In case you haven’t heard yet, California is working towards officially introducing (pdf) (underlined is new legislation. Some of it is cleaning up a mess left from moving EMT-II to AEMT) Advanced Practice Paramedics and Critical Care Paramedics as state levels. While scanning over the proposed legislation, the following line from the proposed Critical Care Paramedic scope of practice struck me as odd.
“1. perform digital and nasotracheal intubation;” -pg 11
Wait, shouldn’t the scope of practice (albeit the basic scope of practice for all paramedics) be “intubation?” If paramedicine is a profession, shouldn’t paramedics be entrusted with the independent judgement to determine, based on their education, training, experience, available tools, and their assessment of the patient, how specifically they intubate? If a paramedic believes that the totality situation calls for digital intubation or a gum bougie or any of the other method instead of or supplemental to direct laryngoscopy, shouldn’t that be the imperative of the professional paramedic? Furthermore, provided standard concerns are met like maintaining oxygenation, isn’t the goal of putting an appropriately sized tube into the slightly larger (and correct) tube, and the ensuing confirmation, more important than how that is achieved?
Could some of the issues with paramedics intubating be, in part, because the wrong tools are being used? If you only have a hammer, then everything is a nail. That’s fine, provided you’re dealing with nails or wooden pegs. However when you get to screws, sure a hammer may work, but why not use a screw driver?
Why is the skill of direct laryngoscopy more important and sacred than the intervention of intubation when other skills can achieve the same goal? Furthermore, if paramedics cannot be trusted to pick the correct mechanical skill when providing the intervention of intubation, what does that say about paramedics, and why are paramedics not fighting back?
On a side note, I’m sure I’ll have more than one person think I’m a complete idiot for this, and the ensuing implication about EMS’s current status between technical trade and profession. Feel free to call me an idiot in the comment section (or email, but the comment section lets you drive the discussion), I don’t mind and without discussion nothing changes. My only request is that you take a minute to call me an idiot, take a second minute to explain why I’m an idiot.