9. Alternative Airways

My List of the 16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic

9. Alternative Airways

When I started as a paramedic – all we had was the ET tube. You brought in a code, the first question you were asked in the EMS room was “Did you get the tube?” If you got the tube, you got an approving nod. You didn’t, after you left, the other medics would shake their head. Of course, if you got the tube, nobody asked how many tries it took you to get the tube. You might hear the medic’s EMT partner later commenting it was a “hard tube,” which meant there were multiple tries. Familiar with the term “A Pass the Larengyscope Code?” I have been at a few of those and heard of many more.

Nowdays, we have alternative airways – The LMA and the Combi-tube. We may soon get the King LT. And we have limits on the number of times a paramedic or any combination of paramedics can attempt an ET.  Two tries for the first medic and one for the second.  No more than three tries total.  And, most importantly, you don’t have to try at all.  You can just go to the alternative airway to start if you think it gives you the best chance to quickly secure the airway.

Here are some old posts describing my first LMA and my first Combi-tube, as well as a post called “The Battle” describing my beginning mindset when contemplating what airway to use.

LMA

Combi-tube

The Battle

I can tell you this now, based on the medical literature, and on my experiences with the LMA and Combi-tube, I no longer hesitate to use an alternative airway as my first line airway.

The goal is not to impress other medics, but to effectively ventilate the patient, and in cases of cardiac arrest, not to interrupt compressions. I can do both of those quite well with an alternative airway.

16 Most Significant EMS Treatment Changes in My 20 Years as a Paramedic

10. Chemical Restraint
11. No More Lasix
12. EZ-IO
13. Permissive Hypotension
14.Expanded Medication Routes, Less IV Emphasis
15. Narrower Use of Narcan
16. Increased Standing Orders

1 Comment

  • Eleanor says:

    Heya I really like your blog, particularly your latest stuff comparing what’s changed between now and 20 years ago as a paramedic. I run a blog on Emergency Services called http://www.helloemergency.co.uk I’d be really interested in getting a guest post from you on your experiences as a paramedic. It would have to be before the 7th of May though. Anyway please let me know if this is possible, email me and we can have a chat!

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Peter Canning

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  • Comments
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30
    Joseph Eriksen
    The Ideal Medic
    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
    2015-03-24 19:37:25
    Shawn McCormick
    The Ideal Medic
    I totally agree. To me those make great paramedics. I work as a Operation Supervisor and encourage teamwork/backup whenever the situation calls for it. I encourage feedback from a difficult call my crews responded to. 1) they have the chance to recall the events that took place and they may self evaluate the call. 2)…
    2015-03-24 17:14:14
    Sean Fitch
    The Ideal Medic
    Totally agree Peter, For too long I had the same interpretation and like you now, I would by far take your current description.
    2015-03-24 17:05:33
    tom combs - ER doc/author
    The Ideal Medic
    Twenty-five years as an ER doc in level one trauma centers has me in total agreement. I Interestingly what you say regarding paramedics also, in many ways, applies to ER docs. "Tries to learn from each call...puts the patient first." A great post. I salute to your wisdom!
    2015-03-24 17:04:06

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