RSI vs. Pharmacologicaly Induced intubation

[Niftymedi911]

Word Spock!!!!!

We typically start right where your talking, and i've also seen someone under medicated with propofol and wake up with th tube. Not a pretty thing, if you've got a tube down your throat and 4 lead, spo2, capnograhy, NIBP hanging off of you. Anyway, We have all offline medical guidelines, we do not have to call MD unless we've given the maximum does of Morphine and still wanna give more or we want to pronounce someone dead. So a lot of this training we call "monthly in-service" where we meet our medical director, and he brings in trauma docs locally and upstate and they come down and talk to us on a particular subject. Last month it was based on our new protocols for carring Lopressor on the truck and certain changes in the protocol book. Next month if I'm not mistaken is an airway in-service. We're reguarlly trained and in serviced on new ways of handling things. We also in our agnecy must past a what's called 2 yr skills based credentialing. We have to demostrate all ALS if your a medic and BLS if your an EMT in front of our training department and if we meet standards we're credentialed for the next 2 yrs. If we dont we're either remediated until its done right or the send us back on an FTO truck for 2 months. If they still can't pass that then its game over.

Anyway, the tones dropped and my relief is here so Peace be with you my brothas in EMS!

Fred

[CBEMT]

Careful Croaker- you risk running afoul of "The Elders." :roll:

[Ridryder 911]

Careful Croaker- you risk running afoul of "The Elders." :roll:

Naww.. I know Croaker from other forums. The only disagreement is the "band-aid" system of having multiple responses. Why run BLS and then ALS, when one can have ALS on every call ? Since, the H & P really should be assessed by an ALS provider and then decided if it is warranted, it would be as economically feasible for that ALS provider to transport.

Of course this has been debated and will continue to be debated forever.

I agree with that EMS is placed in the wrong system nationally. Yet, again we have an army wanting us to be removed from DOT to another non medical liaison (project homeland). This of course is for strong political reasons of recent and non-specific grant monies that was being served out.

Until we are placed under a health care umbrella agency, we will never receive substantial amount of funding from payors such as medicare (insurance, medicaid). Yet, again we would have to make a choice of being medical and to respect of that being held accountable academically and professionally, that many EMS is not willing to make. This also means the main focus of the job would have to be providing medical care, not fire fighting, rescue, law enforcement, etc.. this is why there has not been a demand and shift to be united or placed into a public health or medical liaison agency.

Until we have internal regulating medical organizations such as JCAHO to mandate or place pressure upon EMS administrations to maintain quality and performance, EMS will never advance. I would never believe I would ever be endorsing such an organization such as JCAHO, but I do see the need of such. (Although, JCAHO has become out of hand) The current EMS accreditation is a joke, and no EMS administrators see any benefit of a becoming accredited. If medicare and insurance companies placed pressure on EMS services, similar in comparison to hospitals in payment claims, we would see a change, not until then.

All ALS procedures should be monitored through a good QI program which I doubt very many EMS actually have ( and again, they won't until mandated). Then have a system to correct identified problem areas. Just because one identifies weakness is not a success until they correct it and re-evaluate that it has been truly corrected.

R/r 911