tag:blogger.com,1999:blog-2990254441624674011.post8764598122897308481..comments2023-07-12T14:34:31.407+01:00Comments on A Life In The Day Of A Basics Doc: Tock (warning, contains scenes of a graphic nature!)RapidResponseDochttp://www.blogger.com/profile/03544668439101821499noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-2990254441624674011.post-90664855271542803462009-07-23T00:45:52.001+01:002009-07-23T00:45:52.001+01:00Very interesting debate and one we have regularly ...Very interesting debate and one we have regularly in the crew room. I think I tend to agree with RRD regarding the use of RSI for paramedics, especially in my rural area where we have even less call for it! But who knows whats going to happen with the intoduction of more critical care practitioner pathways?? <br /><br />I was however interested in everyones opinion on the recent recommendation of JRCALC to prevent para's from intubating? Opinions I have come across range from very grumpy anaethetists (one apparently refused to let recently graduated para's do their in-hospital tubes in their hospital cos they didn't agree they should be doing it!) to very disgruntled para's! I've read their paper and have a few concerns of my own, most of which are summed up in the College of Paramedics statement of reply! Apologies if this has been covered in another post?Samoanhttps://www.blogger.com/profile/08336866784929992926noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-77923421946565841482009-04-01T07:23:00.000+01:002009-04-01T07:23:00.000+01:00Interesting debate on Paramedic RSI, we use it ov...Interesting debate on Paramedic RSI, we use it over here (New Jersey) and it’s definitely a double edged sword; fear of airway loss vs. definitive airway control with easier pt. management. I appreciate your concerns RRD (love the blog by the way!) and in many ways agree with you – skill degradation with infrequent use of the technique can result in disastrous outcomes. The oft-quoted “San Diego” study on pre-hospital- RSI (can’t find the citation for it now - sorry) was hampered by the fact that >500 medics were taught the technique but relatively few got to perform it at all.<BR/>Here in NJ Paramedics respond only to ALS calls in 2-man cars and (by state law) work for a hospital based system. As a result ALS skill maintenance is relatively high (typically a few tubes and >10 IV’s per week for the average medic) and since RSI was rolled out statewide 3 years ago there have been relatively few complications. The training was extensive and we work under “active medical command”, in other words we have to get permission from a base doctor to perform it (flight crews are exempt this requirement) and have a salvage airway available (LMA, needle cri... Mommy!!) for a “can’t intubate - can’t ventilate” scenario. <BR/>One of the biggest problems we have, and this is just personal opinion, is the younger, more aggressive medics way overuse it (have you seen this with the younger doctors you train? I’ve noticed our “hot-shot” ED residents can’t wait to paralyze and tube) You can train anyone to perform a technique but the real skill is knowing when it's appropriate...thats the challenge.ZaphodBBhttps://www.blogger.com/profile/15015636836569033474noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-78301049309087826522009-03-31T02:37:00.000+01:002009-03-31T02:37:00.000+01:00You may be interested to look at our local BASICS ...You may be interested to look at our local BASICS team (http://www.wymrt.co.uk). Much the same, but pro-active at the weekend, being on standby in a well equipped Volvo V70 T5. Ambulance Control Cat A calls are monitored in the vehicle, and response can be immediate to any point in West Yorkshire.Anonymoushttps://www.blogger.com/profile/02354726391046357260noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-81668953072493389542009-03-30T22:45:00.000+01:002009-03-30T22:45:00.000+01:00Ah the good old Paramedic RSI debate. I agree with...Ah the good old Paramedic RSI debate. I agree with you RDD. To be honest the only way (I believe)a Paramedic would be able to perform RSI (effectively) is to a have dual role in theatres and work along 'The Gas man' doing 50% on the street & 50% theatres. Having said that, what's the point when you have experienced BASICs DRs like your good self and those on the various HEMs around the country who do it as part of their everyday work. We don't see the required case load that warrant RSI. Also there are many BASIC DRs that don't/can't RSI due to not being able to get the necessary experience/theatre time, although they are still a valuable member of the team (probably from a GP background & they would be the first to agree I think).machttps://www.blogger.com/profile/12224939870747906286noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-20340031577139201122009-03-30T21:07:00.000+01:002009-03-30T21:07:00.000+01:00Medicblog999, without in any way denigrating the w...Medicblog999, without in any way denigrating the work of the paramedics (who, in my case, have saved my bacon hundreds of times out on scene) I do not believe they should be trained to perform RSI. If, as you suggest above, they will be performing this once every two years, they will never be able to retain the necessary skills; nor will they be able to get themselves out of trouble. If I have a "can't ventilate, can't intubate" I will have a chance of getting away with it, but only because I do an RSI about once a month, after having spent 18 months as an anaesthetist and 9 months on HEMS in previous years. I am worried about BASICS docs without the necessary experience doing RSI, and there are some of them around, let me tell you!RapidResponseDochttps://www.blogger.com/profile/03544668439101821499noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-45703634371479886582009-03-30T14:14:00.000+01:002009-03-30T14:14:00.000+01:00Nice job, that's what it's all about. Do what need...Nice job, that's what it's all about. Do what needs to be done and GLF to hospitalmachttps://www.blogger.com/profile/12224939870747906286noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-44429989945825056262009-03-30T13:30:00.000+01:002009-03-30T13:30:00.000+01:00nicely done! trust the girl is properly grateful t...nicely done! trust the girl is properly grateful that she has a foot left at all!petoskystonehttps://www.blogger.com/profile/01633621111274495078noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-38255831534400455192009-03-30T12:24:00.000+01:002009-03-30T12:24:00.000+01:00Paramedics often discuss the liklihood of us event...Paramedics often discuss the liklihood of us eventually being able to do Rapid Sequence Induction for Elective intubation. Its on its way in the North East (with the advanced practitioner degree).<BR/>Personally, I think it would have been of use to me maybe 4 times in the last 8 years (not often enough to keep up to date with it).Its a huge step from tubing someone in cardio-respiratory arrest, to someone who is maitaining their own airway and is achieveing good oxygen saturation. To take that away is a risky business, especially for a paramedic with maybe only one other person their to help them. <BR/>I used to be a theatre and anaesthetics nurse prior to joining the service so I am very familiar with RSI, but it still scares the willies out of me when I think of maybe having to do it at the roadside one day.<BR/>Hopefully by then BASICS will be fully active in the North East and you guys will always be there to bail us out!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-24287611374899394942009-03-30T12:01:00.000+01:002009-03-30T12:01:00.000+01:00Thank you, JoshThank you, JoshRapidResponseDochttps://www.blogger.com/profile/03544668439101821499noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-17622457118240776462009-03-30T09:34:00.000+01:002009-03-30T09:34:00.000+01:00Nice job Doc. JoshNice job Doc. <BR/><BR/>JoshJoshhttps://www.blogger.com/profile/10367998990172150624noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-86523537547102375672009-03-30T08:52:00.000+01:002009-03-30T08:52:00.000+01:00thank you, Darkside. I wish I knew who I want to ...thank you, Darkside. I wish I knew who I want to be when I grow up!!!RapidResponseDochttps://www.blogger.com/profile/03544668439101821499noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-26930349619982498422009-03-29T23:31:00.000+01:002009-03-29T23:31:00.000+01:00Loving your blog... You are who I wish to be when ...Loving your blog... You are who I wish to be when I "grow up" ! :DLizzyFerrethttps://www.blogger.com/profile/04552549116872089222noreply@blogger.comtag:blogger.com,1999:blog-2990254441624674011.post-10892108287803666072009-03-29T23:30:00.000+01:002009-03-29T23:30:00.000+01:00This comment has been removed by the author.LizzyFerrethttps://www.blogger.com/profile/04552549116872089222noreply@blogger.com