Jan 05 2009
EMS A-Z Series “R” - RSI and Ready Or Not By James Hoffman
If you have been reading the A-Z Series you know that I have been trying to avoid too much clinical type articles and have been focusing more on general ideas on what we face each day as EMS professionals and also why the basics of what we learn in the beginning of our careers applies to what we do every day.
When I mention RSI or Rapid Sequence Intubation I don’t want to get into the clinical aspect of it on why Succinylcholine over Vecuronium or on Mallampati classes. There is a wealth of clinical information on this on sites like EMS1.com and JEMS.com to name a few.
What I would like to mention is that RSI is becoming more of a standard in many EMS agencies and most have a specific training requirement of their paramedics to be able to perform this skill in the field. RSI encompasses many dangers and difficulties for the provider and it truly brings us as EMS professionals to the next level of care and skill level.
When many are suggesting that endotracheal intubation in the pre hospital setting should be a thing of the past. The fact that RSI is such a hot topic, I think strengthens our need for advanced airway management in the field. The key is having the proper training not only for the skill itself, but also understanding the medications and their properties. That is where the danger lies and some providers may take this danger too lightly. Which of course can only bring us back to the thought process of sending ETI to the bench.
We as providers must take ETI and in turn RSI seriously. That means getting the proper training, seeking out clinical opportunities to perform the task and most of all knowing when it just isn’t possible and not letting our ego get in the way of what is best for the patient.
While I do see the advantages to non visual airway management. There will always be a place for true advanced airway techniques. After all “airway” is first on the list. Without being able to secure and maintain it - everything else is just spinning our wheels.
I don’t pretend to have all the answers or know it all when it comes to this subject. You can talk to ten people and get ten different views. The one view though I think we can all agree upon is that education, training and practice will allow us to continue providing true pre hospital care that includes everything the ABC’s encompass. Instead of focusing on just the pre hospital transport part.
Along the lines of all this training and advances in how we provide care. You must be ready to do so. When I say ready or not, I mean just that. You are either ready or you are not ready. So, ready for what? Well, think about that for a moment. Ready can relate to checking your ambulance to make sure it not only runs and has the lights working, but also that you have all your equipment and that it works as well. From your laryngyscope light bulb turning on to having enough non rebreather oxygen masks.
It can also apply to being ready as a professional and knowing your local protocols, procedures and how to apply them. Being ready to read the 12 lead ECG, start the IV or just plain lift the patient.
I think you get the idea I am going for here. Be the EMS professional that is ready. Ready in training, equipment, knowledge and attitude. The patients may not say it, but ready or not here they come.
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Jim Hoffman is a contributor to The EMS Professional. Find out about the premium members only VIP website for paramedics, EMT’s and EMS personnel by visiting: http://TheEMSProfessional.com |





















