Airway comments by Rachel

So there I am sitting at home, still not finished with my response to the most recent comments from Anonymous - 3 parts, due to Blogger's character limit (4,095 characters if I remember correctly - not as limiting as Twitter's 140, but . . . ), when I receive a comment from Rachel of Rachel's Rants. Well, it made me smile like the Grinch on Christmas Day.

Why

This has been a debate among a bunch of crazy old men. I am assuming about Anonymous, but I do not think I am wrong about age or gender. Working in EMS pretty much guarantees the crazy part. As for Ambulance Driver, while he is creeping up on AARPville more slowly than I am, he did just put another candle on the cake.

The comment from Rachel is a bit different. She is a young woman and a relatively new paramedic. 3 years worth of new. Well, here is the comment to Teaching Airway - Part I. I do not need to add much to show you why it puts a spring in my step and whatever other optimistic metaphors might apply.

I have come across your blog from 9-Echo-1's site and I have to say as a 3 year medic, I'm all for more training on intubation or even just taking that skill out of the scope of practice altogether.

Of course, my Y chromosome translates that to A man's got to know his limitations. With the squint and everything. This may be the most important thing to understand in EMS, although it might be better to translate it to - A paramedic's got to know his limitations. Or her limitations.

During my 3 years I've only had 2 chances to intubate. I'm glad to say that I currently have a success rate of 100% as confirmed by ED docs but still only 2 chances in 3 years? If we are going to provide that level of care then we really need more practice.

And it is not just the opportunity to intubate, but the quality of education, the refresher training, and the quality of oversight.

I read some of the other comments here and WOW. What happened to treating each patient the way you would want someone to treat your family. Just because I know how to do a skill does not mean I should or even that my patient needs ME to do that skill.

Exactly.

I would feel much better, if the patient was my family member, having a tube placed at the hospital in a more controlled setting with providers that probably have done it more than twice in the last few years.

Another excellent point.

The next two parts I switched to bold text. They deserve extra attention.

I've said this before sometimes the best intervention is a BASIC one.

Right there, you boiled AD's Airway Continuum down to one sentence.

I know hard concept for some to understand. Too often I see medics treat very aggressively and while sometimes that is indicated it should not be standard operating procedure.

I agree. Although I do not think that aggressive is the right word. I consider myself to be very aggressive in not using treatments that are not indicated. I often receive criticism from some other people in EMS, from some nurses, and from some doctors. Rarely from my medical directors. While I may be forgetting something, I don't think that I ever received much criticism from a medical director for under-treating a patient.

We need to figure out which patients are surviving to the hospital because of us, which are surviving to the hospital in spite of us, and how to tell the difference. This is where assessment combined with good research will make a big difference in what we do - and maybe a big difference in patient outcomes.

Anyway, go read Rachel's blog. She only posts about a once a month, but they are worth reading.


PS. Ambulance Driver has a new address for his blog A Day In The Life Of An Ambulance Driver, with a new banner that has more pictures of KatyBeth, Yay! Maybe there will be a blog from her, something like A Day In The Life Of An Ambulance Daughter.


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