Re: National Standards (Long)

December 6, 2004

Kenny,

You say you are for the National SOP. I disagree with you sir. You used the

example of surgical and needle cricothyrotomy currently being used by some

providers.

Let me start off by saying I have never had to do a needle or surgical

cricothyrotomy in my 23+ years as a Paramedic. I am very proud of the fact

that I have never had to use either of these tools. I do teach these skills

and have for over six years. I tell all my students, street medics, critical

care medics and flight nurses that these procedures are a last resort when

all other basic and advanced airway procedures are exhausted. However I do

see the need for all of these skills to be available to benefit our patients

and give them a chance of survival. Until someone comes up with research

that proves these skills are unnecessary in pre-hospital care why limit

their use?

Let me give you an example why having both skills is needed. I teach these

skills in cadaver labs. On more than one occasion I have found that the

commercial needle cricothyrotomy devices out there today have limitations

and may not always work. One particular cadaver lab comes to mind when the

entire class (12 Paramedics with the Medical Director present) attempted a

needle cricothyrotomy with a commercial kit on a very large cadaver. After

everyone had an attempt, I made an incision over the trachea and looked at

the crio/thyroid membrane. Not a single medic had successfully completed the

needle cricothyrotomy. All of the attempts ended up in the subcutaneous

tissue. I realize that most field paramedics would catch this problem, but

what do you use if the surgical option is not available to you. The patient

suffers because you are not allowed to do this procedure. Why should we

limit the level of care we can provide to our patients? Isn't that why we

are here for the patients!

I feel the new national standard is a huge step back in its current format.

It needs work, you cannot plug every system into a format like that. What

works for a rural department would not work for Dallas Fire Rescue and vice

versa. Before we jump into this we need to take a long hard look at this

document and analyze the effect it is going to have on Texas and the rest of

the country, then move forward.

I am all for more education, I tell my students every time I hold a cadaver

lab I learn something new about the human anatomy with every lab I teach. I

enjoy learning and bettering myself to allow me to provide the best patient

care possible.

But I am convinced we need good data, research to move forward with this

National Standard. I just don't see that component being used to approach

this huge change in the way we provide patient care. EMS has always lacked

in the research to backup our claims. I think now is the time to get that

research done.

Another huge issue, who pays??? You have worked for a private ambulance

provider, can you see a private service paying for a BA in Paramedicine. I

can't....even a department like Dallas Fire Rescue wouldn't have the budget

to continue the current level of care they offer under the current National

SOP. What about the rural volunteer department that sends a few to Paramedic

school with grant money. Is that kind of funding going to be there to have

those 2 medics get a BA?

Do I have the answers, no, just a few suggests and it will take someone a

lot smarter than me to solve this quandary. I hope these folks step up and

take up the challenge.

Bernie Stafford EMTP

The opinions expressed in the email are my own.

December 6, 2004