“You suck at airway” – Scott
Don’t play the anesthesiologist’s game. For most emergency, critical care and prehospital providers, airway management is rare and episodic, providing little opportunity for practice, improvement and skill development. Master one technique, know it cold: Scott talks single-technique mastery and first-pass success, anywhere other than in the OR. (15:08)
Link to the EMCrit algorithm: https://bit.ly/2NuqKKw
Scott, not really sure to whom you are addressing, with your message of inspiration. Having said that, I am certain you made it clear to your readers, that this is only an opinion, your opinion. I, however, strongly disagree with you, on the basis of my 26 years working as a Paramedic in the 911 system, in several different demographics, and multiple jurisdictions. I am troubled by your assertion that managing an airway is “rare” and “episodic” because in reality it is anything but. Even if you are addressing students on how to pass an exam for a practical skill, you are still falsely misleading them and, you are seriously underestimating the immense responsibility that is placed on the shoulders of every single Paramedic. Paramedics do not only need to know how to manage an advanced airway, (a skill he or she will encounter almost as often as establishing IVs or interpreting an arrhythmia) but airway management is the highest priority, above all else, in prehospital patient care. Additionally, Paramedics, need to assess quickly and make a life or death treatment decision. It is also the Paramedic’s responsibility to lead the team, and, therefore, must delegate to the other team members, what is needed from them. The responsibility of delegating does not end there, he or she can not assume that the assigned task will be handled competently, so he or she must continue to observe that every single team member is acting effectively. A good Paramedic, must be able to multitask, or else it is his or her license and reputation that is on the line. Paramedics who have honed this ability through experience (not a classroom doll) are capable of making multitasking a thing of mastery. I am very interested in your qualifications and who your target audience is. Sincerely, R Youngman
Robin,
Greatly appreciate you taking the time to write this extensive commentary. I would love to respond to what seems to me, a set of trepidations. However, I can’t really map any of your statements to actual disagreements with anything I said in the lecture. Was wondering if you actually listened to the lecture, or perhaps your objections are based on the blurb above?
Additionally, my own background in EMS was obviously in a very different system if you had to place advanced airways almost as often as IV placement or dysrhythmia interpretation. I would love to know what system that was as I would strongly consider moving to that place.
kindest,
Scott
I have to agree with you Scott, in both your lecture as well as your response to Robin. I am a 10 year paramedic who has worked in multiple different Rural and Urban settings and am currently a Critical Care Paramedic on a Pediatric Critical Care Transport Team. I believe your definition of “rare” and “episodic” are absolutely correct. Through my experience, you would be hard pressed to find a medic who intubates at the frequency of most ED clinicians. I can’t remember a time where I have had more than 5-6 in a 30 day period. I agree with Robins point of having to make the split second decisions, but making those decisions should not compromise patient care. I have developed a technique in most of my skills, be it IV placement, X-ray interpretation, Intubation, or anything else, and I stick with it. I have found that having a set technique not only makes me better at it, but also helps me when the situation changes and I have to adapt. As you compared VL to DL and making it easier to perform DL because you are more familiar with the anatomy, and you’re not focusing on trying to think about what you’re looking for, but more at what you’re trying to accomplish. I have come to the same conclusion that when things go awry I am able to adapt faster because it’s adapting a technique I am very familiar with and not coming up with something completely new.
Unfortunately, in the field of pre-hospital EMS, I feel that ego gets in the way and we spend more time trying to get the most tubes or have the best call, instead of working on skills and knowledge before the tones even drop. I worked as a field training officer in my last position in Pre-Hospital EMS and it was a major challenge to help new paramedics make good, evidence based, decisions instead of doing “what protocols say I should do.” A lot of the challenge, especially with respiratory, came down to “CPAP isn’t working time to intubate” when in all reality, 45 seconds on CPAP isn’t long enough to show marked improvement. EMS seems to be at a standstill with Medical directors not trusting providers or budgets not providing us with the tools we need to become better providers.
I have had many good take-aways from your lectures and podcasts and appreciate any feedback you may have on anything I mentioned in my comment. Thank you for your time and keep the information coming!