Taking Away Paramedic and Pre-hospital Intubation

[Code 8 Paramedic]

So, A few days ago we had a CME at work and our instructor gave us a scare story about how bad pre-hosptial intubation is. I havent had the chance to read any of the recent studies myself, but im hearing that RSI is getting bashed big time. So I just thought id throw it out here and see what everyone thinks about this?

Code 8

[vs-eh?]

So, A few days ago we had a CME at work and our instructor gave us a scare story about how bad pre-hosptial intubation is. I havent had the chance to read any of the recent studies myself, but im hearing that RSI is getting bashed big time. So I just thought id throw it out here and see what everyone thinks about this?

Code 8

http://www.emtcity.com/phpBB2/viewtopic.php?t=3992

How many intubations did you do in the OR/ER under an anesthetists or ER doc's watchful eye prior to precepting?

How many intubations are you required to do during preceptorship?

Have you read/are you required to read any advanced airway texts (Walls manual, etc...)?

I think the above 3 issues should be corrected prior to you worrying about RSI...

[Code 8 Paramedic]

thanks for the link ill check that thread out.

we had to do 10 live intubations in the OR/ride time

currently we dont have any standards for how many intubations you have to do durning precepting, you just need to prove you can.

and we have no requirement for how many tubes you need a year. (personaly i think we need one, and more CE with doing live intubations)

Now we dont have RSI, but it was just something we talked about during that CME. And how even non-assisted intubations were comming under fire from reports across the country

[vs-eh?]

thanks for the link ill check that thread out.

we had to do 10 live intubations in the OR/ride time

currently we dont have any standards for how many intubations you have to do durning precepting, you just need to prove you can.

and we have no requirement for how many tubes you need a year. (personaly i think we need one, and more CE with doing live intubations)

Now we dont have RSI, but it was just something we talked about during that CME. And how even non-assisted intubations were comming under fire from reports across the country

10 "live" combined? You said OR/ride time, so I assume this is both in hospital and during ambulance practicum. Is this an absolute requirement or just a "we'd like to see"?

I should stress that 20 minimum tubes are required in hospital prior to starting ambulance practicum. If you don't get the 20? You go back. Most anesthetist's generally (for the first few anyway) allow you to tube patients that are evaluated with a grade 1 airway +/- edentulous. I assume that is the same everywhere. Teeth for an elective surgery are an anesthetist's number one priority right?

How do you "prove that you can" do an intubation, without having standards? Sedate and intubate a member of your service?

I personally think we should have a minimum number of tubes required per year to. It is a shot in the dark. However, most that are educated now you know have X education and at least have 25+ intubations behind them (minimum).

[Code 8 Paramedic]

We needed 10 intubations, combined between OR and Ride time... everyone got theirs durning OR time but we had ridetime as a back up.. We had a rough time with the OR because they didnt want us there. I had one CRNA tell me "your not f*cking doing my tubes!" We got 1 day a week for 4 weeks in the OR and that was IT, once the month was done, the OR didnt want us back. Thats why we had ride time to fall back on.

As far as the proving you can intubate, you needed at least one successful tube before you can get cut loose.

[vs-eh?]

We needed 10 intubations, combined between OR and Ride time... everyone got theirs durning OR time but we had ridetime as a back up.. We had a rough time with the OR because they didnt want us there. I had one CRNA tell me "your not f*cking doing my tubes!" We got 1 day a week for 4 weeks in the OR and that was IT, once the month was done, the OR didnt want us back. Thats why we had ride time to fall back on.

As far as the proving you can intubate, you needed at least one successful tube before you can get cut loose.

Where I'm from you probably wouldn't be allowed to even enter ambulance preptorship, let alone practicing autonomously.

Why is RSI even being discussed?

*shakes head*

Honestly do the doctors that allow you to practice even care? Are they even aware?

*shakes head*

[Code 8 Paramedic]

ok... get over yourself... standards for training are different all over the country, so are their scopes of practice... and if the OR's wouldnt let you have OR time, you wouldnt have the tubes either, but you make it work.

I guess since I only had to do 10 OR tubes I shouldnt even know what RSI is... Seriously, people can have a conversation about RSI... but dont worry... I wont touch the sucs until you say its ok!

[vs-eh?]

ok... get over yourself... standards for training are different all over the country, so are their scopes of practice... and if the OR's wouldnt let you have OR time, you wouldnt have the tubes either, but you make it work.

I guess since I only had to do 10 OR tubes I shouldnt even know what RSI is... Seriously, people can have a conversation about RSI... but dont worry... I wont touch the sucs until you say its ok!

1. I am not in your country.

2. Perhaps the doctors think that your education is to little. Perhaps your educational institutions should push harder for more time, or simply not allow you to graduate until you meet better standards.

3. A lot of people know (vaguely) what RSI is. At least what the words mean. I don't think RSI should be on normal land ambulance, and I have a fair bit of education. PAI works generally just as well, and at least you aren't paralyzing people. RSI is very dangerous, 2 nasals and an oral with proper BVM technique will adequately ventilate and oxygenate a patient in the VAST majority of cases. Ay least for as long as it takes them to get to a critical care team or hospital.

4. Good, don't touch the succs...

[akroeze]

Kind of Off-topic but I've seen the concept of two nasals and an oral mentioned many times on here. I get the feeling that if I were to bring a pt in like that they would look at me strange due to excessive airways. Isn't one or the other sufficient if you're getting good air flow?

[scratrat]

All I can say is wow

2 nasals and an oral? Why not just intubate since obviously they no longer have an intact gag reflex?

And we don't need RSI. Just something better than Versed which sucks big time. It's a horrible drug c/ far too many side effects (hypotension being my favorite) and I've seen it not do anything to many many people.

Yes, we do need higher standard. I just had this conversation c/ my partner tonight. If we don't tube x amount of people in a 6 month period, we should be given an OR rotation to do x amount of tubes in the OR setting before being allowed to continue working. But as the other guy mentioned, doing OR time as a medic is not fun. They don't want you there, and every tube is a 'difficult' one to them, so they want to do the tube. So how are we supposed to get our tubes when they won't let us? Their just pissed off that we can do their job c/ less training. That might not always be a good thing, but it still needs to be done whether they like it or not.