tag:blogger.com,1999:blog-4505990433916682663.post5712168472222809650..comments2024-03-13T02:04:31.476-04:00Comments on Paramedicine 101: Advocating Airway EducationAdam Thompson, EMT-Phttp://www.blogger.com/profile/18107359165856983910noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-4505990433916682663.post-8579881039399800432010-08-14T08:21:06.953-04:002010-08-14T08:21:06.953-04:00I would like to exchange links with your site para...I would like to exchange links with your site paramedicine101.blogspot.com<br />Is this possible?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-59416621815344234012010-08-09T02:03:38.298-04:002010-08-09T02:03:38.298-04:00Back in 1997 I had the Airway Call From Hell that ...Back in 1997 I had the Airway Call From Hell that resulted in me writing a proposal that eventually got RSI added to the scope of practice for Louisiana medics.<br /><br />The training program wrote required our medics to go through a day of live intubation practice, and semi-annual refreshers.<br /><br />When we approached our insurer about coverage for the class, they not only told us that our existing policy covered such educational classes, they reduced our premiums because of the extra training and CQI made us a lesser risk.Ambulance Driverhttps://www.blogger.com/profile/10175419709184526342noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-30473477959446053442010-08-08T22:57:53.354-04:002010-08-08T22:57:53.354-04:00Gabe,
I agree, but it is also up to the EMS agen...Gabe, <br /><br />I agree, but it is also up to the EMS agencies to get the paramedics into the OR. Many agencies don't want to take on this liability, even though, in the long run, it would probably decrease liability in an entirely different way.Adam Thompson, EMT-Phttps://www.blogger.com/profile/18107359165856983910noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-88971190506664871112010-08-08T15:22:32.911-04:002010-08-08T15:22:32.911-04:00This was a pretty good article that brought up som...This was a pretty good article that brought up some valid points. There needs to be more cooperation, if you will, from the anesthesiologist. Not trying to bash physicians but there are some who refuse to let any student intubate let alone in the room. I feel there needs to be education on their part about why paramedic students, flight crews, etc. are there.<br />While there are physicians and nurse anesthetist that are willing teachers that number seems to be decreasing. I completely understand that there are some airways that should be left to the docs ($10 k of recent dental work, epiglotitis, etc.) If they know that an airway if potentially a difficult or confirmed difficult case and if there would be no harm in allowing the medic to attempt the first tube I don't see the harm in that.<br />Didn't mean to rant this long but just brought up some good points with your blog.Ditch Doctor Gabehttps://www.blogger.com/profile/13796611659377692312noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-43886830357798933872010-08-02T22:07:15.861-04:002010-08-02T22:07:15.861-04:00This is great method to give knowledge or advocati...This is great method to give knowledge or advocating airway education. You have also given images for the piercing of ring in the mouth.L. Ibidohttp://www.femalelibidoboosters.org/noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-12364514746729858212010-07-29T23:08:57.298-04:002010-07-29T23:08:57.298-04:00There are two outcome studies from King County reg...There are two outcome studies from King County regarding intubation:<br /><br />- <a href="http://www.ncbi.nlm.nih.gov/pubmed/8669736" rel="nofollow">Prehospital endotracheal intubation of children by paramedics.</a><br />- <a href="http://www.ncbi.nlm.nih.gov/pubmed/15626000" rel="nofollow">Time to intubation and survival in prehospital cardiac arrest.</a>Timothy Clemanshttp://emscompare.orgnoreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-15028815263570728462010-07-29T20:41:32.161-04:002010-07-29T20:41:32.161-04:00Adam,
I don't think improving their outcome i...Adam,<br /><br /><i>I don't think improving their outcome is the only marker for usefulness. Preventing poorer outcomes may be just as important.</i><br /> <br /> <br />A well done study could show that patients had a better outcome than the placebo group. The difference between a placebo group that had worse outcomes and a treatment group that had no apparent change in outcomes would actually be an improved outcome. That is one of the reasons for the placebo group. <br /><br />Placebo does not necessarily mean no treatment, but the standard treatment that would be used if the patient is not intubated. In the study of IVs in cardiac arrest, they considered the IV and IV medication group to be the <i>placebo group</i>, while the no IV and no medication group was the <i>treatment group</i>, even though the IV and medication are much more accurately defined as <i>treatments</i>. <br /> <br /> <br /><i>I do feel that a large and adequate enough study would show that there is much less of a need for intubation than many of us think.</i><br /> <br /> <br />I agree.<br /><br />If you read the comments to the article, there is one by <i>Subclavia</i>, signed by <i>dammedic</i>, where he/she states that they intubate 9.5% of ALS patients.<br /> <br /><i><b>KCM1’s intubation to “actual patient contact” ratio is at 9.5%.</b></i><br /> <br />I would like to see a study of outcomes in that system - King County Medic 1. They have an excellent intubation success rate, but are they helping patients by intubating so frequently?Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-81066719490222859312010-07-29T20:27:48.979-04:002010-07-29T20:27:48.979-04:00We need to prove that prehospital intubation impro...<i>We need to prove that prehospital intubation improves outcomes for any group of patients or we need to stop harming our patients.</i> <br /><br />I don't think improving their outcome is the only marker for usefulness. Preventing poorer outcomes may be just as important. <br /><br />I do feel that a large and adequate enough study would show that there is much less of a need for intubation than many of us think.Adam Thompson, EMT-Phttps://www.blogger.com/profile/18107359165856983910noreply@blogger.comtag:blogger.com,1999:blog-4505990433916682663.post-16653533719212982472010-07-29T20:16:47.568-04:002010-07-29T20:16:47.568-04:00Dr. Eckstein: . . . Of course the real problem wit...<i><b>Dr. Eckstein</b>: . . . Of course the real problem with this is that successfully placing an ET tube doesn’t necessarily mean that the patient had a better outcome as a result. Those few studies that have some control group, such as the San Diego RSI study, actually found that patients who had RSI in the field had almost a 40% higher mortality rate than the BVM group (using historical controls).1</i><br /> <br /> <br /><i><b>Dr. Wang</b>: . . . As Dr. Eckstein said, in the absence of prospective RCTs, we can’t assume that prehospital RSI has actually improved outcomes for our patients.</i><br /> <br /> <br /><i><b>Dr. Bledsoe</b>: Are the alternative airway devices (e.g., King LT, etc.) good enough for prehospital airway management?</i><br /> <br /><i><b>Mr. Gandy</b>: Yes. The studies have shown that excellent ventilation can be achieved with these devices.</i><br /> <br /> <br /><b>We need to prove that prehospital intubation improves outcomes for any group of patients <i>or</i> we need to stop harming our patients.</b><br /><br />Even if we can show that intubation improves outcomes, we have absolutely no justification for permitting as many incompetent people to intubate on a regular basis. <br /><br />This is the fault of the medical directors <i>and</i> the paramedics. <br />.Rogue Medichttps://www.blogger.com/profile/07598646309630074992noreply@blogger.com