----- Forwarded Message ---- From: "Bryan Bledsoe, DO" <[EMAIL PROTECTED]> To: [EMAIL PROTECTED] Sent: Monday, June 18, 2007 10:35:56 PM Subject: RE: So it's not just Orlando ! ? Adult Prehospital Intubation: More Harm Than Good?
Wes: I know the researchers involved in most of this. Henry Wang at Pitt initially set out to show that prehospital intubations were beneficial. I am not sure about what happened in San Diego. Steve Katz’s paper many years ago showing a 25% UEI in Orlando was a result of seeing so many problems. I think this intubation issue is purely a regional thing. There are many areas where prehospital intubation and even RSI are as safe as in-hospital (e.g., Marv Wayne and his bunch at the Bellingham FD). But, there are obvious problems: Orange County (south Orlando) and San Diego County have a large number of paramedics and I think skills maintenance is the major issue. Now, the bad part of the issue. I do not think we can continue to educate all paramedics in ETI because: 1. The usage of ETI in anesthesia and the hospital setting in general is declining. Approximately 40% of anesthesia cases in most hospitals are being performed with LMAs. 2. Because of the decline in ETI, there is and will be a greater demand for student experience in a dwindling number of patients. Thus, the EM residents, Anesthesia residents, Critical Care Fellows, and CRNA students will all have priority over the EMS people. In fact, respiratory therapy and other residents (IM, PEDS) may also have priority. 3. The private hospitals are trying to minimize the use of their paying patients as student subjects. 4. Some anesthesia groups are forbidden from allowing student intubations because they bargained a discount malpractice insurance rate. 5. Fresh cadavers are limited because now we have to ask the family for permission to practice on these. Socially, we often can’t do this. This used to be a major source of student practice. 6. There is no compelling literature that ETI provides a better airway than other modalities. I think only certain paramedics in high-volume systems and perhaps only true CCPs—not UMBC grads will be the only ones using ETI in the future. There may be system rules that if you don’t do X intubations in a year, the privilege to intubate is pulled. I would start getting comfortable with one of the alternative airways. BEB From: Paramedicine@ yahoogroups. com [mailto:Paramedicine@ yahoogroups. com] On Behalf Of [EMAIL PROTECTED] com Sent: Monday, June 18, 2007 8:59 AM To: Paramedicine@ yahoogroups. com Subject: Re: So it's not just Orlando ! ? Adult Prehospital Intubation: More Harm Than Good? I hate to even suggest this, but is it possible that some (not all, mind you) physicians have a bias against EMS doing prehospital intubations? Also, it bothers me that almost all EMS research is done in larger cities. As has been discussed on here before, much of the best practices in EMS are happening in smaller systems. -Wes Ogilvie [Non-text portions of this message have been removed] __._,_.___ Messages in this topic (0) Reply (via web post) | Start a new topic Messages | Files | Photos | Links | Database | Polls | Calendar Visit our website at www.paramedicine.com Change settings via the Web (Yahoo! ID required) Change settings via email: Switch delivery to Daily Digest | Switch format to Traditional Visit Your Group | Yahoo! Groups Terms of Use | Unsubscribe Recent Activity 3New Members 1New Files Visit Your Group SPONSORED LINKS Emt paramedic Paramedic uniform Paramedic gift Paramedic bag Paramedic equipment HDTV Support on Yahoo! Groups Help with Samsung HDTVs and devices Yoga Groups Find Enlightenment & exhange insights with other members Yahoo! 360° Start Today Get your own place online. __,_._,___
