Guest guest Posted October 28, 2002 Report Share Posted October 28, 2002 Hello Again! I'll weigh in on at least the Pedi intubation issue....... The American Academy of Pediatrics no longer recommends pedi intubation in the pre-hospital environment as the ROUTINE approach to the low GCS or respiratory failure pedi. High rates of failure and airway injury are the reason for the recommendation. If the airway can be maintained via other techniques, i.e.; OPA/NPA, BVM and aggressive suctioning.........don't intubate. IF you cannot maintain the airway as above........intubate. Just try to maintain it without a tube first. PEDI RSI falls under the above recommendation parameters as well.......use it if you need it. Take each case on it's individual presentation, use intubation as a backup, and be aggressive with the suction catheter. Such is the recommendation of the your local PEPP instructor. NOW........you more learned folks can argue all you want about MAST and Adult RSI . They are still clubs in MY golf bag, I have only used each technique RARELY and with mixed results........ NOW.......was that poor record because a call that would require these techniques is probably a snake-bit, High Pucker-Factor call from the start with a poor morbidity/mortality outcome anyway? Or because the techniques are flawed? Or because my infrequent use of the techniques renders me incompetent in their execution? Or because the data is flawed and the studies are inconclusive? I'll let folks like Dr. Bledsoe, and my Medical Director be my guides on this safari....... Regards, TerryD EMTP PEPPI EMSI PG DM EIEIO Re: SSM BEB, I noticed that you have a thing for numbers and research... My question is --- #1 - Since San Diego ended its study of RSI, should we consider that RSI is something NOT needed in pre-hospital care? #2 - Since Houston concluded their study on MAST, should we remove them from ALL units nationally? #3 - Since LA/Orange Counties concluded their joint study, should we no longer intubate pediatrics? OR should we just consider that those agencies decided that it was NOT for them? What was so bad about your SSM experience because I had no problem with mine. I loved the fact that I had a chance to work with some of the best guys in Southern California [Anaheim FD, Orange County Fire Authority, Orange FD, Buena Park FD - back then, and LA County FD] and would not trade that experience for anything. I am sorry that I had a chance to work for a company that cared for employees and could make a dollar doing it. Yes, I will agree with you that there are some companies with less than acceptable operational practices, using both SSM and station placement. In Southern California, SSM is a GREAT concept due to the lack of real estate, and uncertainty of getting the right location for a station. But you also have to take care of your employees and they did that with us. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2002 Report Share Posted October 28, 2002 Hello Again! I'll weigh in on at least the Pedi intubation issue....... The American Academy of Pediatrics no longer recommends pedi intubation in the pre-hospital environment as the ROUTINE approach to the low GCS or respiratory failure pedi. High rates of failure and airway injury are the reason for the recommendation. If the airway can be maintained via other techniques, i.e.; OPA/NPA, BVM and aggressive suctioning.........don't intubate. IF you cannot maintain the airway as above........intubate. Just try to maintain it without a tube first. PEDI RSI falls under the above recommendation parameters as well.......use it if you need it. Take each case on it's individual presentation, use intubation as a backup, and be aggressive with the suction catheter. Such is the recommendation of the your local PEPP instructor. NOW........you more learned folks can argue all you want about MAST and Adult RSI . They are still clubs in MY golf bag, I have only used each technique RARELY and with mixed results........ NOW.......was that poor record because a call that would require these techniques is probably a snake-bit, High Pucker-Factor call from the start with a poor morbidity/mortality outcome anyway? Or because the techniques are flawed? Or because my infrequent use of the techniques renders me incompetent in their execution? Or because the data is flawed and the studies are inconclusive? I'll let folks like Dr. Bledsoe, and my Medical Director be my guides on this safari....... Regards, TerryD EMTP PEPPI EMSI PG DM EIEIO Re: SSM BEB, I noticed that you have a thing for numbers and research... My question is --- #1 - Since San Diego ended its study of RSI, should we consider that RSI is something NOT needed in pre-hospital care? #2 - Since Houston concluded their study on MAST, should we remove them from ALL units nationally? #3 - Since LA/Orange Counties concluded their joint study, should we no longer intubate pediatrics? OR should we just consider that those agencies decided that it was NOT for them? What was so bad about your SSM experience because I had no problem with mine. I loved the fact that I had a chance to work with some of the best guys in Southern California [Anaheim FD, Orange County Fire Authority, Orange FD, Buena Park FD - back then, and LA County FD] and would not trade that experience for anything. I am sorry that I had a chance to work for a company that cared for employees and could make a dollar doing it. Yes, I will agree with you that there are some companies with less than acceptable operational practices, using both SSM and station placement. In Southern California, SSM is a GREAT concept due to the lack of real estate, and uncertainty of getting the right location for a station. But you also have to take care of your employees and they did that with us. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2002 Report Share Posted October 28, 2002 Hello Again! I'll weigh in on at least the Pedi intubation issue....... The American Academy of Pediatrics no longer recommends pedi intubation in the pre-hospital environment as the ROUTINE approach to the low GCS or respiratory failure pedi. High rates of failure and airway injury are the reason for the recommendation. If the airway can be maintained via other techniques, i.e.; OPA/NPA, BVM and aggressive suctioning.........don't intubate. IF you cannot maintain the airway as above........intubate. Just try to maintain it without a tube first. PEDI RSI falls under the above recommendation parameters as well.......use it if you need it. Take each case on it's individual presentation, use intubation as a backup, and be aggressive with the suction catheter. Such is the recommendation of the your local PEPP instructor. NOW........you more learned folks can argue all you want about MAST and Adult RSI . They are still clubs in MY golf bag, I have only used each technique RARELY and with mixed results........ NOW.......was that poor record because a call that would require these techniques is probably a snake-bit, High Pucker-Factor call from the start with a poor morbidity/mortality outcome anyway? Or because the techniques are flawed? Or because my infrequent use of the techniques renders me incompetent in their execution? Or because the data is flawed and the studies are inconclusive? I'll let folks like Dr. Bledsoe, and my Medical Director be my guides on this safari....... Regards, TerryD EMTP PEPPI EMSI PG DM EIEIO Re: SSM BEB, I noticed that you have a thing for numbers and research... My question is --- #1 - Since San Diego ended its study of RSI, should we consider that RSI is something NOT needed in pre-hospital care? #2 - Since Houston concluded their study on MAST, should we remove them from ALL units nationally? #3 - Since LA/Orange Counties concluded their joint study, should we no longer intubate pediatrics? OR should we just consider that those agencies decided that it was NOT for them? What was so bad about your SSM experience because I had no problem with mine. I loved the fact that I had a chance to work with some of the best guys in Southern California [Anaheim FD, Orange County Fire Authority, Orange FD, Buena Park FD - back then, and LA County FD] and would not trade that experience for anything. I am sorry that I had a chance to work for a company that cared for employees and could make a dollar doing it. Yes, I will agree with you that there are some companies with less than acceptable operational practices, using both SSM and station placement. In Southern California, SSM is a GREAT concept due to the lack of real estate, and uncertainty of getting the right location for a station. But you also have to take care of your employees and they did that with us. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2002 Report Share Posted October 29, 2002 Jane, I agree. In terms of patient care, it's great. BUT, I can see a lot of us " medic as technical skills guru " folks may like PALS better. More a technician course, whereas I think PEPP is more a clinician and more a patient care focused course. Much more applicable to caring for peds patients in the field. But everyone won't like it. Similar to the issues we had at the medical school with students at all levels. Some see themselves as patient people, as people people first. But some as scientists, whose primary purpose is bringing the most advanced scientific techniques to bear on a walking bundle of signs and symptoms. Those folks, focused on the procedures not the patient, won't like PEPP much I think. =Steve= Jane Hill wrote: > ly. I have attended and then taught PEPP, and it was a great course. I think it depends (like ANY class) on WHO is teaching it. The material is terrific. I thought the textbook was very well done and geared more specifically to the prehospital environment. I am also a PALS instructor and find most of it useful for Paramedics only (where as PEPP provides pediatric training for all EMS levels). But most of the PALS course is geared toward the hospital environment. I can see where it can be a useful course for medics who work in hospitals, flight programs, or critical care transfer environments. > > I think comparing PALS to PEPP is comparing apples to oranges. Both have up and down sides, but they each have a different mission. > > Jane Hill > Re: SSM > > > > > > BEB, > > > > I noticed that you have a thing for numbers and research... > > > > My question is --- > > > > #1 - Since San Diego ended its study of RSI, should we consider that RSI > is > > something NOT needed in pre-hospital care? > > > > #2 - Since Houston concluded their study on MAST, should we remove them > from > > ALL units nationally? > > > > #3 - Since LA/Orange Counties concluded their joint study, should we no > > longer intubate pediatrics? > > > > OR should we just consider that those agencies decided that it was NOT > for > > them? > > > > What was so bad about your SSM experience because I had no problem with > mine. > > I loved the fact that I had a chance to work with some of the best guys > in > > Southern California [Anaheim FD, Orange County Fire Authority, Orange > FD, > > Buena Park FD - back then, and LA County FD] and would not trade that > > experience for anything. I am sorry that I had a chance to work for a > company > > that cared for employees and could make a dollar doing it. > > > > Yes, I will agree with you that there are some companies with less than > > acceptable operational practices, using both SSM and station placement. > In > > Southern California, SSM is a GREAT concept due to the lack of real > estate, > > and uncertainty of getting the right location for a station. But you > also > > have to take care of your employees and they did that with us. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 29, 2002 Report Share Posted October 29, 2002 Jane, I agree. In terms of patient care, it's great. BUT, I can see a lot of us " medic as technical skills guru " folks may like PALS better. More a technician course, whereas I think PEPP is more a clinician and more a patient care focused course. Much more applicable to caring for peds patients in the field. But everyone won't like it. Similar to the issues we had at the medical school with students at all levels. Some see themselves as patient people, as people people first. But some as scientists, whose primary purpose is bringing the most advanced scientific techniques to bear on a walking bundle of signs and symptoms. Those folks, focused on the procedures not the patient, won't like PEPP much I think. =Steve= Jane Hill wrote: > ly. I have attended and then taught PEPP, and it was a great course. I think it depends (like ANY class) on WHO is teaching it. The material is terrific. I thought the textbook was very well done and geared more specifically to the prehospital environment. I am also a PALS instructor and find most of it useful for Paramedics only (where as PEPP provides pediatric training for all EMS levels). But most of the PALS course is geared toward the hospital environment. I can see where it can be a useful course for medics who work in hospitals, flight programs, or critical care transfer environments. > > I think comparing PALS to PEPP is comparing apples to oranges. Both have up and down sides, but they each have a different mission. > > Jane Hill > Re: SSM > > > > > > BEB, > > > > I noticed that you have a thing for numbers and research... > > > > My question is --- > > > > #1 - Since San Diego ended its study of RSI, should we consider that RSI > is > > something NOT needed in pre-hospital care? > > > > #2 - Since Houston concluded their study on MAST, should we remove them > from > > ALL units nationally? > > > > #3 - Since LA/Orange Counties concluded their joint study, should we no > > longer intubate pediatrics? > > > > OR should we just consider that those agencies decided that it was NOT > for > > them? > > > > What was so bad about your SSM experience because I had no problem with > mine. > > I loved the fact that I had a chance to work with some of the best guys > in > > Southern California [Anaheim FD, Orange County Fire Authority, Orange > FD, > > Buena Park FD - back then, and LA County FD] and would not trade that > > experience for anything. I am sorry that I had a chance to work for a > company > > that cared for employees and could make a dollar doing it. > > > > Yes, I will agree with you that there are some companies with less than > > acceptable operational practices, using both SSM and station placement. > In > > Southern California, SSM is a GREAT concept due to the lack of real > estate, > > and uncertainty of getting the right location for a station. But you > also > > have to take care of your employees and they did that with us. > > > > > > Quote Link to comment Share on other sites More sharing options...
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