Cut vs uncut tubes

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----- Original Message ----
From: Ian Seppelt <SeppelI at wahs.nsw.gov.au>
To: atacc.doc at btinternet.com; nick at macartney.org; "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Friday, October 5, 2007 6:52:53 AM
Subject: RE: Cut vs uncut tubes


I suggest that Nick's case reveals inadequacies in the interhospital
transport process. Who was the attendant? Anaesthetic or ICU registrar
who should have known better? Junior doctor with no idea? Skilled
paramedic with intubation skills (who again should have known better)?
Or non-paramedic, who again would not be expected to have any idea.

In the context of a prehospital paramedic system and a good
interhospital retrieval system [which is the envionment I work in], I
maintain there is no place for cut tubes and a lot of potential problems
with tubes that are too short.

The only purpose for a cut tube is to prevent (inadequately trained)
people pushing it in to far [and that applies equally to doctors, nurses
and ambos].
******************************

I agree with all your comments


Call it culture
Call it state of the art prehospital medecine

But

Intubated prehospital patients automaticaly get a fireman proof E.T. tube tape down job
(Silk tape around the back of the neck and tape on tape securing... or other trully fullproof commercial devices)
Also
Continuous monitoring & Alarms are "de rigeur" (capnometry being the best one) this has to be the undeviable norm
Oxygen reserves have to be checked pre-transport and 30 min into transport to confirm consumption

You can do this rather easily
If you have a "System" and a constance in the transport teams
... not so much if your in a more improvised transports

Who's on call, who's availabke to go (Wekends ? Nights ???), grab the kits(Checked?), get in an unknown BLS unit or 911 ALS unit
Adds a slew of little(lethal) risks factors

A catastrophe is rarely the result of a big mistake
But much more often
... the result of an accumulation of small mistakes


Charles

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