Wednesday, July 7, 2010

Reply to Comments!

Medic 3: First of all, thanks for joining in on a good topic. I wasn't trying to say that Rogue Medic wanted to take it away, I was speaking about a certain part in his article that sparked my interest and I wanted to write about my own experiences. I'm all for taking it away from incompetent medics, hell, I watched a flight medic intubate a womans' stomach and proceded to try and ventillate her that way for the next three minutes until someone higher trained than I that he'd listen to stepped in and told him he FUBAR'd.

You are correct. Incompetent or "bad" medics are just asked to go back through non hands' on classes, or put back to something we at home called 'Mother-May-I?' status where we'd have to call our command doc to do anything other than BLS skills. Neither one of those solves the problem though. How is it going to change how I do my IV/Intubation/whatever ALS skill I want to do? Sure, I'll be using my ALS powers responsibly because I have a doctor telling me when and when not to do something, but it's not going to change the mechanics. The doctor isn't there to hold my hand and show me what I'm doing wrong to facilitate a good intubation.

Back home they also looked at the use of an "alternate" airway as a failed intubation. Per our protocols, unless you use CPAP, the other airways are considered a last ditch effort. On the computerized trip sheets, the only way you can show that you used something other than intubation is if you state that you had an unsuccessful intubation. I know of a medic who actually got dropped back to "Mother May I" status instead of "Full Orders" because he didn't have a single intubation on the year, but because the reporting forms show a bunch of "missed" intubations, he was dropped down.

I completely agree with you, Medic 3. I had a positive tube, all my little doo-dads showed positive, I saw it go through the cords, positive lung sounds with re-checks every 3-5 minutes due to poor road conditions. We get to the ER, and I watch as they (roughly) pick up the patient and nearly drop him back onto the gurney, then they grab the tube tamer I used and switched it out, then put him on the ventillator, took X-rays, THEN and only then did they check lung sounds and lo and behold, it was right mainstem. Did they get screwed for not reassessing, no. I got dinged because I had a bad tube.

Unfortunately it seems as if there are only "bad" medics in the profession. No one, sometimes not even our own services, recognizes "good" medics. All you ever hear about is how a medic "didn't provide quality care" or "gave the wrong medication" or "didn't treat a patient well". Even Medics who did the right thing by breaking protocol because their patient didn't fit into a neat little set of rules gets railroaded because they, in the opinion of those around them, "did the wrong thing." no matter the outcome.

And yes, with multiple patients, we are nothing but a "Cabulance".

Thanks for writing. Your comments were awesome!

Have fun and Be safe

~M. Trommashere~


  1. Do you use capnography at your agency? I am not sure the exact details, but where I used to volunteer, they used capnography to prove tube placement, print the monitor sheet, and save the card from the zoll monitor, to prove that they had the intubation done correctly. It was another way for us to varify placement aside from the color changing attachment that detects CO (not sure what it is called), and listening for lung sounds, and this way can actually provide a record.

  2. Back in my home state, we have to use 3 different forms of checking tube placement: End Tidal CO2 (The color-metric device you are speaking of) Capnography, the little bulb device that you squeeze, and if it inflates back up, your good, if not, in the stomach, and listening to lung sounds.

    We have to (color) copy the top of the ETCO2 device and attach it to the trip sheet as well as the Capnography print-out. We still get dinged if it happens after we transfer care. Like I preach to new EMT's and Medics after they get yelled at for something that isn't their fault: "Shit rolls down hill, and you just happened to be the one standing at the bottom holding the already overflowing bucket..."

    My only issue with the color change cap was that half the time, the color never changed even with a positive tube...