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    Default New Protocol In PA

    I know this should probably go in the EMS forum, but I figured it applies here, and will get more play in this forum. Effective this month, the Pennsylvania BLS protocols are changing. Some things make sense, but two seem a little odd to me. EMT-Bs are now have Endotracheal tubing as a protocol, this seems to be a little intense, seeing as how much of a risk there is with so little training. The other seems really odd. Now, If I find a loaded gun on scene, I am supposed to pick it up and deal with it and my patient. I was always told that my safety was first, then my partner, then everyone else, and picking up a gun in an unsecured environment just seems crazy. Thoughts?

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    First of all, endotracheal intubation isn't that hard. Most competent EMTs shouldn't have a problem performing the skill.

    As far as your gun thing, I'm a little lost. I've been on my share of calls with guns present. Unless LE is on scene, I've been more than willing to secure the gun (lock the chamber open, ensure safety is on, whatever) to further ensure my safety. In most cases, you likely won't have to deal with it, as you'll be staging for LE to arrive.

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    Quote Originally Posted by charlie82 View Post
    I know this should probably go in the EMS forum, but I figured it applies here, and will get more play in this forum. Effective this month, the Pennsylvania BLS protocols are changing. Some things make sense, but two seem a little odd to me. EMT-Bs are now have Endotracheal tubing as a protocol, this seems to be a little intense, seeing as how much of a risk there is with so little training. The other seems really odd. Now, If I find a loaded gun on scene, I am supposed to pick it up and deal with it and my patient. I was always told that my safety was first, then my partner, then everyone else, and picking up a gun in an unsecured environment just seems crazy. Thoughts?
    1. If the tube is the same one that was introduced at a training class I took in Maryland about 5 years ago is the same one, it is just about idiot-proof and a competent EMT will be able to use it.

    2. Sorry, I have to call bullschit on this one. Aside from the fact that I read the updates for both ALS and BLS, nothing is mentioned about EMS personnely dealing with weapons; besides, it is NOT our job. How much training would it take to show ALL EMS personnel how to safely pick up, handle, and safety a loaded weapon?

    Thats what the cops are for.
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    Is it a true ET tube or one of the dual-lumen devices such as a CombiTube?

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    FWDBuff:


    E. Lethal weapons:
    1. Do not move firearms (loaded or unloaded) unless it poses a potential immediate threat.
    2. Secure any weapon that can be used against you or the crew out of the reach of the patient
    and bystanders
    a. Guns should be handed over to a law enforcement officer if possible or placed in a locked
    space, when available.
    1) If necessary for scene security, safely move firearm keeping finger off of the trigger
    and hammer and keeping barrel pointed in a safe direction away from self and
    others.
    2) Do not unload a gun.
    b. Knives should be placed in a locked place, when available.

    Direct from PA DOH

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    Quote Originally Posted by FWDbuff View Post
    1. If the tube is the same one that was introduced at a training class I took in Maryland about 5 years ago is the same one, it is just about idiot-proof and a competent EMT will be able to use it.
    Its not that little crescent oropharyngeal airway, this is the intubation "ER style tube"

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    Funny I'm in EMT school right now and none of this has been taught to us yet. Yes it is in PA for those that sometimes do not read the location information for the poster.

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    Quote Originally Posted by FFTEX55 View Post
    Yes it is in PA for those that sometimes do not read the location information for the poster.
    If you had location information under your name, I would have read it. Great attitude.

    With the proper training i do not see any problems with EMT-Bs intubating.
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    That is not what either of those protocols say.

    Protocol 222 addresses ventilation via an ET tube or similar device, and assisting the ALS provider in securing the tube (tube lock). It also talks about proper ventilation methods.

    Protocol 919 addresses scene safety. It specifically states that firearms should only be moved if they pose a "potential immediate threat" and that if you move it, keep your finger off the trigger. I would have never thought of that last one if they didn't write it.
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    Thanks PATF, you beat me to it. I was wondering where the O.P. got this mis-information. It certainly wasn't from the PA DOH's protocol book.

    To the OP, go to

    http://www.dsf.health.state.pa.us/he...ocols_2004.pdf

    Thats the protocols and they highlight changes in yellow.

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    In Ohio, EMT-B's have been intubating pulseless and apneic patients for over 12 years.....

    And if no LEO is on scene, I would rather secure the weapon myself instead of taking the chance of it getting in the wrong hands.......
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    I could swear at one point my location information was under my name. Freaking weird. I only said that because in the past on many forums including this one I have run across many people that for one reason or another just do not look at the locations.

    I'll get my info posted under there since it has gone missing.

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    Paramedics are barely intubating competently, and there are plenty of studies to prove it. Now somebody thinks EMTs should be doing it because "it isn't hard"?

    What makes you think the public is safe with endotracheal intubation ("the ER tubes," good lord), which is a high-risk, low-frequency, invasive treatment, being given to someone who spent less time (much less time actually) learning the skills they already have than their barber spent learning how to cut hair?
    Last edited by emt161; 11-10-2008 at 03:14 AM.

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    Intubating is a skill that needs practice. Thats it. Having a certain license or having had a certain class doesn't make you better. Just practice. Just because you are a Paramedic doesn't mean you are going to be better. All you need is proper instruction and practice.

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    Quote Originally Posted by emt161 View Post
    Paramedics are barely intubating competently, and there are plenty of studies to prove it. Now somebody thinks EMTs should be doing it because "it isn't hard"?
    Sounds like these medics need some more practice.........
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    And how are they supposed to maintain their skills and GET practice when Basics can do it too?

    Btw, the intubation statistics just HAPPEN to be coming out of jurisdictions where fire departments have their local governments convinced that every ambulance, engine, ladder, and garbage truck needs a half-dozen paramedics on it. Coincidence? I think not.

    Giving ETI to Basics will make an already deadly problem a hundred times worse.
    Last edited by emt161; 11-12-2008 at 02:05 AM.

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    Quote Originally Posted by emt161 View Post
    Giving ETI to Basics will make an already deadly problem a hundred times worse.
    Wow...What county are you from? With that attitude, you must have some of the worst EMT's in the state! We welcome the opportunity to be able to vent a patient more efficiently in the absence of ALS, and will train regularly on this, just as we do the rest of our skills!

    Oh, and BTW, "it isn't hard."
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    You sound like a bitter para-god. It takes training and skill not a license level.

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    The protocols don't give the EMT-B ETI in thier scope of practice. This is mis-understood by the O.P.

    I don't think it can't be learned and practiced by an EMT-B, but I don't think you'll convince the state of that. We just got CPAP!

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    I have been in an EMS conference this past week, and have seen a whole bunch of studies. Medics are messing up at tubes, and the survival rates of tubed vs BLS airway cardiac arrest saves (walk out of hospital) are virtually identical. An agency north of us has even rewritten protocols to make ONE attempt at intubation, and then drop a King IT airway. Also, ONE attempt at peri or EJ IV, and then go for EZ-IO. very neat stuff. For peds, the docs are even more adamant to not waste time with a tube, BLS airways with short transport times. Long transports, yes, go for the tube. I have study references if anyone is interested.

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    I find it very hard to believe that any service is allowing Basics to intubate.

    Using a Combitube or something of that nature that doesn't require visualization of the vocal cords seems much more likely.

    As for whoever said "intubating isn't that hard"...true, I guess it really isn't. Neither is driving fast and turning left in NASCAR, but you wouldn't put the local reigning go-kart track champion in a NASCAR race and expect the same results.
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    Quote Originally Posted by PhillyRube View Post
    I have been in an EMS conference this past week, and have seen a whole bunch of studies. Medics are messing up at tubes, and the survival rates of tubed vs BLS airway cardiac arrest saves (walk out of hospital) are virtually identical. An agency north of us has even rewritten protocols to make ONE attempt at intubation, and then drop a King IT airway. Also, ONE attempt at peri or EJ IV, and then go for EZ-IO. very neat stuff. For peds, the docs are even more adamant to not waste time with a tube, BLS airways with short transport times. Long transports, yes, go for the tube. I have study references if anyone is interested.
    I was at an ACLS refresher a couple of weeks ago and we were working with the Sim Man from UPMC. One of the things it monitors is how much air you are getting into the lungs using various rescue breathing methods. We were able to get just as much lung capacity into the simulator with a King as we were with an ET tube. I don't know how well this would translate in a real patient, but it made a believer out of me.
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    Combitubes, and King Airways are still ALS skills in PA. It's considered an invasive intervention, and therefore is only allowed to be done by the medic.

    At least for now. I can't see this staying true for long, as it's damn near idiot proof if you use a King or Combitube. No matter what happens, short of completely missing the patient's mouth, something will end up in the trachea.

    One of the docs up here, who also is a command physician, and helps make these types of protocols, is betting that in 2 years or less, ETI will be a defunct skill in PA, and not even taught to new medics, as it will be simply insert a King Airway, or Combitube, and bag away.

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    Quote Originally Posted by FWDbuff View Post
    Wow...What county are you from? With that attitude, you must have some of the worst EMT's in the state! We welcome the opportunity to be able to vent a patient more efficiently in the absence of ALS, and will train regularly on this, just as we do the rest of our skills!
    How long is the training, and what does it consist of? How many live tubes would be required before you're cleared? How many do you anticipate getting per year per provider? What is the anticipated drop in numbers of tubes per paramedic pyer year?

    Then come back and tell me it's a good idea.

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    Quote Originally Posted by PhillyRube View Post
    I have study references if anyone is interested.
    Trust me- they aren't.

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