the 100% directionless thread

DesertMedic66

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That is one thing I do enjoy about AMR and my current employer. I am only scheduled for my full time shifts. They are not able to force me after I have clocked out or on my days off.
 

CALEMT

The Other Guy/ Paramaybe?
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RocketMedic

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What’s AMRs transfer policy?
 

CALEMT

The Other Guy/ Paramaybe?
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To those of you in the pages of history who gave everything for a cause greater than you and I, I thank you. Sincerely, one grateful American
 

Lo2w

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Any Coloradans have rental suggestions in the southeast near Pueblo? Got a job offer, now it's figuring out all the logistics of moving cross country. :oops:
 

GMCmedic

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Paramedics,

For those of you who’s systems are like mine and have yet to outfit their entire fleet with VL, and you’re still not at least using, let alone pre-loading your ETT with a Bougie...

You have ZERO business intubating in a prehospital environment.

THANK YOU!!!! I keep getting backlash when I say that in 2019 if you dont have bougies, you shouldnt be intubating.
 

DesertMedic66

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Paramedics,

For those of you who’s systems are like mine and have yet to outfit their entire fleet with VL, and you’re still not at least using, let alone pre-loading your ETT with a Bougie...

You have ZERO business intubating in a prehospital environment.
The real issue starts with paramedic schools who’s instructors are teaching them that a bougie is a last resort option and that real medics don’t need to use one. This line of thinking then gets repeated during in services.
 

VentMonkey

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The real issue starts with paramedic schools who’s instructors are teaching them that a bougie is a last resort option and that real medics don’t need to use one. This line of thinking then gets repeated during in services.
Honestly? I think at this point, the real issue is advanced airway management—not including SGA’s and all of the advancements that they’ve made—should no longer be part of the standard paramedic curriculum.

If you’re fortunate enough to work for a service (ground, or air) that trains to that level, and/ or ops to have advanced airway management guidelines then that’s one thing.

But, to keep lying to ourselves and pointing fingers at instructors, services, or whatever the case may be is getting paramedics nowhere in general. The frequency of the skill and the amount of providers that properly train for it does not balance out.
 

StCEMT

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Honestly? I think at this point, the real issue is advanced airway management—not including SGA’s and all of the advancements that they’ve made—should no longer be part of the standard paramedic curriculum.

If you’re fortunate enough to work for a service (ground, or air) that trains to that level, and/ or ops to have advanced airway management guidelines then that’s one thing.

But, to keep lying to ourselves and pointing fingers at instructors, services, or whatever the case may be is getting paramedics nowhere in general. The frequency of the skill and the amount of providers that properly train for it does not balance out.
I think there is something to be said about having some training and a routine you follow every time though. I by no means intubate as much as some of yall do, but my success rate over the last 12 months is somewhere in the high 80's to low 90's.

I don't consistently get chances. Sometimes it's one a week then I won't do one for 6. But I can consistently get them because I have a system I follow that allows me to be flexible, adapt to my situation, and troubleshoot things as they arise.

Essentially, last night I took the DL Mac3, used to to clean out the airway and not junk up my camera, had one of our providers bag him while I swapped equipment and did a second check to ensure everything was in place, then went and finished with the McGrath. It took maybe 15 seconds with mechanical CPR still going and moving his head pretty good.

Now if you count blade in mouth as an attempt, then it took two. DL is just how I like to clean airways in arrests. If you count actually attempting to pass the tube, then it took me one attempt and it didn't take long at that.

But a lot of the methods I use to troubleshoot, I learned outside of live intubations. I may have solidified the concepts on real patients, but I got the basic idea and patterns down elsewhere in training. So in that regard, I absolutely hold our employers accountable for not having a standard for maintaining education and capability of their providers, because the vast majority of us don't have the access to do the training ourselves.
 

RocketMedic

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Honestly? I think at this point, the real issue is advanced airway management—not including SGA’s and all of the advancements that they’ve made—should no longer be part of the standard paramedic curriculum.

If you’re fortunate enough to work for a service (ground, or air) that trains to that level, and/ or ops to have advanced airway management guidelines then that’s one thing.

But, to keep lying to ourselves and pointing fingers at instructors, services, or whatever the case may be is getting paramedics nowhere in general. The frequency of the skill and the amount of providers that properly train for it does not balance out.

Gotta confess I agree with this. It isn’t done enough anymore to justify being a common skill, especially if it’s being done the “old way”.
 

StCEMT

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I have medics in my service that refuse to use VL and/or a bougie. I’m just building a paper trail.
I don't always use a VL, I usually rotate between the two every so often, but the bougie is 100% of the time. I've never understood the argument against it.
 

GMCmedic

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Im required to use VL on first attempt, even if I wasnt required I would anyway, I always have the bougie out. Currently I try to alternate between stylette and bougie while I become more familiar with the angles that accompany VL.
 

RocketMedic

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Our first-line intubation is a Kingvision if at all possible (only good reasons would be a kid with a mouth too small to take it); Bougie isn't required but I preload my tube with it anyways. Thanks to the Wilco Way, I'm reasonably successful at getting first-time easy passes, and if that doesn't work, the tube is also a Bougie guide and the Bougie makes it easier to pass. I haven't done a DL intubation in a while, but my approach there was a bougie 100% of the time, and that was successful too.
 

RocketMedic

Californian, Lost in Texas
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Paramedics,

For those of you who’s systems are like mine and have yet to outfit their entire fleet with VL, and you’re still not at least using, let alone pre-loading your ETT with a Bougie...

You have ZERO business intubating in a prehospital environment.
Hall is just the CCT units with VL right?
 

VentMonkey

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Hall is just the CCT units with VL right?
Yes, however it’s optional. I typically prefer DL with a “D-Grip” first, then VL. However, things like a suspected high SCI, an extremely soiled airway, or outwardly difficult-looking anatomy would certainly not have me thinking VL as my first choice.

@StCEMT I believe we’re sort of arguing the same point. I practice to death as well (lot of downtime most shifts), but overall in general ground paramedics aren’t taught, nor do they seem to care enough to learn beyond “this is how it’s always been done”.

Truly, my hat goes off to people like @NomadicMedic and @RocketMedic for their dedication to want, and need to change the system(s) as a whole. Without these kind of guys (gals too), we probably wouldn’t even know what VL or a Bougie was.
 
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