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Readers respond to recent JEMS and JEMS.com content.

Care Alternatives in Pittsburgh
This month, the use of ketamine described in an online case by Johnathan Matteo, EMT-P, (“Medics Respond to Dislocated Shoulder,” JEMS.com) caught many readers’ attention, particularly Pittsburgh’s physician response capabilities and how the patient’s pain was managed. How would your system treat a patient with this type of injury? Also, a reader chimes in on the glottic visualization techniques mentioned in the June JEMS feature “Achieve 20/20 Glottic Visualization: Clinical research provides lessons for a perfect view during intubation” by Mark Rock, BA, NREMT-P.

Unusual or Unavailable?
It’s interesting how EMS physicians respond to calls in Pittsburgh. I wish all of EMS would become standardized, which would then require paramedics to achieve a higher standard of care. I think there should be more educational requirements for providers to become paramedics and to stay licensed as paramedics, such as mandatory degrees and internships.

I dream for the day when EMS will be its own subspecialty for advanced prehospital care providers (paramedics). I’m not taking anything away from the EMT-Bs and EMT-Is, but paramedics need to advance further. It has to be more than a simple certification program.
Alexander Woo
Via JEMS.com

I struggle to see the out-of-ordinary treatment here. It’s common practice in my system for physicians to respond to requests from crews either in a response car or via the helicopters where physicians are standard on all UK HEMS services. One has to ask why the physician mentioned in this case had to arrive on scene to start administrating nitrous oxide. Surely pain relief starts with the non-invasive oral methods, then IV methods.
Neil White
Via JemsConnect

Actually, what’s out of the ordinary about this story is that most of those doc-in-the-boxes are resident physicians with training (not unrestricted) medical licenses. Even the seniors with unrestricted licenses are still in training, and if they did the same thing in the emergency department or on the floor without a supervising doc present, there would be hell to pay. I’m not knocking the program, but I think there’s a reason there are so few of this type of program out there.
dr-exmedic
Via JemsConnect

Nice job ... and every metropolitan area should have this type of resource. In 1982–1985, my system set up a team of ED physicians and paramedic interns to respond to major incidents. It not only provided great care, but it also greatly improved the physician’s understanding of the EMS system. The mutual respect only grew from there.
Mike O’Reilley
Via Facebook

Perfect View
I am just pleased as punch that there’s finally an article that accurately differentiates between the anatomical positioning for the BURP maneuver versus the Sellick’s maneuver. All too often even senior medics (and nurses) explain that the Sellick’s is used to position the airway for ease of glottic visualization. Often, when they explain how relatively immobile the cricoid ring is versus the larynx, and then I follow up by asking, “Where are the vocal cords located?” I get a look like I’m from Mars.

Lastly, even some EMS texts and other professional organization’s manuals have confused these procedures. Thank you for providing the accurate information.
Brian Webb, MICP, FP-C
Via JEMS.com

Clarification
Due to a technical error, a paragraph is missing from the Neonatal Resuscitation section of the July 2011 JEMS feature article, “Behind the Mask: Is oxygen harming your patient?” by David Anderson. Visit jems.com/behind-the-mask for the complete and corrected version. We apologize for the error. JEMS

This article originally appeared in August 2011 JEMS as “Letters.”



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