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In regards to EMS intubation issues

David Sullivan fpcems at yahoo.com
Tue Apr 11 23:09:06 BST 2006

This sounds like a bad day for all involved:
  Some of the medics on the list might have run into the same situation, I know that I have a couple of different times...Responding to a Dr's office or urgent care center for chest pain or resp distress. My personal feelings and my protocols are two different things in these cases, my protocols say to contact medical control...and have the two talk....Here is a case, where I just put the pt on my cardiac monitor...igonored the physician, and left.....65 y/o m pt slightly SOB, the dr's office put him on a cardiac monitor....RSR with bigeminal PVCs..they called the paramedics...the physicain giving me a report showed me there EKG, he said that it was insignifigant; and no cause to panic (the rate w/o the PVCs was 60) he called ahead and already gotten the pt a bed...ect....I simply placed him on my stretcher, put him on the monitor, and treated him per protocol, lidocaine...bolus and subsquesnt infusion. I did contact a physican at the Hospital just to CYA...
  I understand it this way; if there is a physicain on scene and he/she is willing to undertake the care of the pt, and treat them to there level of care and preform procedures out of the paramedics scope of practice, then they are in control and responsible for the pt and all care provided. in MA most of the services dont have RSI available to them on the street (boston medflight is the exception as far as I know) if a physicians office has versed, etomidate, sucs there, the doc intubates the pt, the doctor is responsible and needs to accompany the medics to the hospital in the pt compartment of the ambu. I would say that most doctors dont want the responsiblity, or cant find some one to cover there private practive while they take the trip. They simply make a phone call to the hospital if they think of it, and 911 and let the chips fall where they may. This puts the medics in quite the bind, they have protocols to follow...but then they have a doc "sugguesting" a course
 of treatment....med con should have been contacted in this case, and all parties involved may have been able to pick a treatment path ect...
  Documention.....if it wasnt written it wasnt done, A few questions though....are these medics new, or vets....how many RSI tubes had the attempted prior to this case what are there success and failed rates....how come they didnt use an alternative airway LMA or combi tube? What was there training with RSI drugs induction v paralytic. Are there any systems that use RSI in the street, and oversee how many RSI tubes the medic success or failure and require remediate training, or more OR/ER time to become effecient with this skill, I am all for RSI on the street, but I feel that there are times where RSI would be great, but these moments are few and far between, the skill would either be lost, or I would want to paralyze and intubate everyone (i like the back of ambu when its quite..lol) b/c like a an old lacrosse told me once. Practice makes perfect...
  Are these good questions/issuses, anybody out there can answer them or provide more insight!!
  dave sullivan BA NREMT-P

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