tag:blogger.com,1999:blog-7613006767095604889.post791610399024666096..comments2023-03-19T07:57:19.219-04:00Comments on Looking Through a Pair of Pink Trauma Shears: Big Boys taking our toysMedicTrommasherehttp://www.blogger.com/profile/08504162899029148893noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-7613006767095604889.post-17038682109765923482010-07-07T11:21:25.389-04:002010-07-07T11:21:25.389-04:00The only "failure" that should matter wh...The only "failure" that should matter when looking at prehospital intubation is an unrecognized intubation failure. That is a failure to appropriately assess (reassess) one's patient, and reflects poorly on the medic overall. That being said, how are those "unrecognized failures" being recorded for the study? Most likely by radiography in the ED.<br /><br />Radiography involves (generally) a portable X-ray, which in turn involves placing the "film" behind the patient's chest and taking the "photo." If the tube is misplaced in this X-ray, the tube is considered an unrecognized failure. Do you see a problem with this? I do. Tubes can be dislodged by patient movement. This is why we are supposed to (and I do) reassess ventilation quality after each patient move. The radigraphic technician does not do this s/he moves the pt, plces the film, shoots, moves the patient again to remove the film, then leaves.<br /><br />To call the studies "flawed" is like calling the sun "a little bright."<br /><br />What it comes down to is this: in every profession there are people who get by at the minimum level of competency, those who excel, and those who cannot even consistently perform at the minimum. Attempts to limit an entire profession by the performance of those who fail to meet the standards is insane. No profession would be allowed to do anything. Heck, look at ambulance drivers' (not Ambulance Driver's) performance and you should conclude that with the egregious behavior of some, none of us should be on the road at all.<br /><br />You have a point about equipment utilization though. With the amount of 911 abuse we see, the ambulance itself is the only piece of equipment consistently on each call. If we reduce our equipment to that, we'd be a lot cheaper to run and probably have a different name..."taxi." Of course, there's a reason that I'll call in to the hospitals as "Cabulance" with some fares.Medic3https://www.blogger.com/profile/06458884671263093425noreply@blogger.comtag:blogger.com,1999:blog-7613006767095604889.post-55159915337254791822010-07-07T11:21:04.910-04:002010-07-07T11:21:04.910-04:00While I'm happy to disagree with Rogue Medic f...While I'm happy to disagree with Rogue Medic from time to time (idealism v realism) I have to defend him here. If you go back through his archives you may note that he does not advocate taking intubation away from medics in general. Just taking it away from incompetent medics. His big emphasis on this has been that most? medical direction takes a head-in-the-sand mentality toward dangerous providers and those medical directors see the solution as restricting the skill rather than providing the training to maintain adequate proficiency.<br /><br />Of course, I differ with him in some of this interpretation of the EMS intubation "studies." And yes, I know that the plural of anecdote isn't data. The issue that I take with many of those studies is that they use inconsistent definitions of "successful." They look intubation rather than airway management. [Confession time: I rarely intubate patients anymore. With the exception of cardiac arrests, I usually make use of medications and mechanical devices like CPAP.]<br /><br />But on topic, when the studies consider an appropriately ventilated patient with an "alternative airway" in place to be a failed intubation, I take issue with that. I have had patients whose anatomy did not lend itself to intubation with the equipment that my service carries. I placed a combitube instead and delivered them appropriately oxygenated to the hospital while treating their other issues. Was this a "failed" attempt? No. This was appropriate management of an airway within the limitations of the equipment that I was carrying. <br /><br />If this were my only patient for the analysis period, does this mean that my intubation rate is 0%? Yes, but that is misleading. It also means that my airway management was 100%, just utilizing a different means than that being measured. Does it mean that I shouldn't be allowed to intubate? Hardly. It means no more or less than I could not intubate a particular patient and managed the airway with an alternate device. Like cutting a seatbelt with my lockblade when the blade of the purpose built "seatbelt cutter" in the unit was rusted and dull, or when I couldn't get the angle to cut it with shears.Medic3https://www.blogger.com/profile/06458884671263093425noreply@blogger.comtag:blogger.com,1999:blog-7613006767095604889.post-255222957653315842010-07-03T15:33:19.780-04:002010-07-03T15:33:19.780-04:00You know, I have yet to hear anything even remotel...You know, I have yet to hear anything even remotely positive about this whole situation. When are the "bigwigs" going to clue in? <br />You hit it right on the head when you said they just look at numbers...if they have a problem with the lack of skills, the solution should be more training, not taking equipment away. <br />Can you imagine if that's how parents treated their children? Little Johnny doesn't do so well at tying his shoes, so let's just give him velcro shoes for the rest of his life...it doesn't solve the problem, it just pretends that it doesn't exist and raises a whole generation to believe that they don't have to try. If this keeps up, the next EMS generation is going to look much the same way.Lizziehttps://www.blogger.com/profile/06893905318777842896noreply@blogger.com