>What are your concerns regarding "quality, skills,
>competence, etc.". Are you afraid that prehospital care
>providers using RSI will administer incorrect dosages or the
This is less of concern, with proper protocols and QA monitoring.
>Are you concerned that RSI will be used
>inappropriately (too often), or are you concerned about the
>situation where intubation is still not successful even
>after proper RSI?
Absolutely. In pur present situation, we have little control over
training and QA in our EMS. Short staffed and over worked (how unique)
pediatric training has received the short stick. Too many diagnostic
mistakes in lesser conditions lead me to have less than faith.
>The reason I ask is that I want to understand where the
>concerns in the in-hospital medical community lie. Is it
>just that paramedic's aren't sufficiently trained to handle
>RSI and the complications / side-effects, or is it because
>it is occuring in an isolated environment (outside of your
I'm not an anesthesiologist, but my understanding (go ahead burn me) is that
they are trained, retrained, supervised directly in a way that makes street
scene RSI out of control of everyone except the individula on doing the
Of lines placed in the field, I find about 25% "out" on arrival in the ED. IO
access is less successful. Since the EMS has pushed drugs through these "out"
lines by the time they arrive, how are we to get the RSI agents on board?
David G. WArd, M.D.
Le Bonheur Children's Medical Center
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