Crics

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My reread still pretty much says that! Please reassure me I have  
misunderstood!

Ian

On 18/03/2010, at 1:48 AM, "Gross, Ronald" <Ronald.Gross at baystatehealth.org 
 > wrote:

> WHOA, Ian.  I don't think this is what he said at all.  Perhaps a  
> second read might help......
> Ron
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list- 
> bounces at trauma.org] On Behalf Of Ian Seppelt
> Sent: Wednesday, March 17, 2010 8:39 AM
> To: Trauma-List [TRAUMA.ORG]
> Cc: <trauma-list at trauma.org>
> Subject: Re: Crics
>
> That scares me. In summary you are saying "too hard to teach and
> maintain skills in endotracheal intubation so just go for surgical
> airway". Does anyone else subscribe to the same logic?
>
> Ian
>
> On 17/03/2010, at 11:21 PM, <Yves.Ferran at vtg.admin.ch> wrote:
>
>> I am working to determine/define which skills Army Medics will need
>> in the field, even if it's only for the Swiss Army.
>> Here's a more military perspective, than can perhaps explain the
>> army's eagerness to slit throats ...
>>
>> Main advantages for the Cric, in our military setting are:
>> - Quick to teach (a few hours) & the necessary skills are similar to
>> those for chest tube insertion (local anesthesia, skin incision,
>> finger/clamp dissection, tube insertion)
>> - Easy to train (we cover a pig trachea with pig skin, and staple it
>> tightly to a wooden board behind) and requires far less hours/year
>> to remain proficient compared to ETI
>> - Less equipment/volume (shorter tubes, 1 adult size is enough, a
>> blade & maybe a hook)
>> - No "dangerous" drugs (i.e. only local Lido, but no RSI drugs!)
>> - Maximum efficiency (you can still try doing a Cric if intubation
>> fails, but there's no point trying intubation if Cric is impossible!)
>>
>> I also understand the civilian perspective:
>> - Bulk is not a (big) issue
>> - Invasive procedures ARE a big issue, when something else could
>> have been done instead (i.e. ETI)
>> - ETI training is easier, working out of a hospital, because there
>> are many elective intubations to train on (but no elective Cric!)
>> - Teaching the use of RSI drugs is only a small part of a vast
>> education on drugs used mainly for "medical" emergencies (whereas
>> Medics are mainly trained to deal with trauma, hence very few drugs
>> & drug education)
>>
>> When you've been trained and are working in a hospital, where you
>> learn and practice ETI, it's an obvious choice to "export" it to the
>> prehospital setting ... but when you've been trained and are working
>> in a infantry unit, where you learn the bare minimum, it's an
>> obvious choice to try and avoid ETI.
>>
>> I'm pushing for (BVM &) King LT, then Cric if necessary, and nothing
>> else. (this is, again, in Swiss Army)
>> This should cover most cases, with little training (rather than
>> being half-able to perform more procedures)
>>
>> I hope this has shed some light on military imperatives in respect
>> to Cric.
>>
>> Cheers
>>
>> Yves Ferran, médecin
>> Département fédéral de la défense, de la protection
>> de la population et des sports DDPS
>> Armée suisse
>> Base logistique de l'Armée
>> Affaires sanitaires
>> Worblentalstrasse 36; CH-3063 Ittigen BE
>> mailto:yves.ferran at vtg.admin.ch
>> Mobile: +41 79 796 17 10
>> Fax:+41 31 325 92 42
>> www.lba.admin.ch/internet/lba/fr/home/themen/sanit.html
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