Re: RSI...how many medics are needed?

[Guest guest]

Hey ,

I work for a service that has RSI protocols and another that will begin RSI

sometime early 2003. The double paramedic system I work for... basically, I

am hearing that we would perform the task, then send it for our medical

director to look over. Our documentation should speak for itself when he is

looking over it. Plus, I know that our QI/QA Team will also look at the

statistics from our database. The [usual] single paramedic system, you

perform the task... then you fill-out all kinds of supplemental forms. *lol*

Usually, if you are in the situation of RSI, chances are the helicopter is

there or on the way. The single paramedic truck I am on from time to time is

in a very rural community and about 45-75 minutes from the Level I Trauma

Center, further from Level II Trauma Center, Cath Lab about 20-60 minutes.

The 2-Paramedic system... we have been sedating the patients for ET

Procedures [Versed/Morphine/Promethazine], and heading towards using

Succynocoline [i am sure not spelled correctly].

The 1-Paramedic system... chances are, if it is during normal business hours

the Director of Ops will be on the call with you. He still likes to get out

and get his hands dirty.

JM

[Guest guest]

In a message dated 12/12/02 8:30:54 PM Central Standard Time,

relicmedic@... writes:

> I believe that RSI is an emergent intervention, when the patient needs

> ventilatory assistance that cannot be effectively achieved by other means,

> short of cricothyrotomy.

Exactly. There are some; however, who think that every patient that is short

of breath needs to be intubated on scene.

[Guest guest]

In a message dated 12/12/02 8:30:54 PM Central Standard Time,

relicmedic@... writes:

> Having the second paramedic immediately at hand is a bonus - not a

> necessity. Remember that you still have a second person with you that can

> assist to the level of their ability even if that is just BVM, Sellick's,

> etc.

>

Okay then, what is a good scene time for a RSI call with one Paramedic and

one EMT-B? RSI is a busy procedure, a lot is going on in a short amount of

time.

[Guest guest]

I also work for two services which utilize the RSI protocols, one relatively

liberal, and the protocols state that RSI can be used by any medic when the

situation requires, regardless of dual vs. sole medic.

Both services are 911, and both are rural, if that makes any difference to

your survey.

The second service is a little more controlled, and states that there must

be two personell on the scene before RSI can be used, in the event one

cannot get the intubation, the other can at least try. Seeing as how our

basics are taught intubation, and authorized to do so, AFTER their skills

have been checked off by thje medical director and/or the appointee, this

also becomes somewhat liberal.

If you have any questions, feel free to email me off list.

Mike

Re: RSI...how many medics are needed?

> Hey ,

>

> I work for a service that has RSI protocols and another that will begin

RSI

> sometime early 2003. The double paramedic system I work for... basically,

I

> am hearing that we would perform the task, then send it for our medical

> director to look over. Our documentation should speak for itself when he

is

> looking over it. Plus, I know that our QI/QA Team will also look at the

> statistics from our database. The [usual] single paramedic system, you

> perform the task... then you fill-out all kinds of supplemental forms.

*lol*

> Usually, if you are in the situation of RSI, chances are the helicopter is

> there or on the way. The single paramedic truck I am on from time to time

is

> in a very rural community and about 45-75 minutes from the Level I Trauma

> Center, further from Level II Trauma Center, Cath Lab about 20-60 minutes.

>

> The 2-Paramedic system... we have been sedating the patients for ET

> Procedures [Versed/Morphine/Promethazine], and heading towards using

> Succynocoline [i am sure not spelled correctly].

>

> The 1-Paramedic system... chances are, if it is during normal business

hours

> the Director of Ops will be on the call with you. He still likes to get

out

> and get his hands dirty.

>

> JM

>

>

>

[Guest guest]

A few questions come to mind when you ask " how many Paramedics are needed "

Are you asking how many it takes to do the actual RSI procedure itself, or

should another skills person, (any level protocoled to secure an airway) be

there to backup/assist? If YOU fail to get an intubation you have the

combitube.

Are you always going to be able to stay on scene and wait for another

unit/supervisor to show up? While it would be nice to have the extra hands

sometimes, no.Your transport distance/time is relatively short, do what you

have to do and transport, without delay.

Christy

RSI...how many medics are needed?

> I have a question for all of you who have RSI protocols at your service.

Are

> you running single or double Paramedic units? If you run a Paramedic-EMT

> unit, do you request backup such as a roaming Paramedic Supervisor or

backup

> unit? The reason why I am asking is that there is some debate on this

issue

> and I am just curious to see some views on this. Thanks.

>

> e, LP

>

>

>

[Guest guest]

,

Are you a Director? Educator? or FTO for your service?

I completely understand where you are coming from. Field Paramedics always

want to be able to use the " hottest and latest " things to improve patient

care. I looked at your question as if you were looking for input on folks

that have RSI to assist you in creating questions and scenerios that you

could take to your administrative staff. With the overall hopes of creating

the " BEST " protocol for your EMS system.

I think it is a wise thing that you are doing. I do understand that all

medics [at all levels] don't perform on the same level, and you have to

" tailor " a protocol to what you have. Once you have the protocol in place,

you can look at improving the education, skill training and the protocol

itself when the time is " RIGHT! "

Good Luck!

JM

[Guest guest]

Thanks to all of those who replied as I am now enlightened on the issue. Your

responses will help me with any future decisions that I will need to make.

, I knew you would come out of the woodwork on this one

Next question and then I will be through. What kind of scene time is

acceptable on a call involving RSI with say one basic and one Paramedic?

Actually, how long should the procedure take?

[Guest guest]

In a message dated 12/13/02 10:26:14 AM Central Standard Time,

myncite@... writes:

> Ok - I feel stupid, but I am new afterall (currently in EMT school,

> not working in the field yet) - but what is RSI?

>

> Thanks a billion,

> Stefanie

>

> (I'm sure I'll feel even more stupid once I hear the answer and am

> embarrassed that i couldn't figure that out myself..)

>

>

>

Stefanie,

No question is a stupid question if it leads to greater understanding. This

statement was said over an over again by a high school mathematics teacher

who I had a great respect for. I felt pretty dumb asking my question knowing

how some are on this list so I know how you feel.

[Guest guest]

,

We here at Nacogdoches County EMS run Paramedic/EMT units. In the city we have

back-up from City Fire, and in some locals First responders. If we don't get

them, we run a back-up unit.

Nacogdoches County EMS

Public Education

ambubag@... wrote:

> I have a question for all of you who have RSI protocols at your service. Are

> you running single or double Paramedic units? If you run a Paramedic-EMT

> unit, do you request backup such as a roaming Paramedic Supervisor or backup

> unit? The reason why I am asking is that there is some debate on this issue

> and I am just curious to see some views on this. Thanks.

>

> e, LP

>

>

[Guest guest]

Ok - I feel stupid, but I am new afterall (currently in EMT school,

not working in the field yet) - but what is RSI?

Thanks a billion,

Stefanie

(I'm sure I'll feel even more stupid once I hear the answer and am

embarrassed that i couldn't figure that out myself..)