RE: New Thread--Pedi ALS Equipment

[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!

>

>

>

>

>

>

[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!

>

>

>

>

>

>

[Guest guest]

Wes,

The peds committee serves a number of functions and has done some very good

work. One of the biggest is that they brought forward and EMS and Medical

Directors agreed and endorsed pediatric specific training in the continuing

education hours for each certification level. The fact that Texas didn't have

that is why 's arguement about education is really accurate.

In addition, on the Trauma side of the house they are working issues regarding

children facility designation and other pediatric issues. This group is and

should be represented at GETAC because of the special needs this population

presents...and this committee should be the one that forms and publishes the

DSHS position paper on what equipment is necessary on ambulances...so that there

is a document from pediatric specialists that ALL medical directors can use to

formulate what their individual agency will be carrying/doing.

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!

>

>

>

>

>

>

[Guest guest]

Wes,

The peds committee serves a number of functions and has done some very good

work. One of the biggest is that they brought forward and EMS and Medical

Directors agreed and endorsed pediatric specific training in the continuing

education hours for each certification level. The fact that Texas didn't have

that is why 's arguement about education is really accurate.

In addition, on the Trauma side of the house they are working issues regarding

children facility designation and other pediatric issues. This group is and

should be represented at GETAC because of the special needs this population

presents...and this committee should be the one that forms and publishes the

DSHS position paper on what equipment is necessary on ambulances...so that there

is a document from pediatric specialists that ALL medical directors can use to

formulate what their individual agency will be carrying/doing.

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!

>

>

>

>

>

>

[Guest guest]

Wes,

The peds committee serves a number of functions and has done some very good

work. One of the biggest is that they brought forward and EMS and Medical

Directors agreed and endorsed pediatric specific training in the continuing

education hours for each certification level. The fact that Texas didn't have

that is why 's arguement about education is really accurate.

In addition, on the Trauma side of the house they are working issues regarding

children facility designation and other pediatric issues. This group is and

should be represented at GETAC because of the special needs this population

presents...and this committee should be the one that forms and publishes the

DSHS position paper on what equipment is necessary on ambulances...so that there

is a document from pediatric specialists that ALL medical directors can use to

formulate what their individual agency will be carrying/doing.

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!

>

>

>

>

>

>

[Guest guest]

Would a successful intubation not be one where the patient is intubated and

proper ventilation is then accomplished? I believe that anything less is an

unsuccessful intubation.

We keep coming up with the fact that California is omitting intubation.

Perhaps further training is needed there.

If your skills are not proficient you are inviting naysayers to be proven

right with their comments. This is an area where each and every person must

keep their skill level at a high level (personal commitment). This is also

where the services are tasked with assuring the skill levels of their personnel

are kept at a high level (lawsuit prevention).

It has never been easy to be proficient at your job or skill or both. It will

never be easy to be proficient without personal commitment and continued

education.

The rural providers have the same tasks it is just harder to do, not

impossible.

>

> 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

>

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

Fax

[Guest guest]

Would a successful intubation not be one where the patient is intubated and

proper ventilation is then accomplished? I believe that anything less is an

unsuccessful intubation.

We keep coming up with the fact that California is omitting intubation.

Perhaps further training is needed there.

If your skills are not proficient you are inviting naysayers to be proven

right with their comments. This is an area where each and every person must

keep their skill level at a high level (personal commitment). This is also

where the services are tasked with assuring the skill levels of their personnel

are kept at a high level (lawsuit prevention).

It has never been easy to be proficient at your job or skill or both. It will

never be easy to be proficient without personal commitment and continued

education.

The rural providers have the same tasks it is just harder to do, not

impossible.

>

> 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

>

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

Fax

[Guest guest]

Would a successful intubation not be one where the patient is intubated and

proper ventilation is then accomplished? I believe that anything less is an

unsuccessful intubation.

We keep coming up with the fact that California is omitting intubation.

Perhaps further training is needed there.

If your skills are not proficient you are inviting naysayers to be proven

right with their comments. This is an area where each and every person must

keep their skill level at a high level (personal commitment). This is also

where the services are tasked with assuring the skill levels of their personnel

are kept at a high level (lawsuit prevention).

It has never been easy to be proficient at your job or skill or both. It will

never be easy to be proficient without personal commitment and continued

education.

The rural providers have the same tasks it is just harder to do, not

impossible.

>

> 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

>

Danny L.

Owner/NREMT-P

Panhandle Emergency Training Services And Response

(PETSAR)

Office

Fax