Teaching Airway - Part I

Also posted over at Paramedicine 101. Go check out the rest of what is there.

On Teaching Airway: EMS Educast Episode 33, they have Kelly Grayson as their guest. The first of many times they will have Kelly Grayson as a guest. Hint! Hint!

Kelly says (50 minutes into the 1 hour show, so I am starting at the beginning) -

If you are going to allow paramedics to intubate, and I happen to agree with Bryan Bledsoe on this, . . . unless things change in the way we educate and regulate our EMS providers, within 10 years you are going to see intubation disappear from the paramedic skill set, except for a relatively few very well trained providers.

Since I have made similar comments, I want to point out the way that a lot of paramedics seem to interpret this sentence.

They are going to take our tubes away!

That ignores the really important part of the sentence. The part of the sentence that comes before and after the part I highlighted. That important part is this - unless things change in the way we educate and regulate our EMS providers, . . . except for a relatively few very well trained providers.

The way to prevent having the tubes taken away? If we really want to have intubation in our scope of practice, we need to continually prove that we can intubate well. We need to continually practice and work on learning more, if we expect to be able to prove that we can intubate well.

Many paramedics do not want to be told that. They want to be able to intubate, just because they think wanting to is enough. They want their Nobel Intubation Prize. Well, this isn't politics, you actually need to do something.

What do we need to do?

Kelly's immediately follows that with -

If we would pull the trigger and do what is necessary to make every paramedic like those well trained providers we envision intubating in the future. That's what needs to be done. We need to have far more stringent requirements for intubation in the initial clinical experience. It needs to be far more than 6, or 8, or 10 tubes. If it takes an extra 6 months to get those tubes, then so be it. That's the price we're going to have to pay to be taken seriously. And once on the street, if you are not getting say X number of tubes - a tube a month, call it 12 a year - if you don't get 12 successful intubations, or at least 12 attempts, in a 12 month period, there should be a clinical re-education requirement.

This was followed by Buck Feris saying, Agreed.

Can any of us disagree? Unfortunately, for many a medic/medic wanna be, that is asking too much.

Why should we have to be competent? Isn't sitting through the classes, getting food for the preceptors as a bribe, and following all of the rules that I agree with - isn't that enough?

Sure. That is good enough, but only if you work in a really unimportant job, not one where incompetence can kill patients.

We cannot demonstrate that prehospital intubation improves outcomes, but we insist on intubating.

Except for a few, we cannot demonstrate competence (pick almost any EMS intubation study), but we insist on intubating.

Why do we insist on harming our patients?

We need to prove that intubation works and prove that we have the skill to be trusted intubating patients.

We do have to want it. We have to want to work at competence - not whine about being victims and whine about not being given what we want.


1 comment:

Adam Thompson, EMT-P said...

I have come to realize a few things.

-Paramedics that are educated in the research and outcomes of patients are much less likely to use endotracheal intubation as a primary modality for airway management.

-Those same paramedics will advocate the treatments presence in the paramedicine scope just as much as someone who uses the skill often. The only difference is that the educated paramedic would like more continued training and QI/QA.

-Anyone with sense will use ETCO2 100% of the time, if available, for ET intubations.

-If you put 100 paramedics in a room and ask the ones who feel weak at endotracheal intubation to raise their hands--you won't see any hands.

I think this intubation = paramedic thing starts in paramedic school, and the attitude continues for too many throughout their careers. Understanding that we should do everything in our power NOT to intubate is the practice of a good prehospital clinician.