RE: New Thread--Pedi ALS Equipment

[Guest guest]

I don't think defending yourself against why you didn't use equipment is an

issue. We should provide everyone with the tools and education to do their

job well. It is up to the educated paramedic to make the informed decision

as to whether or not to use a piece of equipment. If you put paralytics on

your unit and an adult pt needed to be intubated but the medic recognized a

difficult airway and decided to use a BVM with an OPA, is it an issue to

defend not using the paralytic that was available? There should not be

skill decay. We all need to recognize that we have a very serious job and

should stay on top of our skills and education...b/c you never know when

you'll get that urgent pedi pt. Services need to provide the education to

their medics so that we, as a state, can raise our standards to where they

should be.

Yes, most first pedi intubations are done in the field, without

supervison...so are chest decompressions, adult intubations, cardioversions,

etc. That's where CE comes in. My first intubation ever was as a new

paramedic in the field on a 28wk gestation neonate. I had excellent

training and was able to perform the skill successfully.

We have got to start trusting our medics. I understand that the way to

attain that trust is to make sure medics are adequately trained in skills

and have the knowledge to know when or when not to use those skills. Raise

the bar!

>

> The problem is, say, you put pedi laryngoscopes on a rural service where

> the

> ambulance only does 1 pediatric intubation every two years (the paramedics

> may do 0), Thus, it might be better to have the paramedics simply bag the

> patient. But, then you would have to defend why you did not use equipment

> that was on the ambulance. Then, you are into explaining skill decay and

> rust-out and the Gausche-Hill UCLA study. It is best to keep it a local

> issue.

>

> In terms of pediatric intubations, how many paramedics and EMT-Is get to

> perform 3-5 supervised pediatric intubations in the hospital before going

> to

> the field. Most do their first pediatric intubation in the field without

> supervision.

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of Hervey

> Sent: Wednesday, December 28, 2005 11:22 AM

> To:

> Subject: Re: New Thread--Pedi ALS Equipment

>

>

> The problem isn't in the amount of money we spend on equipment...it's

> getting everyone trained to know how to use the baseline ALS equipment

> well. We wouldn't have to spend money on IV infusion pumps if everyone

> would really become proficient at calculating drips, using a Buretrol,

> Broselow tape, etc. We need to have a baseline for everyone. From there,

> local medical direction can take it as far as it wants (and I hope they go

> FAR). It's the rural places that don't necessarily have ED physicians as

> medical directors that need some guidance and that's where GETAC can come

> in

> and mandate minimum equipment (and training on how to use it).

>

>

> >

> > What cost do you put on a kids life? $ 22k is $ 22k...how much are you

> > willing to spend on a kid to get him better treatment? How little are

> you

> > willing to spend on them?

> >

> > I'm all for local control but there is a wide expanse of how well we

> take

> > care of patients from community to community.

> >

> >

> >

> > S. Suprun Jr., NREMT-P, CCEMT-P

> > csuprun@...

> > www.consurgo.org

> > Prepare. Respond. Overcome.

> >

> >

> > Re: New Thread--Pedi ALS Equipment

> >

> >

> >

> > In a message dated 12/28/2005 10:44:58 A.M. Central Standard Time,

> > jenherv@... writes:

> >

> > don't have to take a huge hit buying unneeded equipment.

> >

> >

> > Yea but isn't 22,000 per truck (using Dr. B's number) by default just

> > that?

> >

> > How can we justify 22,000 bucks?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/EMSI

> > LNMolino@...

> > (Office)

> > (Office Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > The comments contained in this E-mail are the opinions of the author

> and

> > the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated with

> > unless I

> > specifically state that I am doing so. Further this E-mail is intended

> > only

> > for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public domain

> > by

> > the

> > original author.

> >

> >

> >

[Guest guest]

I don't think defending yourself against why you didn't use equipment is an

issue. We should provide everyone with the tools and education to do their

job well. It is up to the educated paramedic to make the informed decision

as to whether or not to use a piece of equipment. If you put paralytics on

your unit and an adult pt needed to be intubated but the medic recognized a

difficult airway and decided to use a BVM with an OPA, is it an issue to

defend not using the paralytic that was available? There should not be

skill decay. We all need to recognize that we have a very serious job and

should stay on top of our skills and education...b/c you never know when

you'll get that urgent pedi pt. Services need to provide the education to

their medics so that we, as a state, can raise our standards to where they

should be.

Yes, most first pedi intubations are done in the field, without

supervison...so are chest decompressions, adult intubations, cardioversions,

etc. That's where CE comes in. My first intubation ever was as a new

paramedic in the field on a 28wk gestation neonate. I had excellent

training and was able to perform the skill successfully.

We have got to start trusting our medics. I understand that the way to

attain that trust is to make sure medics are adequately trained in skills

and have the knowledge to know when or when not to use those skills. Raise

the bar!

>

> The problem is, say, you put pedi laryngoscopes on a rural service where

> the

> ambulance only does 1 pediatric intubation every two years (the paramedics

> may do 0), Thus, it might be better to have the paramedics simply bag the

> patient. But, then you would have to defend why you did not use equipment

> that was on the ambulance. Then, you are into explaining skill decay and

> rust-out and the Gausche-Hill UCLA study. It is best to keep it a local

> issue.

>

> In terms of pediatric intubations, how many paramedics and EMT-Is get to

> perform 3-5 supervised pediatric intubations in the hospital before going

> to

> the field. Most do their first pediatric intubation in the field without

> supervision.

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of Hervey

> Sent: Wednesday, December 28, 2005 11:22 AM

> To:

> Subject: Re: New Thread--Pedi ALS Equipment

>

>

> The problem isn't in the amount of money we spend on equipment...it's

> getting everyone trained to know how to use the baseline ALS equipment

> well. We wouldn't have to spend money on IV infusion pumps if everyone

> would really become proficient at calculating drips, using a Buretrol,

> Broselow tape, etc. We need to have a baseline for everyone. From there,

> local medical direction can take it as far as it wants (and I hope they go

> FAR). It's the rural places that don't necessarily have ED physicians as

> medical directors that need some guidance and that's where GETAC can come

> in

> and mandate minimum equipment (and training on how to use it).

>

>

> >

> > What cost do you put on a kids life? $ 22k is $ 22k...how much are you

> > willing to spend on a kid to get him better treatment? How little are

> you

> > willing to spend on them?

> >

> > I'm all for local control but there is a wide expanse of how well we

> take

> > care of patients from community to community.

> >

> >

> >

> > S. Suprun Jr., NREMT-P, CCEMT-P

> > csuprun@...

> > www.consurgo.org

> > Prepare. Respond. Overcome.

> >

> >

> > Re: New Thread--Pedi ALS Equipment

> >

> >

> >

> > In a message dated 12/28/2005 10:44:58 A.M. Central Standard Time,

> > jenherv@... writes:

> >

> > don't have to take a huge hit buying unneeded equipment.

> >

> >

> > Yea but isn't 22,000 per truck (using Dr. B's number) by default just

> > that?

> >

> > How can we justify 22,000 bucks?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/EMSI

> > LNMolino@...

> > (Office)

> > (Office Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > The comments contained in this E-mail are the opinions of the author

> and

> > the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated with

> > unless I

> > specifically state that I am doing so. Further this E-mail is intended

> > only

> > for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public domain

> > by

> > the

> > original author.

> >

> >

> >

[Guest guest]

I don't think defending yourself against why you didn't use equipment is an

issue. We should provide everyone with the tools and education to do their

job well. It is up to the educated paramedic to make the informed decision

as to whether or not to use a piece of equipment. If you put paralytics on

your unit and an adult pt needed to be intubated but the medic recognized a

difficult airway and decided to use a BVM with an OPA, is it an issue to

defend not using the paralytic that was available? There should not be

skill decay. We all need to recognize that we have a very serious job and

should stay on top of our skills and education...b/c you never know when

you'll get that urgent pedi pt. Services need to provide the education to

their medics so that we, as a state, can raise our standards to where they

should be.

Yes, most first pedi intubations are done in the field, without

supervison...so are chest decompressions, adult intubations, cardioversions,

etc. That's where CE comes in. My first intubation ever was as a new

paramedic in the field on a 28wk gestation neonate. I had excellent

training and was able to perform the skill successfully.

We have got to start trusting our medics. I understand that the way to

attain that trust is to make sure medics are adequately trained in skills

and have the knowledge to know when or when not to use those skills. Raise

the bar!

>

> The problem is, say, you put pedi laryngoscopes on a rural service where

> the

> ambulance only does 1 pediatric intubation every two years (the paramedics

> may do 0), Thus, it might be better to have the paramedics simply bag the

> patient. But, then you would have to defend why you did not use equipment

> that was on the ambulance. Then, you are into explaining skill decay and

> rust-out and the Gausche-Hill UCLA study. It is best to keep it a local

> issue.

>

> In terms of pediatric intubations, how many paramedics and EMT-Is get to

> perform 3-5 supervised pediatric intubations in the hospital before going

> to

> the field. Most do their first pediatric intubation in the field without

> supervision.

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of Hervey

> Sent: Wednesday, December 28, 2005 11:22 AM

> To:

> Subject: Re: New Thread--Pedi ALS Equipment

>

>

> The problem isn't in the amount of money we spend on equipment...it's

> getting everyone trained to know how to use the baseline ALS equipment

> well. We wouldn't have to spend money on IV infusion pumps if everyone

> would really become proficient at calculating drips, using a Buretrol,

> Broselow tape, etc. We need to have a baseline for everyone. From there,

> local medical direction can take it as far as it wants (and I hope they go

> FAR). It's the rural places that don't necessarily have ED physicians as

> medical directors that need some guidance and that's where GETAC can come

> in

> and mandate minimum equipment (and training on how to use it).

>

>

> >

> > What cost do you put on a kids life? $ 22k is $ 22k...how much are you

> > willing to spend on a kid to get him better treatment? How little are

> you

> > willing to spend on them?

> >

> > I'm all for local control but there is a wide expanse of how well we

> take

> > care of patients from community to community.

> >

> >

> >

> > S. Suprun Jr., NREMT-P, CCEMT-P

> > csuprun@...

> > www.consurgo.org

> > Prepare. Respond. Overcome.

> >

> >

> > Re: New Thread--Pedi ALS Equipment

> >

> >

> >

> > In a message dated 12/28/2005 10:44:58 A.M. Central Standard Time,

> > jenherv@... writes:

> >

> > don't have to take a huge hit buying unneeded equipment.

> >

> >

> > Yea but isn't 22,000 per truck (using Dr. B's number) by default just

> > that?

> >

> > How can we justify 22,000 bucks?

> >

> > Louis N. Molino, Sr., CET

> > FF/NREMT-B/FSI/EMSI

> > LNMolino@...

> > (Office)

> > (Office Fax)

> >

> > " A Texan with a Jersey Attitude "

> >

> > The comments contained in this E-mail are the opinions of the author

> and

> > the

> > author alone. I in no way ever intend to speak for any person or

> > organization that I am in any way whatsoever involved or associated with

> > unless I

> > specifically state that I am doing so. Further this E-mail is intended

> > only

> > for its

> > stated recipient and may contain private and or confidential materials

> > retransmission is strictly prohibited unless placed in the public domain

> > by

> > the

> > original author.

> >

> >

> >

[Guest guest]

Would you go to a doctor whose first procedure was done without supervision

outside of a training program? The educational programs are essential and

the simulators are better than ever. But, there is no substitute for human

practice under supervision. This is the issue we are wrestling with at a

national level. There is a significant push, based upon some pretty good

science that children do better when paramedics don't intubate them, to

remove pediatric endotracheal intubation from the paramedic scope of

practice. It is already occurring in parts of California. pediatric

intubation training has always been a problem for EMS. There are several

reasons for this:

1. Mannequins for pediatric intubations are unsatisfactory. Generally you

have an infant and an adult--nothing in between.

2. EMT-Is and EMT-Ps are usually not allowed access to pediatric anesthesia

areas for human intubations.

3. Pediatric intubations overall in the ED are rare and there the pecking

order comes into play--the pedi EM fellow will get first shot, then the pedi

EM resident, then the pedi resident, then the medical student, then the CRNA

student, then the EMS student.

4. Studies are showing that between 25 and 125 repetitions are necessary to

begin t lay in the psychomotor pathways for even simple medical skills.

5. It seems that 5 pediatric intubations a year (real or simulator) is the

minimum necessary to assure competency (although some researchers say more).

Thus, in the new National Scope of Practice EMT-Intermediates (now called

Advanced EMTs) will not be allowed to intubate--only use other airways. I

would not be surprised to see pediatric endotracheal intubation removed from

routine paramedic usage.

In regard to procedures first performed unsupervised, I can say this. I am

often asked to be an expert witness for EMS providers in regard to standard

of care issues. I can assure you that they will subpoena every document in

your personnel file and your EMT and paramedic education records. I would be

hard pressed to convince a judge or jury that a paramedic is competent at a

given skill when the first time they perform a high-risk skill is in an

unsupervised field environment. You might as well avoid the courthouse and

open your checkbook. The plaintiff's attorney will have an expert from

California attest that such skills are dangerous and it is nearly criminal

to allow a paramedic to perform a high-risk skill for the first time without

supervision.

The poster of the previous email wrote, " My first intubation ever was as a

new paramedic in the field on a 28wk gestation neonate. I had excellent

training and was able to perform the skill successfully. " The plaintiff's

attorney will surely tell the jury, " How can the defendant know that he/she

performed the skill successfully if they have never done it. They will then

subpoena the run report and start tracking down records. They find the kid,

now five years old and retarded. The attorney will say that, because of your

intubation, this child's only future is in politics or the judiciary.

Be advised, you can be sued over that one case for the next 23 years (from

the time of birth until the victim is aged 21 plus 2 year statute of

limitations).

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of Hervey

Sent: Wednesday, December 28, 2005 12:04 PM

To:

Subject: Re: New Thread--Pedi ALS Equipment

I don't think defending yourself against why you didn't use equipment is an

issue. We should provide everyone with the tools and education to do their

job well. It is up to the educated paramedic to make the informed decision

as to whether or not to use a piece of equipment. If you put paralytics on

your unit and an adult pt needed to be intubated but the medic recognized a

difficult airway and decided to use a BVM with an OPA, is it an issue to

defend not using the paralytic that was available? There should not be

skill decay. We all need to recognize that we have a very serious job and

should stay on top of our skills and education...b/c you never know when

you'll get that urgent pedi pt. Services need to provide the education to

their medics so that we, as a state, can raise our standards to where they

should be.

Yes, most first pedi intubations are done in the field, without

supervison...so are chest decompressions, adult intubations, cardioversions,

etc. That's where CE comes in. My first intubation ever was as a new

paramedic in the field on a 28wk gestation neonate. I had excellent

training and was able to perform the skill successfully.

We have got to start trusting our medics. I understand that the way to

attain that trust is to make sure medics are adequately trained in skills

and have the knowledge to know when or when not to use those skills. Raise

the bar!

[Guest guest]

Correct and you certainly don't need a special pediatric monitor as was

mentioned here before. Additionally much of the standards can be met without

purchasing fancy " broslow bags " and color coded rolls and such.

But basic pediatric equipment should be a requirement.

Jim<

_____

From: [mailto: ] On

Behalf Of Hervey

Sent: Wednesday, December 28, 2005 10:04 AM

To:

Subject: Re: New Thread--Pedi ALS Equipment

I'm not supporting the $22000...that's WAY TOO HIGH!!! I think the minimal

needed should only cost a fraction of that.

_____

[Guest guest]

Correct and you certainly don't need a special pediatric monitor as was

mentioned here before. Additionally much of the standards can be met without

purchasing fancy " broslow bags " and color coded rolls and such.

But basic pediatric equipment should be a requirement.

Jim<

_____

From: [mailto: ] On

Behalf Of Hervey

Sent: Wednesday, December 28, 2005 10:04 AM

To:

Subject: Re: New Thread--Pedi ALS Equipment

I'm not supporting the $22000...that's WAY TOO HIGH!!! I think the minimal

needed should only cost a fraction of that.

_____

[Guest guest]

Okay, I did not mean to start the argument scope of practice. I am just

trying to defend the idea of mandating certain equipment on an MICU. I am

also trying to defend medics in general. Give us the tools and education to

do our job well.

If that doesn't include a pedi ETT, then that's fine. When we are provided

with the education and training needed to satisfy lawyers that we're

competent caregivers, it would be nice to be able to set the same high

standard of care across the board.

When people (general population, MDs, and medics themselves have to start to

hold themselves accountable) start to recognize that medics are an integral

part of emergency medicine then maybe in the ER rotations where there are

knowledgeable doctors to train and supervise us, we'll be able to move up

the list on who gets to practice on patients since we are the first line of

care to the very sick patients.

Please help Texas EMS rise to the national standard. A great way to do this

is to mandate everyone to have a baseline of pediatric equipment needed to

treat an emergency. I will not submit examples of what equipment...that's

obviously for the medical directors to decide. I just want to see EMS

improve and grow as a whole and someone to step in and give everyone a solid

starting point.

>

> Would you go to a doctor whose first procedure was done without

> supervision

> outside of a training program? The educational programs are essential and

> the simulators are better than ever. But, there is no substitute for human

> practice under supervision. This is the issue we are wrestling with at a

> national level. There is a significant push, based upon some pretty good

> science that children do better when paramedics don't intubate them, to

> remove pediatric endotracheal intubation from the paramedic scope of

> practice. It is already occurring in parts of California. pediatric

> intubation training has always been a problem for EMS. There are several

> reasons for this:

>

> 1. Mannequins for pediatric intubations are unsatisfactory. Generally you

> have an infant and an adult--nothing in between.

> 2. EMT-Is and EMT-Ps are usually not allowed access to pediatric

> anesthesia

> areas for human intubations.

> 3. Pediatric intubations overall in the ED are rare and there the pecking

> order comes into play--the pedi EM fellow will get first shot, then the

> pedi

> EM resident, then the pedi resident, then the medical student, then the

> CRNA

> student, then the EMS student.

> 4. Studies are showing that between 25 and 125 repetitions are necessary

> to

> begin t lay in the psychomotor pathways for even simple medical skills.

> 5. It seems that 5 pediatric intubations a year (real or simulator) is the

> minimum necessary to assure competency (although some researchers say

> more).

>

>

> Thus, in the new National Scope of Practice EMT-Intermediates (now called

> Advanced EMTs) will not be allowed to intubate--only use other airways. I

> would not be surprised to see pediatric endotracheal intubation removed

> from

> routine paramedic usage.

>

> In regard to procedures first performed unsupervised, I can say this. I am

> often asked to be an expert witness for EMS providers in regard to

> standard

> of care issues. I can assure you that they will subpoena every document in

> your personnel file and your EMT and paramedic education records. I would

> be

> hard pressed to convince a judge or jury that a paramedic is competent at

> a

> given skill when the first time they perform a high-risk skill is in an

> unsupervised field environment. You might as well avoid the courthouse and

> open your checkbook. The plaintiff's attorney will have an expert from

> California attest that such skills are dangerous and it is nearly criminal

> to allow a paramedic to perform a high-risk skill for the first time

> without

> supervision.

>

> The poster of the previous email wrote, " My first intubation ever was as a

> new paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully. " The plaintiff's

> attorney will surely tell the jury, " How can the defendant know that

> he/she

> performed the skill successfully if they have never done it. They will

> then

> subpoena the run report and start tracking down records. They find the

> kid,

> now five years old and retarded. The attorney will say that, because of

> your

> intubation, this child's only future is in politics or the judiciary.

>

> Be advised, you can be sued over that one case for the next 23 years (from

> the time of birth until the victim is aged 21 plus 2 year statute of

> limitations).

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of Hervey

> Sent: Wednesday, December 28, 2005 12:04 PM

> To:

> Subject: Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>

[Guest guest]

Okay, I did not mean to start the argument scope of practice. I am just

trying to defend the idea of mandating certain equipment on an MICU. I am

also trying to defend medics in general. Give us the tools and education to

do our job well.

If that doesn't include a pedi ETT, then that's fine. When we are provided

with the education and training needed to satisfy lawyers that we're

competent caregivers, it would be nice to be able to set the same high

standard of care across the board.

When people (general population, MDs, and medics themselves have to start to

hold themselves accountable) start to recognize that medics are an integral

part of emergency medicine then maybe in the ER rotations where there are

knowledgeable doctors to train and supervise us, we'll be able to move up

the list on who gets to practice on patients since we are the first line of

care to the very sick patients.

Please help Texas EMS rise to the national standard. A great way to do this

is to mandate everyone to have a baseline of pediatric equipment needed to

treat an emergency. I will not submit examples of what equipment...that's

obviously for the medical directors to decide. I just want to see EMS

improve and grow as a whole and someone to step in and give everyone a solid

starting point.

>

> Would you go to a doctor whose first procedure was done without

> supervision

> outside of a training program? The educational programs are essential and

> the simulators are better than ever. But, there is no substitute for human

> practice under supervision. This is the issue we are wrestling with at a

> national level. There is a significant push, based upon some pretty good

> science that children do better when paramedics don't intubate them, to

> remove pediatric endotracheal intubation from the paramedic scope of

> practice. It is already occurring in parts of California. pediatric

> intubation training has always been a problem for EMS. There are several

> reasons for this:

>

> 1. Mannequins for pediatric intubations are unsatisfactory. Generally you

> have an infant and an adult--nothing in between.

> 2. EMT-Is and EMT-Ps are usually not allowed access to pediatric

> anesthesia

> areas for human intubations.

> 3. Pediatric intubations overall in the ED are rare and there the pecking

> order comes into play--the pedi EM fellow will get first shot, then the

> pedi

> EM resident, then the pedi resident, then the medical student, then the

> CRNA

> student, then the EMS student.

> 4. Studies are showing that between 25 and 125 repetitions are necessary

> to

> begin t lay in the psychomotor pathways for even simple medical skills.

> 5. It seems that 5 pediatric intubations a year (real or simulator) is the

> minimum necessary to assure competency (although some researchers say

> more).

>

>

> Thus, in the new National Scope of Practice EMT-Intermediates (now called

> Advanced EMTs) will not be allowed to intubate--only use other airways. I

> would not be surprised to see pediatric endotracheal intubation removed

> from

> routine paramedic usage.

>

> In regard to procedures first performed unsupervised, I can say this. I am

> often asked to be an expert witness for EMS providers in regard to

> standard

> of care issues. I can assure you that they will subpoena every document in

> your personnel file and your EMT and paramedic education records. I would

> be

> hard pressed to convince a judge or jury that a paramedic is competent at

> a

> given skill when the first time they perform a high-risk skill is in an

> unsupervised field environment. You might as well avoid the courthouse and

> open your checkbook. The plaintiff's attorney will have an expert from

> California attest that such skills are dangerous and it is nearly criminal

> to allow a paramedic to perform a high-risk skill for the first time

> without

> supervision.

>

> The poster of the previous email wrote, " My first intubation ever was as a

> new paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully. " The plaintiff's

> attorney will surely tell the jury, " How can the defendant know that

> he/she

> performed the skill successfully if they have never done it. They will

> then

> subpoena the run report and start tracking down records. They find the

> kid,

> now five years old and retarded. The attorney will say that, because of

> your

> intubation, this child's only future is in politics or the judiciary.

>

> Be advised, you can be sued over that one case for the next 23 years (from

> the time of birth until the victim is aged 21 plus 2 year statute of

> limitations).

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of Hervey

> Sent: Wednesday, December 28, 2005 12:04 PM

> To:

> Subject: Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>

[Guest guest]

Okay, I did not mean to start the argument scope of practice. I am just

trying to defend the idea of mandating certain equipment on an MICU. I am

also trying to defend medics in general. Give us the tools and education to

do our job well.

If that doesn't include a pedi ETT, then that's fine. When we are provided

with the education and training needed to satisfy lawyers that we're

competent caregivers, it would be nice to be able to set the same high

standard of care across the board.

When people (general population, MDs, and medics themselves have to start to

hold themselves accountable) start to recognize that medics are an integral

part of emergency medicine then maybe in the ER rotations where there are

knowledgeable doctors to train and supervise us, we'll be able to move up

the list on who gets to practice on patients since we are the first line of

care to the very sick patients.

Please help Texas EMS rise to the national standard. A great way to do this

is to mandate everyone to have a baseline of pediatric equipment needed to

treat an emergency. I will not submit examples of what equipment...that's

obviously for the medical directors to decide. I just want to see EMS

improve and grow as a whole and someone to step in and give everyone a solid

starting point.

>

> Would you go to a doctor whose first procedure was done without

> supervision

> outside of a training program? The educational programs are essential and

> the simulators are better than ever. But, there is no substitute for human

> practice under supervision. This is the issue we are wrestling with at a

> national level. There is a significant push, based upon some pretty good

> science that children do better when paramedics don't intubate them, to

> remove pediatric endotracheal intubation from the paramedic scope of

> practice. It is already occurring in parts of California. pediatric

> intubation training has always been a problem for EMS. There are several

> reasons for this:

>

> 1. Mannequins for pediatric intubations are unsatisfactory. Generally you

> have an infant and an adult--nothing in between.

> 2. EMT-Is and EMT-Ps are usually not allowed access to pediatric

> anesthesia

> areas for human intubations.

> 3. Pediatric intubations overall in the ED are rare and there the pecking

> order comes into play--the pedi EM fellow will get first shot, then the

> pedi

> EM resident, then the pedi resident, then the medical student, then the

> CRNA

> student, then the EMS student.

> 4. Studies are showing that between 25 and 125 repetitions are necessary

> to

> begin t lay in the psychomotor pathways for even simple medical skills.

> 5. It seems that 5 pediatric intubations a year (real or simulator) is the

> minimum necessary to assure competency (although some researchers say

> more).

>

>

> Thus, in the new National Scope of Practice EMT-Intermediates (now called

> Advanced EMTs) will not be allowed to intubate--only use other airways. I

> would not be surprised to see pediatric endotracheal intubation removed

> from

> routine paramedic usage.

>

> In regard to procedures first performed unsupervised, I can say this. I am

> often asked to be an expert witness for EMS providers in regard to

> standard

> of care issues. I can assure you that they will subpoena every document in

> your personnel file and your EMT and paramedic education records. I would

> be

> hard pressed to convince a judge or jury that a paramedic is competent at

> a

> given skill when the first time they perform a high-risk skill is in an

> unsupervised field environment. You might as well avoid the courthouse and

> open your checkbook. The plaintiff's attorney will have an expert from

> California attest that such skills are dangerous and it is nearly criminal

> to allow a paramedic to perform a high-risk skill for the first time

> without

> supervision.

>

> The poster of the previous email wrote, " My first intubation ever was as a

> new paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully. " The plaintiff's

> attorney will surely tell the jury, " How can the defendant know that

> he/she

> performed the skill successfully if they have never done it. They will

> then

> subpoena the run report and start tracking down records. They find the

> kid,

> now five years old and retarded. The attorney will say that, because of

> your

> intubation, this child's only future is in politics or the judiciary.

>

> Be advised, you can be sued over that one case for the next 23 years (from

> the time of birth until the victim is aged 21 plus 2 year statute of

> limitations).

>

> E. Bledsoe, DO, FACEP

> Midlothian, Texas

>

> Don't miss the Western States EMS Cruise!

> http://proemseducators.com/index.html

>

>

>

> _____

>

> From: [mailto: ] On

> Behalf Of Hervey

> Sent: Wednesday, December 28, 2005 12:04 PM

> To:

> Subject: Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>

[Guest guest]

--

I think we all (especially Dr. Bledsoe) favor increased training and the right

equipment to do the job.

I've had the privilege to know the good doctor for several years. Without

putting words into his mouth, I think his concern, at least regarding the

equipment, comes from the perspective of a medical director. Current DSHS regs

allow the medical director to determine the appropriate equipment to be carried

on an ambulance. The proposed list from the pediatric committee is an intrusion

on the physician's perogative as medical director.

I realize that pediatric patients are much more different than being miniature

versions of adult patients, but I'm curious what the specific need for a GETAC

peds committee is...

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>

[Guest guest]

--

I think we all (especially Dr. Bledsoe) favor increased training and the right

equipment to do the job.

I've had the privilege to know the good doctor for several years. Without

putting words into his mouth, I think his concern, at least regarding the

equipment, comes from the perspective of a medical director. Current DSHS regs

allow the medical director to determine the appropriate equipment to be carried

on an ambulance. The proposed list from the pediatric committee is an intrusion

on the physician's perogative as medical director.

I realize that pediatric patients are much more different than being miniature

versions of adult patients, but I'm curious what the specific need for a GETAC

peds committee is...

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>

[Guest guest]

--

I think we all (especially Dr. Bledsoe) favor increased training and the right

equipment to do the job.

I've had the privilege to know the good doctor for several years. Without

putting words into his mouth, I think his concern, at least regarding the

equipment, comes from the perspective of a medical director. Current DSHS regs

allow the medical director to determine the appropriate equipment to be carried

on an ambulance. The proposed list from the pediatric committee is an intrusion

on the physician's perogative as medical director.

I realize that pediatric patients are much more different than being miniature

versions of adult patients, but I'm curious what the specific need for a GETAC

peds committee is...

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>

[Guest guest]

I am playing the evil's advocate obviously. But, the truth is, as long as

paramedic education can be attained with 700 hours of education (compared to

2,000 for a cosmetologist), they will never be taken seriously in the house

of medicine. Physicians have 12-16 years of college, nurses 2-6, respiratory

therapists 2-4 radiological technicians 2, and paramedics 700 hours. EMS

providers need at least a 2-year degree to be even taken seriously. This

would be mandated in the new National Scope of Practice but for the big city

fire chiefs. The word, I have been told, is that National Registry, by 2010,

will require that all EMS personnel wanting to write one of their exams be

graduates of accredited programs. This will not result in degrees--but will

mandate that all programs meet certain standards (access to a college

library, laboratory facilities, etc.). A 700 hour paramedic program is

about 28 semester hours--not even 25% of a college degree.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

[Guest guest]

I am playing the evil's advocate obviously. But, the truth is, as long as

paramedic education can be attained with 700 hours of education (compared to

2,000 for a cosmetologist), they will never be taken seriously in the house

of medicine. Physicians have 12-16 years of college, nurses 2-6, respiratory

therapists 2-4 radiological technicians 2, and paramedics 700 hours. EMS

providers need at least a 2-year degree to be even taken seriously. This

would be mandated in the new National Scope of Practice but for the big city

fire chiefs. The word, I have been told, is that National Registry, by 2010,

will require that all EMS personnel wanting to write one of their exams be

graduates of accredited programs. This will not result in degrees--but will

mandate that all programs meet certain standards (access to a college

library, laboratory facilities, etc.). A 700 hour paramedic program is

about 28 semester hours--not even 25% of a college degree.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

[Guest guest]

I am playing the evil's advocate obviously. But, the truth is, as long as

paramedic education can be attained with 700 hours of education (compared to

2,000 for a cosmetologist), they will never be taken seriously in the house

of medicine. Physicians have 12-16 years of college, nurses 2-6, respiratory

therapists 2-4 radiological technicians 2, and paramedics 700 hours. EMS

providers need at least a 2-year degree to be even taken seriously. This

would be mandated in the new National Scope of Practice but for the big city

fire chiefs. The word, I have been told, is that National Registry, by 2010,

will require that all EMS personnel wanting to write one of their exams be

graduates of accredited programs. This will not result in degrees--but will

mandate that all programs meet certain standards (access to a college

library, laboratory facilities, etc.). A 700 hour paramedic program is

about 28 semester hours--not even 25% of a college degree.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

[Guest guest]

Just curious, but how many volunteer cosmotologists, RT's, RN's, or MD's are

there in Texas? I'm not talking the occasional free clinic, but EVERYDAY, as a

primary role?

[Guest guest]

" E. Bledsoe, DO, FACEP " wrote: A 700 hour

paramedic program is about 28 semester hours--not even 25% of a college degree.

Granted, but appropriate core curriculum for a good start toward an associate

of applied science (entry point for RNs, Resp Techs, and Radiology Techs) in

skill related academics. Add 12 additional credit hours for clinical, and 26

hours for A & P, General Biology, Technical Writing, English, Technical Math (or

College Algebra), History and Government, and you have a good start toward a

follow-on Bachelors with multi- track capabilities.

" The true soldier fights not because he hates what is in front of him, but

because he loves what is behind him. " - GK Chesterton

---------------------------------

Yahoo! DSL Something to write home about. Just $16.99/mo. or less

[Guest guest]

" E. Bledsoe, DO, FACEP " wrote: A 700 hour

paramedic program is about 28 semester hours--not even 25% of a college degree.

Granted, but appropriate core curriculum for a good start toward an associate

of applied science (entry point for RNs, Resp Techs, and Radiology Techs) in

skill related academics. Add 12 additional credit hours for clinical, and 26

hours for A & P, General Biology, Technical Writing, English, Technical Math (or

College Algebra), History and Government, and you have a good start toward a

follow-on Bachelors with multi- track capabilities.

" The true soldier fights not because he hates what is in front of him, but

because he loves what is behind him. " - GK Chesterton

---------------------------------

Yahoo! DSL Something to write home about. Just $16.99/mo. or less

[Guest guest]

" E. Bledsoe, DO, FACEP " wrote: A 700 hour

paramedic program is about 28 semester hours--not even 25% of a college degree.

Granted, but appropriate core curriculum for a good start toward an associate

of applied science (entry point for RNs, Resp Techs, and Radiology Techs) in

skill related academics. Add 12 additional credit hours for clinical, and 26

hours for A & P, General Biology, Technical Writing, English, Technical Math (or

College Algebra), History and Government, and you have a good start toward a

follow-on Bachelors with multi- track capabilities.

" The true soldier fights not because he hates what is in front of him, but

because he loves what is behind him. " - GK Chesterton

---------------------------------

Yahoo! DSL Something to write home about. Just $16.99/mo. or less

[Guest guest]

Where would they work? It is an apples and oranges argument. Who will come

if EMS is not present? EMS is the safety net. In medicine, the ED is the

safety net. If a person cannot access an MD, nurse or other practitioner,

they always have the ED to fall back on. And, in many communities here in

Texas community physicians take unreimbursed ED call because of OBRA and

EMTALA requirements and their medical staff membership requires it. They may

occasionally get paid--but that is only about 30% of the cases. Hair

cutting can wait. RTs I guess could volunteer if there was a freestanding

respiratory clinic. Many nurses and physicians volunteer in charity clinics,

missions and even jails. Here in Ellis County several of the internists and

family physicians volunteer one to two days a month on the local indigent

clinic--without pay.You could never volunteer all of your time unless you

were independently wealthy and could afford the malpractice insurance.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of ,

Sent: Wednesday, December 28, 2005 5:18 PM

To:

Subject: RE: New Thread--Pedi ALS Equipment

Just curious, but how many volunteer cosmotologists, RT's, RN's, or MD's are

there in Texas? I'm not talking the occasional free clinic, but EVERYDAY, as

a primary role?

[Guest guest]

Where would they work? It is an apples and oranges argument. Who will come

if EMS is not present? EMS is the safety net. In medicine, the ED is the

safety net. If a person cannot access an MD, nurse or other practitioner,

they always have the ED to fall back on. And, in many communities here in

Texas community physicians take unreimbursed ED call because of OBRA and

EMTALA requirements and their medical staff membership requires it. They may

occasionally get paid--but that is only about 30% of the cases. Hair

cutting can wait. RTs I guess could volunteer if there was a freestanding

respiratory clinic. Many nurses and physicians volunteer in charity clinics,

missions and even jails. Here in Ellis County several of the internists and

family physicians volunteer one to two days a month on the local indigent

clinic--without pay.You could never volunteer all of your time unless you

were independently wealthy and could afford the malpractice insurance.

E. Bledsoe, DO, FACEP

Midlothian, Texas

Don't miss the Western States EMS Cruise!

http://proemseducators.com/index.html

_____

From: [mailto: ] On

Behalf Of ,

Sent: Wednesday, December 28, 2005 5:18 PM

To:

Subject: RE: New Thread--Pedi ALS Equipment

Just curious, but how many volunteer cosmotologists, RT's, RN's, or MD's are

there in Texas? I'm not talking the occasional free clinic, but EVERYDAY, as

a primary role?

[Guest guest]

,

First, the 22K number is based upon the wording of transport monitor meaning a

monitor separate from the heart monitor and defibrillator.

In my opinion, the problem with a standardized list, which is what is currently

proposed by a State recognized committee of pediatric experts, is that it will

always have items that others do not feel is appropriate and when research or

technology changes we are stuck with a list in rule that will take months to

change...meanwhile each ambulance will have to continue to carry equipment (and

potentially have to replace it due to expiration) that protocols and standard of

care says should not be used because it is on a standardized list...

A position paper can assist here because it establishes a standard but it is not

rule and each agency can make changes more rapidly than State rules can be

changed.

Just my thoughts...

Dudley

Re: New Thread--Pedi ALS Equipment

I'm not supporting the $22000...that's WAY TOO HIGH!!! I think the minimal

needed should only cost a fraction of that.

>

>

>

> In a message dated 12/28/2005 10:44:58 A.M. Central Standard Time,

> jenherv@... writes:

>

> don't have to take a huge hit buying unneeded equipment.

>

>

> Yea but isn't 22,000 per truck (using Dr. B's number) by default just

> that?

>

> How can we justify 22,000 bucks?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

> (Office Fax)

>

> " A Texan with a Jersey Attitude "

>

> The comments contained in this E-mail are the opinions of the author and

> the

> author alone. I in no way ever intend to speak for any person or

> organization that I am in any way whatsoever involved or associated with

> unless I

> specifically state that I am doing so. Further this E-mail is intended

> only for its

> stated recipient and may contain private and or confidential materials

> retransmission is strictly prohibited unless placed in the public domain

> by the

> original author.

>

>

>

[Guest guest]

,

First, the 22K number is based upon the wording of transport monitor meaning a

monitor separate from the heart monitor and defibrillator.

In my opinion, the problem with a standardized list, which is what is currently

proposed by a State recognized committee of pediatric experts, is that it will

always have items that others do not feel is appropriate and when research or

technology changes we are stuck with a list in rule that will take months to

change...meanwhile each ambulance will have to continue to carry equipment (and

potentially have to replace it due to expiration) that protocols and standard of

care says should not be used because it is on a standardized list...

A position paper can assist here because it establishes a standard but it is not

rule and each agency can make changes more rapidly than State rules can be

changed.

Just my thoughts...

Dudley

Re: New Thread--Pedi ALS Equipment

I'm not supporting the $22000...that's WAY TOO HIGH!!! I think the minimal

needed should only cost a fraction of that.

>

>

>

> In a message dated 12/28/2005 10:44:58 A.M. Central Standard Time,

> jenherv@... writes:

>

> don't have to take a huge hit buying unneeded equipment.

>

>

> Yea but isn't 22,000 per truck (using Dr. B's number) by default just

> that?

>

> How can we justify 22,000 bucks?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> LNMolino@...

> (Office)

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> " A Texan with a Jersey Attitude "

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[Guest guest]

Slow your roll just a tad there ......The question was posed not to get

your blood boiling, but to get an answer. I consider myself to be a free

thinker and not one of those " goes with the crowd " bunch, and I don't always

agree with you, but, in THIS case I do.

The question was posed because volunteers make up a great majority of our

50,000 numbers in Texas. Before anyone jumps on my case, I believe volunteers

are very important, and have served our communities when no one else would. But

lets face some HARD facts. What other occupation has to deal with the

" volunteer issue " ? Let me re-phrase, what profession looking for professional

recognition?

[Guest guest]

,

How do we mandate certain pediatric equipment...but not certain adult equipment?

If we are going to say you have to have infant NRB's...then don't we also need

to mandate that you have adult NRB's...or do we only really care about the peds?

Once we open that door, it is going to be tough to close it again...at least for

the next 10 to 12 years when we repeat history again and take the lists away and

give control back to local medical directors.

If the list is going to be made by the medical directors (instead of the

pediatric specialists) then why have a list at all and just let each agencies

medical director make the decision...

Dudley

Re: New Thread--Pedi ALS Equipment

>

>

> I don't think defending yourself against why you didn't use equipment is

> an

> issue. We should provide everyone with the tools and education to do

> their

> job well. It is up to the educated paramedic to make the informed

> decision

> as to whether or not to use a piece of equipment. If you put paralytics

> on

> your unit and an adult pt needed to be intubated but the medic recognized

> a

> difficult airway and decided to use a BVM with an OPA, is it an issue to

> defend not using the paralytic that was available? There should not be

> skill decay. We all need to recognize that we have a very serious job and

> should stay on top of our skills and education...b/c you never know when

> you'll get that urgent pedi pt. Services need to provide the education to

> their medics so that we, as a state, can raise our standards to where they

> should be.

>

> Yes, most first pedi intubations are done in the field, without

> supervison...so are chest decompressions, adult intubations,

> cardioversions,

> etc. That's where CE comes in. My first intubation ever was as a new

> paramedic in the field on a 28wk gestation neonate. I had excellent

> training and was able to perform the skill successfully.

>

> We have got to start trusting our medics. I understand that the way to

> attain that trust is to make sure medics are adequately trained in skills

> and have the knowledge to know when or when not to use those skills.

> Raise

> the bar!

>

>

>

>

>

>