So I was reading an article/blog written by Rogue Medic. If you haven't checked him out, you should. He's incredible! Some of the things he writes about are just fantastic. He brings an interesting spin to the EMS Table. Anywho, he posted about Customer Service in the EMS application. (Here's the link: http://roguemedic.blogspot.com/2010/07/customer-service-patient-care-part-i.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+RogueMedic+%28Rogue+Medic%29)
What struck me was about the idea that intubation success was not taken seriously, and he sited various examples. I agreed with his entire article, but the comment about taking away of the tubes struck a nerve. I was from a state that tried it for a while and failed miserably, so here's my retort for that particular side of the coin:
The taking away of the "ALS" Airway like Endotracheal Intubation is a double edged sword. Yes, there are a lot of medics out there who suck at it because it's not a skill that is done often enough to gain proficiency. The problem is, there's nothing in place to allow us to get better at it.
Flight Medics, Nurses, Doctors, what have you, are given the opportunity, and in some companies, are required to go in hospital every month to obtain ten intubations. The state I used to live in required all Flight Medics and Flight Nurses to go in hospital and get 10 tubes either in the ER or the OR.
Now try to call a hospital and get in to their ER or OR to "steal" tubes away from the interns, residents, and Flight Providers, you may get shot on site.
Medics have a hard enough time while precepting getting ER/OR time in when they have to, let alone any other time.
The mentality of, if-they-don't-do-it-let's-take-it-away won't work. Think for a moment about your drug box and all the other little Para-toys we have in our scope of practice.
You know that Hare Traction splint? We hardly use it, so since we don't that means we're not proficient in it, so let's get rid of it.
OB Kits? That's what hospitals are for. Since EMT's and Medics don't deliver them on a regular basis, let's trash those as well.
Needle Decompression/Needle Crich Kits? Nope, just taking up space. Trash that.
Drug wise? Well, Dopamine, Dobuatime, those clumsy Mark 1 (or whatever addition your on) kits, Versed (for those services that carry other drugs that can stop seizures)...the list goes on and on. If our ambulances were subject to usage reviews, at the end of a year, we'd have no equipment!
You take away intubation and you add another "mindless" airway adjunct, fine. You're still going to run into the same problem; lack of usage.
Also, when the docs sit around in their Fat Cat Pow-wow and decide which toys they're going to take away because of failed usage, they just look at numbers. They don't look at Paramedic Smith who was trying to intubate a kid while upside down, in a ditch, in the dark, at 3 am while generators were going, and all he could see by was the little bulb at the end of his blade. They don't look at Paramedic Johnson who was trying to intubate a smoke inhalation victim whos' airway was swelling shut because his service took away the expensive TTJ's and needle cric. equipment for "lack of use". All they see is a missed intubation.
Where is our hands on, remedial training? I'd love to be able to go in to the ER/OR once a month, hell, once every three months and get to practice. I got kicked out of OR's while precepting for my Medic because I wasn't a nursing student/person who wears flight suits to work/person who wears a lab coat to work.
If this mentality continues, we can expect to go backwards in time, back to when we were throwing someone in back and hopping up front.
I'm not throwing a temper tantrum because they want to take *my* tubes away, I'm pissed off they want to take my ability to save lives in an effective manner away. Why don't we take something away from the doctors...like IV's. Doctors turf that out to Nurses and IV Tech's and lowly Interns. When was the last time you saw a full fledged doctor do an IV on someone besides a cut down or a femeral stick? I bet if someone stood up and said they wanted to take IV's away from doctors, we'd have a herd of stampeeding white coated Angrius Doctoriis and the creation of "IV Remediation" classes would begin.
I ask all medics and other Pre-Hospital providers who can make someone chew plastic, to stand up for your right to do it. If you let them take tubes away, what else are they going to take away from you?