Budgets cuts and belt tightening have left EMS and fire agencies with little choice—not just the fat is being cut from agency budgets, but also some of the meat. One area that continues to suffer from tighter purse strings is training.1
In many systems, staff is reduced and on duty for longer periods of time. Because of this, there are often less opportunities for EMTs and paramedics to retain proficiency—especially for skills that may not be used on a regular basis.
A good example of one of these skills is endotracheal (ET) intubation:a key prehospital procedure used to control and protect a patient’s airway, often preventing death.
The debate on whether this practice is an appropriate first line skill for the prehospital setting is as strong as ever, largely due to low success rates often rooted in a lack of training.2 In 1994, the U.S. Department of Transportation developed an 18-hour training curriculum detailing how responders should perform ET intubation.3 This prompted many cities to prepare training modules, develop competency standards, certify their staff, develop programs to maintain proficiency and conduct field tests.
Twenty years later, the percentage of successful ET intubation ranges wildly from department to department, from the low 60s to the mid 90s.2 The lack of intubation training could mean greater failure rates when performing these procedures on calls. This can lead to lawsuits, disciplinary action against providers, or hesitancy by crews to intubate patients for fear of causing patient harm. We can’t leave this critical skill set absent from an EMS service because airway management is a, if not the, top priority during most critical calls. However, we now have the power of more advanced technology, and we must utilize it.
Finding the time and money for training programs that meet specific needs poses a significant challenge for many departments. And, as referenced earlier, reduced budgets also cause specialty programs to be cut from budgets in lieu of fleet and staffing categories. These decisions can have cascading negative effects.
Technology providers must create systems that are effective without requiring significant training time or unique certifications. Tools that can allow responders to do their jobs better are the responsibility of those who make their living in support of these individuals.
Low-cost, single-use intubation devices exist in both adult and pediatric versions. Some provide a hyper-angulated design that allows tube insertion that follows the natural curvature of the airway and affords the provider an excellent view of the vocal cords without a head tilt. Others have an integrated ET tube channel that directs the preloaded ET tube into the field of view of a video image and directly toward the vocal cords, allowing for quick and confirmed definitive intubations. To provide greater efficiency, some systems are now available with seamless interface to electronic patient care reporting (ePCR) platforms that easily transfer data to patient medical records. The intent is to help make intubation as safe as possible.
These systems are being used to verify proper intubation and tube placement on scene by capturing video and photographic data and transferring it to the crew’s ePCR. This can document placement while chest compression are being performed in moving vehicles, and during suctioning of the airway by the same person performing the intubation.
Developing skill monitoring and direct data transfer technology is important, but the implementation process that must accompany it is equally important. And even though a skill verification system can be easy to use, EMS personnel still need to be confident in their technological use. At minimum, technology providers should include the following with their technological offerings:
Indoctrination programs: Although the systems discussed don’t necessarily require a certification regimen, any new technology platform has a learning curve. Technology providers should offer indoctrination programs to all necessary department personnel as part of their package. Learning the new technology platform in an artificial classroom atmosphere alone isn’t always the best path to follow. Therefore, EMS agencies should request that consultations be included for key staff members and, if needed ,extensive ride-alongs to better acquaint the crews with the system in their environment.
A full team to rapidly deploy platforms: Most EMS agencies have neither the time nor the resources to completely implement a new program. Therefore, it should be the responsibility of the technology provider to fully set up the system for their client in a minimal amount of time. A good implementation schedule leads to quick user adoption to the system’s maximum benefit.
Extend a hand to partnering agencies: EMS departments don’t operate in a vacuum. The information they gather is of critical importance to those within and outside their department. Technology providers must be ready to create development plans detailing how EMS agencies can share their information with organizations such as receiving hospitals, medical directors and third party EMS transport services.
Utilizing technology providers to compensate for training budget shortfalls is a great opportunity for EMS departments to increase capabilities without a rise in costs or liability risks. By developing state-of-the-art solutions that can empower crews, the question is no longer “What can be done?” but rather “How will it be implemented?”
The responsibility falls on technology companies to help guide this new world of ever-tightening funds to create mission-critical systems that require less training, development and deployment time. In doing so, we become not just a tactical solution offering, but a strategic asset that saves lives.
1. Brant J. (March 14, 2014.) Obama budget calls for cuts to fire grants programs. In EMS Grants Help. Retrieved June 15, 2014, from www.emsgrantshelp.com/Columnists/Jerry-Brant/articles/1864295-Obama-budget-calls-for-cuts-to-fire-grants-programs/.
2. Lossius HM, Roislien J, Lockey DJ. Patient safety in pre-hospital emergency tracheal intubation: A comprehensive meta-analysis of the intubation success rates of EMS providers. Crit Care. 2012;16(1):R24.
3. Navvaro K. (Jan. 31, 2014.) To intubate or not to intubate? In Bound Tree University. Retrieved June 15, 2014, from www.boundtreeuniversity.com/columnists/kennynavarro/articles/1661390-To-intubate-or-not-to-intubate.