LMA + untrained, unskilled provider = broken trachea

With all due respect Asys...They aren't going to be breaking any trachea's with an LMA....At least without a HUGE amount of effort...

[medic001918]

I vote no. With statistics of 78% of the time and 94% of the time, a paramedic would come under heavy fire from medical control. Those kinds of statistics for those skills would be unacceptable by nearly any standard. Having experience with both the LMA and the EZ-IO, 3 hours isn't nearly enough time to allow these providers to use those devices. While the theory of not being able to harm a dead person is being presented, is it fair to a higher level of provider to have a sub par provider either complicate an airway (or fail one by not recognizing that the LMA isn't functioning properly), or to blow an IO site on a patient? If someone's going to blow a site that I can use in an emergent case, I'd rather have it be myself. Then I can't get mad at anyone else.

I think that as a paramedic, I should be able to take a short skills course and be able to perform any skill that a doctor might perform. Somehow, that just doesn't make sense and would never be entertained as an acceptable thought. Why should this be any different?

Shane

NREMT-P

[vs-eh?]

Nobody on the yes side has voiced an opinion...

I find this interesting...

[Asysin2leads]

With all due respect Asys...They aren't going to be breaking any trachea's with an LMA....At least without a HUGE amount of effort...

If EMT-I's can insert an ET tube backward (seen it), some panicky EMT-B somewhere can break a trachea with an LMA, particularly if its someone who already has a tracheal injury. Okay, it would be easier to do with an EOA, but...you could still do it.

[vs-eh?]

If EMT-I's can insert an ET tube backward (seen it), some panicky EMT-B somewhere can break a trachea with an LMA, particularly if its someone who already has a tracheal injury. Okay, it would be easier to do with an EOA, but...you could still do it.

If people are inserting this divice...

http://www.vitaid.com/canada/lma/proseal.htm

or this device...

http://www.tempe.gov/fire/training/Power%2...tube/sld001.htm

wrongly (with any kind of regularity) in your service (NEW YORK CITY)...

YOU MY FRIEND HAVE WAYYYYYYYYY BIGGER FISH TO FRY! Remind me NEVER to go to New York.

I hope this was a joke. An endotachael tube is not the same (nor is it a blind insertion generally) as the above mentioned devices....

This is not a valid comparison...

[Asysin2leads]

Actually, neither are the LMA or the EOA are used in NYC. People are either tubed or they aren't. What I was referring too in the endotracheal tube in backwards was actually from many a year ago during rotations in a very rural area where EMT-I's are used. The breaking of the trachea comes from an over aggressive medic crew from Jersey I saw a report on who stuck an ETT tube through someone's trachea that had been damaged from a hanging.

Now an LMA, I'll admit, is pretty hard to do damage with, though not impossible. An EOA, on the other hand, yes, if you push it in or try to "make it fit" you could easily cause damage to the trachea. If you want to say it is absolutely impossible to do that and both of them are idiot proof, fine, have at ye, but I still say blindly trying to shove something down someone's throat, particularly someone with a damaged airway, with the training that is proposed can be a set up for trouble.

[mediccjh]

F**K NO!

Plain and simple. There is too much anatomy and physiology for some jolly volly EMT from the backwoods of PA, whose company does only 200 jobs a year, that must be learned, and too much for them to f**k up when they get their stiffy going on the cardiac arrest with the new toys. And as was pointed out, what good is another hole that you CAN'T push drugs in?

78% success on a MANNEQUIN? Gimme a break.

DISCLAIMER: I live and work (part time) in PA, and started out as a volly. Therefore, it is within my constitutional right to bash my own Commonwealth, since PA is not a State.

Let the hate mail begin.

[Dustdevil]

Okay, so after this wonderful training, they are now capable of performing the technical procedure successfully 78 percent of the time, Which is, I suspect, roughly on par with the success rate of a monkey given the same training. Hmmm... if their success rate actually performing this very simple technique is no better than that, what do you think their success rate at intelligently and competently evaluating their patient's condition and needs (not so simple) will be?

You've got to be farking kidding me. :roll:

I vote yes, because, with a little more education (about two years worth), they absolutely should be able to do these skills.

[Scaramedic]

Wow VS nice artwork, please don't quit your day job. :wink:

I hate to sound juvenile but am I the only one that thinks the LMA looks like some kind of Japanese sex toy? Seriously would you want that thing rammed down your throat?

I find it interesting that we are always inventing new airways to put in the hands of under educated personnel. Let's be honest this isn't about better patient care it's about money, Basics are a lot cheaper than Paramedics and FD's can whip out a class of Basics in a few weeks. When it comes to EMS the US is always looking for a cheaper way to provide ALS care, this is part of the reason we are becoming the backwoods of EMS.

Oh VS, I talked to Jesus and he says this is the dumbest f*cking idea he has heard since Ecce Homo!

Peace,

Marty