Down the Tube
"The Disappearing Endotracheal Tube" (March„JEMS) has been a long time coming. Although ETI is a useful tool, the focus of the technician performing the skill has changed from "we need to get this patient ventilated" to "we need to have the patient intubated," and that„must„ change. At my service, we_ve found that our first time success rate needed improvement, and second and third attempts yielded even lower success rates than first attempts, and have changed our protocol to limit intubation attempts to one per technician, and a total of two per patient. We_ve also almost abolished the intubation of CHF patients with the addition of CPAP. Our intubation attempts have decreased dramatically, which may be a double-edged sword because now, even though the changes are benefiting our patients, we have reduced the experience maintenance of the paramedic. I agree that ETI in the field setting will soon become a thing of the past. I think we_re willing to accept that and embrace the change, however; Dr. Bledsoe is very right in saying that the "emotional setback" to the paramedic will not come without resistance or pain.
R. Allen Haynes, Training Officer
Moncks Corner, South Carolina
Quit Your Complaining
Most of Guy Haskell_s article "I Don_t Have to Pay for a Taxi" (www.jems.com/haskell) rang true for me. Sometimes, I complain all the way to the call, but as soon as I get there, I stop and really try to talk to my patient and their family.„I_ve learned that most people just want to be validated.„Once I stopped taking the abuse of the 9-1-1 system so personally, I became happier with my job. I couldn_t imagine doing anything else, so I try and take everything in stride.„I acknowledge the fact that there needs to be a systemwide reform on abuse, but I can_t complain too much because I don_t have the solution.„My father taught me not to complain if you don_t have a solution, or else you_re just wasting your breath!„
In March JEMS, one of the Prehospital Care Research Forum abstracts was incorrect. To read the correct abstract for "Efficacy and Compliance of a Prehospital Clinical Clearance Spinal Immobilization Guideline," go to„www.jems.com/jems.„JEMS