This month, readers chimed in on two feature articles: one from May JEMS that discussed the prevalence of bedbugs (“What’s Buggin’ EMS: How to rid your rigs of a bedbug infestation,” by Wayne Zygowicz, BA, EFO, EMT-P) and one April clinical education article on treating penetrating trauma wounds (“Breaking the Surface: Arm yourself with knowledge about penetrating trauma,” by Bryan E. Bledsoe, DO, FACEP, FAAEM, EMT-P; Michael Casey, MD, & Ryan Hodnick, DO). In addition to the interest these two articles garnered, a Street Science review on JEMS.com by Keith Wesley, MD, FACEP & Marshall Washick, NREMT-P, added to the long-standing debate over the effectiveness of endotracheal intubation (“Study Analyzes Use of ETI vs. King LT-D for Cardiac Arrest Patients). Finally, we asked our Facebook fans to fill in the blank: “You know you’re a medic when ______.” Read what they said.
Bedbugs Bugging You?
We have ambulances getting patients with bedbugs on a weekly basis. It’s become a huge epidemic among our “hometels” in San Diego. We subcontracted with a company that comes out and completely disinfects the entire ambulance from top to bottom. This involves taking every single piece of equipment out of the ambulance that isn’t bolted to the ground.
They take you out of service immediately after you notify a supervisor that you had a contamination. Four hours later, they put you back in service. I suppose they’re using such an aggressive approach because a few of our fire stations got infested with bedbugs after contact with a patient. Gross.
Our department uses Tyvek suits for everyone, including the patient. We carry a can of pyrethrum that we can spray down the crew, inside a bus. Then, we call an exterminator who comes out who treats the entire truck. Next, we strip down and place our clothing into a dryer on high for 30 minutes. We are placed out of service for the duration. This is a daily occurrence.
This study’s researchers have reanalyzed that first attempt “placement” is more successful for King LT-Ds over endotracheal intubation (ETI). There is no data included in this study to support patient outcomes with regards to cardiac arrest outcome data. It’s certainly possible that a bag-valve mask (BVM) plus an orophayrangeal airway (OPA) until intubation is indicated in the patient would provide better end-result outcomes than either of these options. Just because something is more successfully inserted doesn’t mean it’s a better option for use.
A pediatric study comparing ETI and King Airway LT-Ds is about to be published in Prehospital Emergency Care. It was a small study in simulated patients, but it’s the first pediatric study looking at the King Airway that I’m aware of. Examining alternative airways for pediatrics in the prehospital setting is a perfect area for further research.
I would say ETI no doubt. It’s a tube that goes into the trachea; King tubes rarely do. It’s a blind airway device that’s fine for a rapid need to provide ventilation, but why not just use an OPA and a BVM? We got rid of practicing rapid sequence intubation because many couldn’t properly intubate, wouldn’t cooperate with capnography or couldn’t figure out that they tubed the stomach. I personally think there needs to be a rigorous airway course in all schools, and I also think all ALS agencies need to drill on the importance of ETI, the proper techniques and the appropriate use.
A King is obviously easier and causes minimal disruption of the most important part, which is CPR. Endotracheal tubes are important when they’re needed, but it depends on which medics are doing the tubing. There are simply too many providers with not enough skills. It’s easy to say “train more,” but large departments are hard pressed to have the time, money and tracking ability to keep medics properly trained.
Let’s just stick to the science please. In the article, it mentions “assault rifles.” Epic fail gang. Most “assault” rifles are of smaller caliber than hunting rifles. They’re nothing more than military-style rifles, and the term “assault rifles” is a political term that isn’t needed in a magazine like JEMS.
To nitpick some more, the ballistic charts are far from accurate, nor do they list a source.The AK 7.62 X 39 doesn’t come in 168 grain and doesn’t achieve the optimistic figures you give it, just as the 30-06 is bit more potent than you state, and it’s a more common hunting round. This begins to make me wonder if there is an agenda behind this article because the numbers aren’t exact. So let’s be accurate as a science-based article should be and leave the subtle politics out of it.
Andrew Friedman, NREMT-P
Author Bryan E. Bledsoe, DO, FACEP, FAAEM responds: First, I am a hunter and a gun owner. There was a great deal of discrepancy in these numbers, and multiple sources were reviewed. We had two weapons experts, one military and the other civilian, review the document and they made no comments. There appears to be a great deal of irritability regarding this, and the purpose was primarily to give relative examples—not be totally precise in terms of ballistics The purpose of the article is more related to penetrating trauma than ballistics, and in the future it might be prudent to leave the ballistics out. There was no hidden agenda.
What Makes a Medic?
Eric Henry: You find yourself staring at everyone’s veins, from family friends to total strangers.
Crystal Haynes: The term “frequent flyer” has nothing to do with getting on a plane.
Tiffany Johnson Groves: You sit down with your family at dinner, and your food is gone in 90 seconds flat.
Dylan Beickman: You run on a regular patient, and play the game “how much of the patient healthcare record can I complete before I
Michael White: When you were an EMT, friends always introduced you as a paramedic, and now that you’re actually a paramedic, friends introduce you as an EMT. Also, you know every homeless person in town on a first-name basis and have no problem having a casual conversation with them even while you’re off duty, even while all your friends are trying as fast as they can to get away.
Cheryl Menkhorst: You’ve stopped at a red light, made sure it was clear and went through ... in your personal car, followed by “oh crap, I am not in an ambulance.” This article originally appeared in June 2012 JEMS as "Letters: In Your Words."