In response to Is it time we give up endotracheal intubation – Part III, which was a response to Thoughts on ETI by Happy Medic, there are a couple of comments. This is a response to Justin Schorr, AKA Happy Medic –
Excellent points as always Rogue, but I think the underlying message of my post was not conveyed as clearly as I thought. My point was that we need to remove incompetent intubation through realistic training, not just leave the tubes just because we might need them.
Thank you. I think that we all have problems communicating when it comes to intubation. We have so many assumptions about what intubation is, what airway management is, and whether we are improving outcomes with intubation.
I completely agree that we need to eliminate incompetent intubation through excellent training.
As I mentioned in my response to Sean Eddy, the blame is with everyone – not just the medics.
If the arguments for removing tubes are that we don’t need them. Then take my dopamine, Mag Sulfate and the 90% of the kit I never use and could just as easily kill someone with.
How often do medics use/misuse these drugs?
How often do medics use/misuse intubation?
It isn’t that these do not cause problems, they do cause problems, but that they do not seem to cause problems as noticeable as the problems from pumping 100% oxygen into the stomach. And that is just the most blatant example.
We do need to deal with medication mistakes. That is why I think that EMSMedRx is an important new blog for EMS to pay attention to. Medics do not tend to want to learn about medication. People used to feel the same way about 12 leads, but Tom Bouthillet has done a lot to change that with EMS 12 Lead.
We have much to do to improve EMS. We have plenty of people trying to discourage any criticism of the problems we have in this best of all possible EMS worlds.
Training is the key to understanding not when to intubate, but when NOT to intubate. Taking my ETT and replacing it with an LMA is not a solution. Providing both and the training to know when to use each and how is the key, is it not?
Yes, but as we decrease the need for intubation with the use of other methods of airway management, we have to acknowledge that this means a decrease in available experience. Not every system will be willing to do what is necessary to maintain competence. Look at how many systems do not do what is necessary to maintain competence at pain management, on either end of the medical command line.
Anesthesia departments seem to be leading the way in switching to non-intubation airway management. We used to be proud of our similarities with anesthesia.
When anesthesia does something that is good for patients, but bad for encouraging EMS intubation, we no longer see anesthesiologists as doctors to emulate. We are wrong to allow our biases to mislead us on this important issue.
Like an awkward marriage, I think we’re all saying the same thing in this argument, just using different words and not completely explaining ourselves.
This is true.
What do we do to deal with the absentee medical directors? I might be able to find some of the missing posters put up by local EMS agencies.
Have you seen this medical director?
Neither have any of the medics at Sold Out EMS.
We have more resuscitations than sightings of our medical director, but we know that someone is cashing his checks.
I overheard a medic in my service telling a co-worker he wished someone would come by and train him more. I suggested heading to the yard the next morning and I got a look.
If we believe that we have great skills, one way we will find out that we are wrong is by practicing. Of course, if we spend a lot of time at high quality practice, then we might not have to worry about not having great skills.
Too many medics assume their department or service will give them all they need to continue being a competent provider, but we all know this is not true.
It should actually be a bit different.
The department or service should demand that the medics demonstrate excellence.
For example –
If we cannot demonstrate excellence at intubation, we will be removed from the approved to intubate list and our pay will be cut by 25% for failing to maintain competence.
If we really want to improve the quality of intubation in EMS, we can find a way. We can probably find many ways. We should not expect them to be popular.
I would expect unions to oppose this, but if the EMS agency goes to the public and points out that the union is only defending incompetence, there should not be many people supporting union opposition to improved patient care.
It would be better to try to find some ways to get the union to persuade the members that this is a good idea. It would be better to get the union to persuade members that the union does not want to be defending incompetence.
Thanks for the post, it made me realize I had failed to convey my intent completely. Perhaps less angry writing in the future will do me good.
Thank you for the post.
By working through our different ways of expressing ourselves, maybe we can come up with ways to convince medics to maintain competence in airway management, rather than take away intubation.
Don’t get angry, get a punching bag. I’d recommend Newman’s Gym, but it closed.