Are emergency medical technicians (Paramedics) the right people to undertake pre-hospital endotracheal intubations?
I would agree that they could perform 'crash-intubations' in situations like 'cardio-respiratory arrest' or 'traumatic cardiac arrest'. They could also use other adjuncts like LMAs if available. But PHEA (pre-hospital emergency anaesthesia) is totally different.
PHEA in most situations is a very controversial topic, even in the most mundane sense. Anaesthetists and intensivists would be up in arms at the slightest hint of it being undertaken. Rightly so with many studies proving that PHEA in inexperienced hands is giving the death-bill.
I feel that there has to be a very tight system of training and assessment before health care professionals are allowed to practise it. Lest one could open oneself to litigation....
Having not had any response to the thread so far, let me rephrase it...
Is anyone aware of any EMS system in our country that undertakes PHEA (or RSIs pre hospitally)?
If so, what training do the EMT/Paramedics get? (I am hoping that there are EMTs registered on this site and are active in the forum!!!)
Another issue is, are any of the ambulances kitted with ventilators and other monitoring equipment?
had the opportunity to discuss the similar question at different levels.
1. India , Gujarat, EMRI
Em Technicians not trained to do RSI. Dont want to do RSI.
2. India, Hyderabad, NNES 1066 ambulances
EMTs trained to do RSI. Never felt the need to do an urgent RSI, except one or two, where they did and it was very well accepted by the doctors in the hospital. But would definitely want to do RSI.
3. South Africa, EMSSA conference.
Paramedics told not to do RSI. Success rates documented on first attempt way below the accepted minimum, Paramedics themselves fought this opinion with fervour.. but alas...
4. Palo Alto, USA
Paramedics trained to do RSI, have done RSI, but no longer allowed to do it now as per company rules. More comfortable with using an LMA.
Personally
i would prefer if a paramedic i trusted completely only did an RSI. Wouldnt like an unknown paramedic to do the RSI.
Some of the ambulances where i worked were equipped with ventilators... but most are not. And even ambulances equipped with vents, get patients on bains curcuits for short distance transfers...the economics are better i guess.
But the entire problem is the training of the EMTs.
unless we train them....and in a formal way... which would need the intitiation of a formal body for training the same... we are in for... half baked knowledge.
So as long as that happens... no RSI for paramedics.
Funny enough, the latest JRCALC guidelines, which form the basis of paramedic (EMT) practice in the UK, also took a similar stance. Needless to say, most critical care paramedics are not pleased...
Clearly, the risk of RSI in inexperienced hands is being acknowledged.
This raises the next question. Should EM physicians who have limited exposure to anaesthetics (and also not get to undertake RSI on a regular basis to prevent skill-fade!!!) be allowed to undertake PHEA/Pre-hospital RSI??
Edited by maroju on 19-08-2008 03:14
