Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 http://www.star-telegram.com/state_news/story/593026.html ________________________________________________________________________________\ ____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 I think a major " telling " point in the article is the section about the lack of carbon dioxide monitoring devices in many systems. Monitoring CO2 for placement as well as continued placement is vital. And the fact is that too many systems consider the expense too high for the devices themselves and/or the disposable adapters, so they don't purchase them. Other systems purchase and provide them, but give their crews very little training on all of their potential uses and the ABSOLUTE need for its use when intubating. Other systems purchase the much less expensive versions capable of reading CO2 initially but not capable of providing ongoing monitoring. I am one of many Paramedic educators who believe the following statements: 1. RSI should NOT be a standard protocol in the hands necessarily of every Paramedic in your system ( some medics fresh out of school may need more time while other medics just may not ever have the self-confidence level to be comfortable with it no matter how much you train). It requires intense training and ongoing assessments to ensure competency. This includes EVERY aspect including the medications, delivery procedure and intubation techniques including failed intubation techniques. 2. " What to do if your intubation fails " techniques should be taught and there should be a back-up plan and equipment and a back-up for the back-up and that necessary equipment. There is no excuse to not provide things like a Gum Elastic Bougie, an Intubate Mate and/or other inexpensive equipment to help achieve intubation. 3. Carbon dioxide monitoring to include tube placement initial verification and ongoing monitoring should be available, heavily taught, and mandatory in protocol. 4. EVERY intubation, especially RSI procedures, should be monitored retrospectively individually by Medical Control. 5. Medical Control physicians and administration should make a much larger push even than is currently underway to find ways to PUSH the healthcare team in hospitals into understanding, promoting and allowing opportunities for practicing Paramedics (not just students in EMS schools) to practice live intubations in a controlled setting like ER or OR. I realize there are many issues in this area and that it has been discussed at GETAC meetings, but the AAA, the emergency physicians organizations, and others should be pro-active and work avidly with the AHA to achieve this goal - whatever it takes. Anyway, those are my thoughts. I think we should not thrown the baby out with the bathwater. I think we should, as a profession, enforce ways to ensure better education for these medics who are expected to perform the skill, better equipment, and better oversight. In EVERY medical profession, glaring errors in patient management causing patient demise pretty much every day, but unfortunately, the spotlight is on us, and we have to take steps to improve what we do while maintaining the ability to save lives. I personally have utilized this procedure with success many times and without any problems, so I know that it is a useful tool in our toolbox that I would hate to lose. Jane Dinsmore To: texasems-l ; Paramedicine@...: simple_emt@...: Sun, 20 Apr 2008 06:20:30 -0700Subject: Intubation article http://www.star-telegram.com/state_news/story/593026.html_______________________\ ___________________________________Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ _________________________________________________________________ Going green? See the top 12 foods to eat organic. http://green.msn.com/galleries/photos/photos.aspx?gid=164 & ocid=T003MSN51N1653A Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 >>I think a major " telling " point in the article is the section about the lack of carbon dioxide monitoring devices in many systems.<< Not only that, but I saw no mention of the use of a rescue airway in the cases cited. A King LT, Combitube or LMA may have been all that was needed after the failed intubation... ....or hell, just a plain old BVM and an OPA. Systems that implement RSI without addressing intubation skills maintenance, the possibility of failed intubations, and expertise in BLS ventilation are *begging* for trouble, in my opinion - the negligence starts right at the top, with the medical director. -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 Exactly. I did forget to mention those backup rescue airways. I think the problem is not in that we shouldn't be performing the skill, it is that we should be enforcing, in our systems, all of the training, rescue methods, medical control oversight, and appropriate verification and monitoring. Without those things in place, I agree that the system is then negligent. Jane Dinsmore To: texasems-l@...: Grayson902@...: Sun, 20 Apr 2008 09:22:50 -0500Subject: Re: Intubation article >>I think a major " telling " point in the article is the section about the lack of carbon dioxide monitoring devices in many systems.<<Not only that, but I saw no mention of the use of a rescue airway in the cases cited. A King LT, Combitube or LMA may have been all that was needed after the failed intubation......or hell, just a plain old BVM and an OPA.Systems that implement RSI without addressing intubation skills maintenance, the possibility of failed intubations, and expertise in BLS ventilation are *begging* for trouble, in my opinion - the negligence starts right at the top, with the medical director.-- Grayson, CCEMT-Pwww.kellygrayson.com _________________________________________________________________ Going green? See the top 12 foods to eat organic. http://green.msn.com/galleries/photos/photos.aspx?gid=164 & ocid=T003MSN51N1653A Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR part. We must teach our new medics that it's not about pride, it's about the patient. It seems to me that DSHS should add capnography as a new minimum standard on each MICU. Grayson wrote: >>I think a major " telling " point in the article is the section about the lack of carbon dioxide monitoring devices in many systems.<< Not only that, but I saw no mention of the use of a rescue airway in the cases cited. A King LT, Combitube or LMA may have been all that was needed after the failed intubation... .....or hell, just a plain old BVM and an OPA. Systems that implement RSI without addressing intubation skills maintenance, the possibility of failed intubations, and expertise in BLS ventilation are *begging* for trouble, in my opinion - the negligence starts right at the top, with the medical director. -- Grayson, CCEMT-P www.kellygrayson.com , FF/LP/NREMTP " Live your life. Respect its brevity. " FBFD1426@... --------------------------------- Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 The article made a point of mentioning that aeromedical providers usually have a paramedic and a nurse, two trained providers, for a single patient. I wonder how many of the RSI problem incidents involve a challenging patient, and I'm defining " challenging " in any number of ways: combative, clenched, multi-trauma...I think we're all on the same page regarding " challenging " , in the back of a ground ambulance careening through the streets with only one provider in the back. So what, you administered sux and then were unable, for whatever reason, to pass the tube to your satisfaction? Big deal. Suction and BLS airway maneuvers (OPA, NPA, BVM, etc) or rescue airways will handle the vast majority of your patients until they're out of the back of the moving ambulance. For that matter, I've heard it argued pretty convincingly that ETs should never be attempted by a single person in the back of a moving vehicle; success of that specific procedure is important enough to warrant safely pulling out of traffic so the driver can get in the back and assist the attending medic. If the airway is so unstable as to require advanced procedures to control, you should probably have at least one person whose ONLY job is to manage the airway. Several times, I have been dispatched (FD BLS First Responders) simply because the attending Paramedic decided advanced airway maneuvers were necessary, and they wanted additional horsepower in the back during the transport. We arrive on scene and find a sparkling ambulance (once it was stopped in a major intersection, traffic backed up all directions all the way to Chicago, with lights AND SIREN going...and both medics in the back with the patient...we thought the little green men had taken our medics while they were driving...lol), both medics in the back doing their thang to stabilize the patient as best possible with the limited hands they have, and THRILLED to see some BLS folks arrive to assist. Â Phil Reynolds Jr. 115 Harold Dr. Burnet, TX., 78611 HP CP ________________________________________________________________________________\ ____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 I think you guys are correct. So many times, medics forget the old adage, " BLS before ALS and when all else fails, fall back on BLS. " I would be ok with capno being required as long as it was not just the type that only confirms initial placement. Ongoing monitoring is essential, and it is too easy to dislodge what was previously a secure tube while in the back of an ambulance or helicopter. Jane Dinsmore To: texasems-l@...: fbfd1426@...: Sun, 20 Apr 2008 09:34:03 -0700Subject: Re: Intubation article hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR part. We must teach our new medics that it's not about pride, it's about the patient.It seems to me that DSHS should add capnography as a new minimum standard on each MICU. Grayson wrote:>>I think a major " telling " point in the article is the section about the lack of carbon dioxide monitoring devices in many systems.<<Not only that, but I saw no mention of the use of a rescue airway in the cases cited. A King LT, Combitube or LMA may have been all that was needed after the failed intubation.......or hell, just a plain old BVM and an OPA.Systems that implement RSI without addressing intubation skills maintenance, the possibility of failed intubations, and expertise in BLS ventilation are *begging* for trouble, in my opinion - the negligence starts right at the top, with the medical director.-- Grayson, CCEMT-Pwww.kellygrayson.com , FF/LP/NREMTP " Live your life. Respect its brevity. " FBFD1426@...---------------------------------Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 In at least two of the cases the author looked at, one of which I worked on and he didn't mention, the intubations were done by the nurse. In none of the cases was there what could be described as a " difficult airway. " GG > > The article made a point of mentioning that aeromedical providers usually > have a paramedic and a nurse, two trained providers, for a single patient. I > wonder how many of the RSI problem incidents involve a challenging patient, > and I'm defining " challenging " in any number of ways: combative, clenched, > multi-trauma.The article made a point of mentioning that aeromedical provThe > article made a point of mentioning that aeromedical providers usually have a > paramedic and a nurs > So what, you administered sux and then were unable, for whatever reason, to > pass the tube to your satisfaction?  So what, you administered sux and then > were unable, for whatever reason, to pass the tube to your satisfaction?  < > wbr>Big deal. Suction and BLS airway maneuvers (OPA, NPA, BVM, etc) or rescue > airways will handle the vast majority of your patients until they're out of > the back of the moving ambulance. For that matter, I've heard it argued > pretty convincingly that ETs should never be attempted by a single person in the > back of a moving vehicle; success of that specific procedure is important > enough to warrant safely pulling out of traffic so the driver can get in the back > and assist the attending medic. If the airway is so unstable as to requi > Several times, I have been dispatched (FD BLS First Responders) simply > because the attending Paramedic decided advanced airway maneuvers were necessary, > and they wanted additional horsepower in the back during the transport. We > arrive on scene and find a sparkling ambulance (once it was stopped in a major > intersection, traffic backed up all directions all the way to Chicago, with > lights AND SIREN going...and both medics in the back with the patient...we > thought the little green men had taken our medics while they were > driving...lol) Several times, I have been dispatched (FD BLS First Responders) simply > because the attending Paramedic decided advanced airway maneuvers were necessary, > and they wanted ad >  Phil Reynolds Jr. > 115 Harold Dr. > Burnet, TX., 78611 > HP > CP > > ____________ ________ ________ ________ ________ ________ > Be a better friend, newshound, and > know-it-all with Yahoo! Mobile. Try it now. > http://mobile.http://mobhttp://mobile.<whttp://mobile.<wht > > ************** Need a new ride? Check out the largest site for U.S. used car listings at AOL Autos. (http://autos.aol.com/used?NCID=aolcmp00300000002851) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 Yes, is right. Airway management is, in the words of Wes Ogilvie, a continuum of care which involves VENTILATION as the goal, not intubation. Until we get people to stop thinking that intubation is the goal, we will continue to have these disasters. Last weekend I taught the SLAM course in Ft Worth, and one of the students attending was an Army Captain who is a PA who has served on the front lines both in Afghanistan and Iraq. He has done over 30 surgical airways, all under blackout conditions. He does not even carry ET tubes. He uses the King LT exclusively. Now, there must be a good reason for that, don't you think? GG > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient. > > It seems to me that DSHS should add capnography as a new minimum standard on > each MICU. > > Grayson wrote: > >>I think a major " telling " point in the article is the section about > the lack of carbon dioxide monitoring devices in many systems.<< > > Not only that, but I saw no mention of the use of a rescue airway in the > cases cited. A King LT, Combitube or LMA may have been all that was > needed after the failed intubation.. > > ....or hell, just a plain old BVM and an OPA. > > Systems that implement RSI without addressing intubation skills > maintenance, the possibility of failed intubations, and expertise in BLS > ventilation are *begging* for trouble, in my opinion - the negligence > starts right at the top, with the medical director. > > -- > Grayson, CCEMT-P > www.kellygrayson. ww > > , FF/LP/NREMTP > " Live your life. Respect its brevity. " > FBFD1426@... > > ------------ -------- -------- -- > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > now. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 Waveform capnography IS THE STANDARD OF CARE! GG > > > I think you guys are correct. So many times, medics forget the old adage, > " BLS before ALS and when all else fails, fall back on BLS. " > > I would be ok with capno being required as long as it was not just the type > that only confirms initial placement. Ongoing monitoring is essential, and it > is too easy to dislodge what was previously a secure tube while in the back > of an ambulance or helicopter. > Jane Dinsmore > > To: texasems-l@yahoogrotexasems-l@: fbfd1426@...: Sun, 20 Apr 2008 > 09:34:03 -0700Subject: Re: Intubation article > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient.It seems to me that DSHS should add capnography as a new minimum > standard on each MICU. Grayson wrote:>>I think a major > " telling " point in the article is the section about the lack of carbon dioxide > monitoring devices in many systems.<<Not only that, but I saw no mention of > the use of a rescue airway in the cases cited. A King LT, Combitube or LMA > may have been all that was needed after the failed intubation..Not only that, > but I saw no mention of the use of a rescue airway in the cases cited. A King > LT, Combitube or LMA may have been all that was needed after the failed > intubation..<wbr>.....or hell, just a plain old BVM and an OPA.Systems that > implement RSI without addressing intubation skills maintenance, the possibility of > failed intubationNot only that, but I saw no mention of Not only that, but I > saw no mention oFBFD1426@...------------------------------------------< > wbr>---------<wbr>---------<wbr>---Be a better friend, newshound, and > know-it-all with Yahoo! Mobile. Try it now.[Non-text > > ____________ ________ ________ ________ ________ ________ > Going green? See the top 12 foods to eat organic. > http://green.http://green.<wbhttp://grhttp://greenhttp:// & ocid=ocid=<wbr> > T003M > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 20, 2008 Report Share Posted April 20, 2008 Apparently not. This guy was in uniform and had Captain's Bars. GG > > > > Last weekend I taught the SLAM course in Ft Worth, and one of the students > attending was an Army Captain who is a PA who has served on the front lines > both > in Afghanistan and Iraq. He has done over 30 surgical airways, all under > blackout conditions. He does not even carry ET tubes. He uses the King LT > exclusively. Now, there must be a good reason for that, don't you think? > > Gene, I thought that the Army (unlike the Navy and AF), was still?making? > Gene, I thought that the Army (unlike the Navy a > > ck > S. Krin, DO FAAFP > > Re: Intubation article > > Yes, is right. Airway management is, in the words of Wes Ogilvie, a > continuum of care which involves VENTILATION as the goal, not intubation. > Until we get people to stop thinking that intubation is the goal, we will > continue to have these disasters. > > Last weekend I taught the SLAM course in Ft Worth, and one of the students > attending was an Army Captain who is a PA who has served on the front lines > both > in Afghanistan and Iraq. He has done over 30 surgical airways, all under > blackout conditions. He does not even carry ET tubes. He uses the King LT > exclusively. Now, there must be a good reason for that, don't you think? > > GG > > > > > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > > part. We must teach our new medics that it's not about pride, it's about > the > > patient. > > > > It seems to me that DSHS should add capnography as a new minimum standard > on > > each MICU. > > > > Grayson wrote: > > >>I think a major " telling " point in the article is the section about > > the lack of carbon dioxide monitoring devices in many systems.<< > > > > Not only that, but I saw no mention of the use of a rescue airway in the > > cases cited. A King LT, Combitube or LMA may have been all that was > > needed after the failed intubation.. > > > > ....or hell, just a plain old BVM and an OPA. > > > > Systems that implement RSI without addressing intubation skills > > maintenance, the possibility of failed intubations, and expertise in BLS > > ventilation are *begging* for trouble, in my opinion - the negligence > > starts right at the top, with the medical director. > > > > -- > > Grayson, CCEMT-P > > www.kellygrayson. ww > > > > , FF/LP/NREMTP > > " Live your life. Respect its brevity. " > > FBFD1426@... > > > > ------------ -------- -------- -- > > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > > now. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 Last weekend I taught the SLAM course in Ft Worth, and one of the students attending was an Army Captain who is a PA who has served on the front lines both in Afghanistan and Iraq. He has done over 30 surgical airways, all under blackout conditions. He does not even carry ET tubes. He uses the King LT exclusively. Now, there must be a good reason for that, don't you think? Gene, I thought that the Army (unlike the Navy and AF), was still?making?PA's Warrant Officers, not Commissioned officers? ck S. Krin, DO FAAFP Re: Intubation article Yes, is right. Airway management is, in the words of Wes Ogilvie, a continuum of care which involves VENTILATION as the goal, not intubation. Until we get people to stop thinking that intubation is the goal, we will continue to have these disasters. Last weekend I taught the SLAM course in Ft Worth, and one of the students attending was an Army Captain who is a PA who has served on the front lines both in Afghanistan and Iraq. He has done over 30 surgical airways, all under blackout conditions. He does not even carry ET tubes. He uses the King LT exclusively. Now, there must be a good reason for that, don't you think? GG > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient. > > It seems to me that DSHS should add capnography as a new minimum standard on > each MICU. > > Grayson wrote: > >>I think a major " telling " point in the article is the section about > the lack of carbon dioxide monitoring devices in many systems.<< > > Not only that, but I saw no mention of the use of a rescue airway in the > cases cited. A King LT, Combitube or LMA may have been all that was > needed after the failed intubation.. > > ....or hell, just a plain old BVM and an OPA. > > Systems that implement RSI without addressing intubation skills > maintenance, the possibility of failed intubations, and expertise in BLS > ventilation are *begging* for trouble, in my opinion - the negligence > starts right at the top, with the medical director. > > -- > Grayson, CCEMT-P > www.kellygrayson. ww > > , FF/LP/NREMTP > " Live your life. Respect its brevity. " > FBFD1426@... > > ------------ -------- -------- -- > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > now. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 Depends on under grad status. My PC Provider was a career army PA who had a BS in biochemistry before PA school an was made a 2nd 01:48:20 upon his induction. He's insulted if I call him Doctor LNM Sent via BlackBerry by AT & T Re: Intubation article Yes, is right. Airway management is, in the words of Wes Ogilvie, a continuum of care which involves VENTILATION as the goal, not intubation. Until we get people to stop thinking that intubation is the goal, we will continue to have these disasters. Last weekend I taught the SLAM course in Ft Worth, and one of the students attending was an Army Captain who is a PA who has served on the front lines both in Afghanistan and Iraq. He has done over 30 surgical airways, all under blackout conditions. He does not even carry ET tubes. He uses the King LT exclusively. Now, there must be a good reason for that, don't you think? GG > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient. > > It seems to me that DSHS should add capnography as a new minimum standard on > each MICU. > > Grayson wrote: > >>I think a major " telling " point in the article is the section about > the lack of carbon dioxide monitoring devices in many systems.<< > > Not only that, but I saw no mention of the use of a rescue airway in the > cases cited. A King LT, Combitube or LMA may have been all that was > needed after the failed intubation.. > > ....or hell, just a plain old BVM and an OPA. > > Systems that implement RSI without addressing intubation skills > maintenance, the possibility of failed intubations, and expertise in BLS > ventilation are *begging* for trouble, in my opinion - the negligence > starts right at the top, with the medical director. > > -- > Grayson, CCEMT-P > www.kellygrayson. ww > > , FF/LP/NREMTP > " Live your life. Respect its brevity. " > FBFD1426@... > > ------------ -------- -------- -- > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > now. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 I see them all the time at levels up to O-3 in the Army Special Forces. I know the Command Surgeon USSOCOM tried to promote one Later career PA to O-4 and was unsuccessful. BEB From: texasems-l [mailto:texasems-l ] On Behalf Of krin135@... Sent: Monday, April 21, 2008 1:33 AM To: texasems-l Subject: Re: Intubation article Last weekend I taught the SLAM course in Ft Worth, and one of the students attending was an Army Captain who is a PA who has served on the front lines both in Afghanistan and Iraq. He has done over 30 surgical airways, all under blackout conditions. He does not even carry ET tubes. He uses the King LT exclusively. Now, there must be a good reason for that, don't you think? Gene, I thought that the Army (unlike the Navy and AF), was still?making?PA's Warrant Officers, not Commissioned officers? ck S. Krin, DO FAAFP Re: Intubation article Yes, is right. Airway management is, in the words of Wes Ogilvie, a continuum of care which involves VENTILATION as the goal, not intubation. Until we get people to stop thinking that intubation is the goal, we will continue to have these disasters. Last weekend I taught the SLAM course in Ft Worth, and one of the students attending was an Army Captain who is a PA who has served on the front lines both in Afghanistan and Iraq. He has done over 30 surgical airways, all under blackout conditions. He does not even carry ET tubes. He uses the King LT exclusively. Now, there must be a good reason for that, don't you think? GG In a message dated 4/20/08 10:50:29 AM, fbfd1426@... <mailto:fbfd1426%40yahoo.com> writes: > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient. > > It seems to me that DSHS should add capnography as a new minimum standard on > each MICU. > > Grayson <Grayson902@... <mailto:Grayson902%40aol.Gra> > wrote: > >>I think a major " telling " point in the article is the section about > the lack of carbon dioxide monitoring devices in many systems.<< > > Not only that, but I saw no mention of the use of a rescue airway in the > cases cited. A King LT, Combitube or LMA may have been all that was > needed after the failed intubation.. > > ....or hell, just a plain old BVM and an OPA. > > Systems that implement RSI without addressing intubation skills > maintenance, the possibility of failed intubations, and expertise in BLS > ventilation are *begging* for trouble, in my opinion - the negligence > starts right at the top, with the medical director. > > -- > Grayson, CCEMT-P > www.kellygrayson. ww > > , FF/LP/NREMTP > " Live your life. Respect its brevity. " > FBFD1426@... <mailto:FBFD1426%40yahoo.FBF> > > ------------ -------- -------- -- > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > now. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 When I got out in 1992 Army PA's were just starting to receive their commissions. Our CW-3 and CW-4's received CPT and MAJ commissions. The chief of the PA section at HSC or AMMED, I don't remember where he was stationed, became an O-6. AJL > > > > > > > Last weekend I taught the SLAM course in Ft Worth, and one of the students > attending was an Army Captain who is a PA who has served on the front lines > both > in Afghanistan and Iraq. He has done over 30 surgical airways, all under > blackout conditions. He does not even carry ET tubes. He uses the King LT > exclusively. Now, there must be a good reason for that, don't you think? > > Gene, I thought that the Army (unlike the Navy and AF), was > still?making?PA's Warrant Officers, not Commissioned officers? > > ck > S. Krin, DO FAAFP > > > Re: Intubation article > > > Yes, is right. Airway management is, in the words of Wes Ogilvie, a > continuum of care which involves VENTILATION as the goal, not intubation. > Until we get people to stop thinking that intubation is the goal, we will > continue to have these disasters. > > Last weekend I taught the SLAM course in Ft Worth, and one of the students > attending was an Army Captain who is a PA who has served on the front lines > both > in Afghanistan and Iraq. He has done over 30 surgical airways, all under > blackout conditions. He does not even carry ET tubes. He uses the King LT > exclusively. Now, there must be a good reason for that, don't you think? > > GG > > > > > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > > part. We must teach our new medics that it's not about pride, it's about > the > > patient. > > > > It seems to me that DSHS should add capnography as a new minimum standard > on > > each MICU. > > > > Grayson wrote: > > >>I think a major " telling " point in the article is the section about > > the lack of carbon dioxide monitoring devices in many systems.<< > > > > Not only that, but I saw no mention of the use of a rescue airway in the > > cases cited. A King LT, Combitube or LMA may have been all that was > > needed after the failed intubation.. > > > > ....or hell, just a plain old BVM and an OPA. > > > > Systems that implement RSI without addressing intubation skills > > maintenance, the possibility of failed intubations, and expertise in BLS > > ventilation are *begging* for trouble, in my opinion - the negligence > > starts right at the top, with the medical director. > > > > -- > > Grayson, CCEMT-P > > www.kellygrayson. ww > > > > , FF/LP/NREMTP > > " Live your life. Respect its brevity. " > > FBFD1426@... > > > > ------------ -------- -------- -- > > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > > now. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 But surprisingly enough, there are still so many services that fail to provide that standard even so.... Jane Dinsmore To: texasems-l@...: wegandy1938@...: Mon, 21 Apr 2008 00:12:16 -0400Subject: Re: Intubation article Waveform capnography IS THE STANDARD OF CARE! GGIn a message dated 4/20/08 10:59:13 AM, texas.paramedic@... writes:> > > I think you guys are correct. So many times, medics forget the old adage, > " BLS before ALS and when all else fails, fall back on BLS. " > > I would be ok with capno being required as long as it was not just the type > that only confirms initial placement. Ongoing monitoring is essential, and it > is too easy to dislodge what was previously a secure tube while in the back > of an ambulance or helicopter.> Jane Dinsmore> > To: texasems-l@yahoogrotexasems-l@: fbfd1426@...: Sun, 20 Apr 2008 > 09:34:03 -0700Subject: Re: Intubation article> > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient.It seems to me that DSHS should add capnography as a new minimum > standard on each MICU. Grayson wrote:>>I think a major > " telling " point in the article is the section about the lack of carbon dioxide > monitoring devices in many systems.<<Not only that, but I saw no mention of > the use of a rescue airway in the cases cited. A King LT, Combitube or LMA > may have been all that was needed after the failed intubation..Not only that, > but I saw no mention of the use of a rescue airway in the cases cited. A King > LT, Combitube or LMA may have been all that was needed after the failed > intubation..<wbr>.....or hell, just a plain old BVM and an OPA.Systems that > implement RSI without addressing intubation skills maintenance, the possibility of > failed intubationNot only that, but I saw no mention of Not only that, but I > saw no mention oFBFD1426@...------------------------------------------<> wbr>---------<wbr>---------<wbr>---Be a better friend, newshound, and > know-it-all with Yahoo! Mobile. Try it now.[Non-text> > ____________ ________ ________ ________ ________ ________> Going green? See the top 12 foods to eat organic.> http://green.http://green.<wbhttp://grhttp://greenhttp:// & ocid=ocid=<wbr>> T003M> > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 And still EMS is ahead of hospital emergency departments in providing WFC. We take a patient in being monitored, and the monitoring can't continue in the ED. That's a breakdown in care. G > > > But surprisingly enough, there are still so many services that fail to > provide that standard even so.... > > Jane Dinsmore > > To: texasems-l@yahoogrotexasems-l@: wegandy1938@wegandy1938: Mon, 21 Apr > 2008 00:12:16 -0400Subject: Re: Intubation article > > Waveform capnography IS THE STANDARD OF CARE! GGIn a message dated 4/20/08 > 10:59:13 AM, texas.paramedic@... writes:> > > I think you guys are > correct. So many times, medics forget the old adage, > " BLS before ALS and when > all else fails, fall back on BLS. " > > I would be ok with capno being required > as long as it was not just the type > that only confirms initial placement. > Ongoing monitoring is essential, and it > is too easy to dislodge what was > previously a secure tube while in the back > of an ambulance or helicopter.> > Jane Dinsmore> > To: texasems-l@yahoogro To: texa To:fbfd1426@...: > Sun, 20 Apr 2008 > 09:34:03 -0700Subject: Re: Intubation article> > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > > part. We must teach our new medics that it's not about pride, it's about the > > patient.It seems to me that DSHS should add capnography as a new minimum > > standard on each MICU. Grayson wrote:>>I think a > major > " telling " point in the article is the section about the lack of > carbon dioxide > monitoring devices in many systems.<<Not only that, but I saw no > mention of > the use of a rescue airway in the cases cited. A King LT, > Combitube or LMA > may have been all that was needed after the failed intubation.. > may have been > but I saw no mention of the use of a rescue airway in the > cases cited. A King > LT, Combitube or LMA may have been all that was needed > after the failed > intubation..<wbr>........<wbr>.or hell, just a plain old BVM > and an OPA.Syst> implement RSI without addressing intubation skills > maintenance, the possibility of > failed intubationNot only that, but I saw no mention > of Not only that, but I > saw no mention > oFBFD1426@...------------------------------------------<> wbr>---------<wbr>------<wb<wbr><wbr>---Be a > better friend, newshound,> know-it-all with Yahoo! Mobile. Try it now.[Non-text> > > ____________ ________ ________ ________ ________ ________> Going green? > See the top 12 foods to eat organic.> http://green.http://green.< > wbhttp://grhttp:wbhttp://grhwb & ocid=ocid=<wbr>> T003M> > [Non-text portions of this message > have been removed]> > > ************ ************<wbr>**Need a new ride? > Check out the largest site for U.S. used car listi > http://autos.http://autos.http://autos.<wbhttp://au)[Non-text portions of this message have been removed] > > ____________ ________ ________ ________ ________ ________ > Get in touch in an instant. Get Windows Live Messenger now. > > http://www.windowslhttp://www.windohttp://www.http://wwwhttp://wwwhttp://www.htt\ p://www.http:/ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 Yes indeed. Ventilation is the overall standard of care, not intubation. As you say, WFC is the standard of care for monitoring. Unfortunately, I'm probably not going to be able to make it to EMStock because of conflicts. G > > > > Waveform capnography IS THE STANDARD OF CARE! > > NO! Proper ventilation, with?ADEQUATE c spine protection, by what ever > means, is the standard of care... > > Waveform capnography as a " Best Practice " monitoring standard, yes. > > as THE standard of care, harder to defend. > > Sounds like a case for EMSTOCK, Gene... > > ck > S. Krin, DO FAAFP > > Re: Intubation article > > > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > > part. We must teach our new medics that it's not about pride, it's about > the > > patient.It seems to me that DSHS should add capnography as a new minimum > > standard on each MICU. Grayson wrote:>>I think > a major > > " telling " point in the article is the section about the lack of carbon > dioxide > > monitoring devices in many systems.<<Not only that, but I saw no mention > of > > the use of a rescue airway in the cases cited. A King LT, Combitube or LMA > > may have been all that was needed after the failed intubation.. may have > been > > but I saw no mention of the use of a rescue airway in the cases cited. A > King > > LT, Combitube or LMA may have been all that was needed after the failed > > intubation..<wbr>........<wbr>.or hell, just a plain old BVM and an > OPA.Syst > > implement RSI without addressing intubation skills maintenance, the > possibility of > > failed intubationNot only that, but I saw no mention of Not only that, but > I > > saw no mention oFBFD1426@... > ------------------------------------------< > > wbr>---------<wbr>------<wb<wbr><wbr>---Be a better friend, newshound, > > know-it-all with Yahoo! Mobile. Try it now.[Non-text > > > > ____________ ________ ________ ________ ________ ________ > > Going green? See the top 12 foods to eat organic. > > http://green.http://green.<wbhttp://grhttp:wbhttp://grhwb & ocid=ocid=<wbr> > > T003M > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 Waveform capnography IS THE STANDARD OF CARE! NO! Proper ventilation, with?ADEQUATE c spine protection, by what ever means, is the standard of care... Waveform capnography as a " Best Practice " monitoring standard, yes. as THE standard of care, harder to defend. Sounds like a case for EMSTOCK, Gene... ck S. Krin, DO FAAFP Re: Intubation article > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > part. We must teach our new medics that it's not about pride, it's about the > patient.It seems to me that DSHS should add capnography as a new minimum > standard on each MICU. Grayson wrote:>>I think a major > " telling " point in the article is the section about the lack of carbon dioxide > monitoring devices in many systems.<<Not only that, but I saw no mention of > the use of a rescue airway in the cases cited. A King LT, Combitube or LMA > may have been all that was needed after the failed intubation..Not only that, > but I saw no mention of the use of a rescue airway in the cases cited. A King > LT, Combitube or LMA may have been all that was needed after the failed > intubation..<wbr>.....or hell, just a plain old BVM and an OPA.Systems that > implement RSI without addressing intubation skills maintenance, the possibility of > failed intubationNot only that, but I saw no mention of Not only that, but I > saw no mention oFBFD1426@...------------------------------------------< > wbr>---------<wbr>---------<wbr>---Be a better friend, newshound, and > know-it-all with Yahoo! Mobile. Try it now.[Non-text > > ____________ ________ ________ ________ ________ ________ > Going green? See the top 12 foods to eat organic. > http://green.http://green.<wbhttp://grhttp://greenhttp:// & ocid=ocid=<wbr> > T003M > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2008 Report Share Posted April 22, 2008 I would like to know how many of us only completed 700 hours of training. Or how many of us uses a dripping drug to facilitate paralysis. Therre are several miss quotes in this article. I do agree that education is the key. A failed airway is unacceptable by any means. The seasoned medics I have here in my organization feel the same way. It is not pride that causes an intubation but the overall distress of the patient. Maybe there needs to be a seperate certification that permits the practice of RSI. RSI needs to be taught at the cellular level on up to the actual procedure and its benefits and hazards instead of, " this is how you do it, " mentality. wegandy1938@... wrote: Yes indeed. Ventilation is the overall standard of care, not intubation. As you say, WFC is the standard of care for monitoring. Unfortunately, I'm probably not going to be able to make it to EMStock because of conflicts. G > > > > Waveform capnography IS THE STANDARD OF CARE! > > NO! Proper ventilation, with?ADEQUATE c spine protection, by what ever > means, is the standard of care... > > Waveform capnography as a " Best Practice " monitoring standard, yes. > > as THE standard of care, harder to defend. > > Sounds like a case for EMSTOCK, Gene... > > ck > S. Krin, DO FAAFP > > Re: Intubation article > > > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR > > part. We must teach our new medics that it's not about pride, it's about > the > > patient.It seems to me that DSHS should add capnography as a new minimum > > standard on each MICU. Grayson wrote:>>I think > a major > > " telling " point in the article is the section about the lack of carbon > dioxide > > monitoring devices in many systems.<<Not only that, but I saw no mention > of > > the use of a rescue airway in the cases cited. A King LT, Combitube or LMA > > may have been all that was needed after the failed intubation.. may have > been > > but I saw no mention of the use of a rescue airway in the cases cited. A > King > > LT, Combitube or LMA may have been all that was needed after the failed > > intubation..<wbr>........<wbr>.or hell, just a plain old BVM and an > OPA.Syst > > implement RSI without addressing intubation skills maintenance, the > possibility of > > failed intubationNot only that, but I saw no mention of Not only that, but > I > > saw no mention oFBFD1426@... > ------------------------------------------< > > wbr>---------<wbr>------<wb<wbr><wbr>---Be a better friend, newshound, > > know-it-all with Yahoo! Mobile. Try it now.[Non-text > > > > ____________ ________ ________ ________ ________ ________ > > Going green? See the top 12 foods to eat organic. > > http://green.http://green.<wbhttp://grhttp:wbhttp://grhwb & ocid=ocid=<wbr> > > T003M > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2008 Report Share Posted April 22, 2008 My paramedic course at UTHSC Houston in 1981 was 400 hours, 160 of which was in the classroom. At Tyler Junior College, the paramedic course curriculum I designed in 1990 was 1270 hours before the new curriculum came out which doubled it. Since then they have reduced it, I think, but it's still way more than 700 hours. As one writer so aptly said, it takes over 1,500 hours to learn how to cut hair, and around 2,500 hours to become an embalmer. GG > > I would like to know how many of us only completed 700 hours of training. Or > how many of us uses a dripping drug to facilitate paralysis. Therre are > several miss quotes in this article. I do agree that education is the key. A > failed airway is unacceptable by any means. The seasoned medics I have here in my > organization feel the same way. It is not pride that causes an intubation > but the overall distress of the patient. Maybe there needs to be a seperate > certification that permits the practice of RSI. RSI needs to be taught at the > cellular level on up to the actual procedure and its benefits and hazards > instead of, " this is how you do it, " mentality. > > wegandy1938@wegandy wrote: Yes indeed. Ventilation is the overall standard > of care, not intubation. > As you say, WFC is the standard of care for monitoring. > > Unfortunately, I'm probably not going to be able to make it to EMStock > because of conflicts. > > G > > > > > > > > > > Waveform capnography IS THE STANDARD OF CARE! > > > > NO! Proper ventilation, with?ADEQUATE c spine protection, by what ever > > means, is the standard of care... > > > > Waveform capnography as a " Best Practice " monitoring standard, yes. > > > > as THE standard of care, harder to defend. > > > > Sounds like a case for EMSTOCK, Gene... > > > > ck > > S. Krin, DO FAAFP > > > > Re: Intubation article > > > > > > hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on > OUR > > > part. We must teach our new medics that it's not about pride, it's about > > the > > > patient.It seems to me that DSHS should add capnography as a new minimum > > > standard on each MICU. Grayson wrote:>>I > think > > a major > > > " telling " point in the article is the section about the lack of carbon > > dioxide > > > monitoring devices in many systems.<<Not only that, but I saw no mention > > of > > > the use of a rescue airway in the cases cited. A King LT, Combitube or > LMA > > > may have been all that was needed after the failed intubation.. may have > > been > > > but I saw no mention of the use of a rescue airway in the cases cited. A > > King > > > LT, Combitube or LMA may have been all that was needed after the failed > > > intubation..<wbr>........<wbr><wbr>.or hell, just a plain old BVM an > > OPA.Syst > > > implement RSI without addressing intubation skills maintenance, the > > possibility of > > > failed intubationNot only that, but I saw no mention of Not only that, > but > > I > > > saw no mention oFBFD1426@... > > ------------ -------- -------- -------- --< > > > wbr>---------<wbr>------<wb<wbr><wbr>---Be a better friend, newshound, > > > know-it-all with Yahoo! Mobile. Try it now.[Non-text > > > > > > ____________ ________ ________ ________ ________ ________ > > > Going green? See the top 12 foods to eat organic. > > > http://green.http://green.<wbhttp://grhttp:wbhttp://wbhtt & ocid=ocid=<wbr> > > > > T003M > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2008 Report Share Posted April 22, 2008 Thanks. I thought it was about there, but I wasn't sure. GG > > Gene > We are sitting at 1250 contact hours for the count as of now > > Dave T. > > ------------ -------- -------- -- > Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it > now. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2008 Report Share Posted April 22, 2008 Gene We are sitting at 1250 contact hours for the count as of now Dave T. --------------------------------- Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2008 Report Share Posted April 23, 2008 " As one writer so aptly said, it takes over 1,500 hours to learn how to cut hair, and around 2,500 hours to become an embalmer " No argument here for having less hours in Paramedic training than currently exists but these are relative things. Maybe it takes 1,500 hours to complete " barber " training but should it? Or 2,500 hours for mortuary school? Hair stylists and funeral directors may say it's excessive or unnecessary. Many schools of every sort may spend huge percentages of their " hours " not accomplishing much of anything. I've known reputable college instructors who can kill time with the best of 'em. Often it appears we're in a system of " put in more hours - have more stature and get paid more " ? Rather than more of a system of competency measurement. Numbers are relative. Don =========================================================== This message is confidential, intended only for the named recipient(s) and may contain information that is privileged or exempt from disclosure under applicable law. If you are not the intended recipient(s), you are notified that the dissemination, distribution or copying of this message is strictly prohibited. If you received this message in error, or are not the named recipient(s), please notify the sender and delete this e-mail from your computer. ETMC has implemented secure messaging for certain types of messages. For more information about our secure messaging system, go to: http://www.etmc.org/mail/ Thank you. =========================================================== Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 23, 2008 Report Share Posted April 23, 2008 I agree R wrote: hits it on the head. Why not a plain ol' BVM? TOO MUCH PRIDE on OUR part. We must teach our new medics that it's not about pride, it's about the patient. It seems to me that DSHS should add capnography as a new minimum standard on each MICU. Grayson wrote: >>I think a major " telling " point in the article is the section about the lack of carbon dioxide monitoring devices in many systems.<< Not only that, but I saw no mention of the use of a rescue airway in the cases cited. A King LT, Combitube or LMA may have been all that was needed after the failed intubation... .....or hell, just a plain old BVM and an OPA. Systems that implement RSI without addressing intubation skills maintenance, the possibility of failed intubations, and expertise in BLS ventilation are *begging* for trouble, in my opinion - the negligence starts right at the top, with the medical director. -- Grayson, CCEMT-P www.kellygrayson.com , FF/LP/NREMTP " Live your life. Respect its brevity. " FBFD1426@... --------------------------------- Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. Quote Link to comment Share on other sites More sharing options...
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