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PHTLS, Ground EMS, Air EMS, Chest Tubes

Michael Ferker xg2k2 at yahoo.com
Mon Apr 10 02:06:18 BST 2006

Oftentimes when air EMS is called, a patient is considerably out of reach of any help, and it may often be safe to assume that an individual in need of such care is in real bad shape anyway. In such scenarios, immediate steps such as poking holes and possibly putting something in those holes may be necessary in order to atleast assure the individual can still be saved by the time they reach trauma. Certainly, if an EMS doesn't have sufficient training and experience in intubation, they should stay away from the pt. But if the proper training was provided and there is a serious condition such a p or h thorax that can be aided with some simple pressure relief, I don't see a reason why such a step shouldn't be taken. I don't think anyone is suggesting clearing EMTs to perform anything difficult like thorascotomies or splenectomies, but putting in tubes is something necessary and a thing I believe more EMTs should be taught sufficiently so they can safely perform it in the field.
  -Mike F

KMATTOX at aol.com wrote:
  Previous post: 

PHTLS, does not teach you to load and go and NOT do any other 
treatment. It DOES teach you to get on the road asap and treat enroute. 
I have always questioned if this continued "interpretation" of load and 
go is somehow connected to one's lack of confidence in skills being 
performed in the back of moving ambulances...i.e..IVs, airway 
management, etc?

Regardless, the point is, treat enroute to definitive care (Trauma 
Center I or II in Iowa). And as per the topic of this thread as it 
began, never have know a medic to place a chest tube, in my state, and 
certainly have not ever seen it taught in PHTLS, oh these many, many 


What I do not understand is the tremendous variations among EMS systems 
despite the PHTLS. For example, the only, ONLY advantage of air EMS over 
ground EMS is that it flys to remote, wilderness, and high rise locations. AIR 
ems is still EMS, and should be under the same scrutiny as ground EMS. Yet 
there is some urban legend that air ems is a higher level of care than ground 
EMS. The opposite is probably more correct. 

In my continuing view NEITHER air or ground EMS should be putting in chest 
tubes or putting needles into the chest. 


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