Airway & Respiratory, Cardiac & Resuscitation, Patient Care, Training

A Matter of Integrity

Issue 9 and Volume 35.

Matters of Common sense?
This month, Gregg Lord’s article on the recent suspensions of Massachusetts EMS providers over falsifying recertification documentation (“Massachusetts EMS Providers Violated Public’s Trust by Falsifying Credentials”) stirred a lot of discussion on personal integrity and continuing education (CE) programs. Also, many readers responded to a July 2010 JEMS panel discussion (“Experts Debate Paramedic Intubation: Should paramedics continue to intubate?”) that delved into whether paramedics should perform endotracheal intubation (ETI) in the field.

When I first became a paramedic in the 1980s, there was no recertification by continuing education. You had to pass a written and practical exam every three years. At the time, I felt it was unfair, as other professions (such as nursing) didn’t have the same requirement. Now, with the CE program (we follow NREMT, 72 hours every two years), I think it’s a fair system—if you honestly complete the requirements.

If you don’t think you’re getting anything out of CE, you’re either attending the wrong classes or you’re not taking your job seriously.
User Wvfdc640

Not everything is black and white, but honesty and integrity are everything in EMS. I was once “asked” by billing at the ambulance service I worked for
to change a run sheet on a transfer to make the patient “unconscious” when he was sitting up and talking to me because insurance wouldn’t pay the $2,000 bill otherwise.

I refused and threatened to go to the state bureau of EMS. I know tons of people who renew their CPR card by getting an instructor to “sign off” on it.
User Mike Grill

Airway Analysis
Thank you for that insightful and provocative discussion. Once again, JEMS proves itself to be at the forefront of bringing great information to the table. As a paramedic of 22 years with few ETI experiences, I’ve become a firm believer that, in urban settings, it’s a waste of valuable time to spend 20 minutes on scene trying to perform ETI when you’re five minutes to the closest ED. If the airway is patent, then use the bag-valve mask (BVM). If you can’t get the endotracheal tube in two tries, then go to a Combitube or King Airway. Common sense should tell you to stop wasting time and not let your patient suffer from anoxia; get to the hospital using the BVM to assist.

Thanks again for the intelligent discussion. I think you’re correct in stating that airway management will look very different in five years in EMS. I welcome the changes.
User EMSwife

 This article originally appeared in the September 2010 issue of JEMS as “Letters.”

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