Ok, so I had my second book signing and as usual I learned a thing or two. Not a bad thing for a college professor talking about ambulance education. Never too old to learn and continue learning. The book signing was at the Firehouse Exposition in Baltimore Maryland. I was doing the signing at the exhibition booth of the bookseller Firehouse books. I did however take some time to walk around the exhibits in an effort to see what some of the latest technologies are. This proved to be quite educational.

I learned how the profession of EMS is more and more about putting disposable plastic stuff into and onto people. As one example, I liked the concept of a plastic template for placing an endotracheal tube into the patient without the need for a stylette or visualization of the vocal cords. This will, according to the sales woman, “work perfectly every time,” for the right sized patient without abnormal anatomy.

The exception is a concern for me. If all the easy intubations on non-swollen, non-hemorrhaging and normal body type patients are done with the idiot proof device will that make the intubation skill set of the paramedic get stale? My concern is that when he or she needs to do a hard intubation the lack of repetition on the easy ones will magnify the difficulty of a challenging intubation.

There are emergency rooms where the policy is to have anesthesiology intubate patients as opposed to the emergency room physicians or ACLS certified nurses. There is some justification for this type of protocol because the ER has a staff to back up each other. The paramedic does not have this luxury of a quick back up. I talked about this concept briefly in my book, My Ambulance Education’ in chapter 16 entitled Along for the Ride. So if you can’t ‘tube’ the patient the patient dies. Therefore, keep up those skills and try to not be too dependent on fair weather technology.

So while I love the technology and I support faster and better EMS concepts, I firmly believe that the practice of emergency medicine needs hands on practice. I am neither for nor against the company or intubation technology. I just wish to emphasize that those skills need practiced and proficient hands and eyes.

Learned thing number two. Every time I tell EMS people about my current research to develop diagnostic technologies for the neuro patient including stroke and head injury, they nod vigorously. They bemoan the fact that over 85% of the time an EMT or paramedic can diagnose a stroke but not treat that stoke patient because it is not yet possible to diagnose the subtypes of stroke, which need different treatments. They are equally concerned with the “dead man walking” patient where a patient with a mild concussion is bleeding in the brain and in a lethal condition. This is what most paramedical personnel fear and may be what happened to Natasha Richardson. So the community seems open to diagnostics in the ambulance and anxious to adopt new things. With limited space on the ambulance, we need to be very careful what is developed and how it is packaged. But changes and improvements are coming.