Colorado Panel Recommends Consensus in Field for RSI

A panel of medical experts recommended Tuesday that paramedics reach consensus in the field before using a controversial breathing procedure.

Its proposal, which includes mandatory training for Colorado Springs Fire Department medics, will be submitted to the Emergency Services Agency by its advisory panel, the Medical Control Committee.

At issue is a Sept. 5 demand by the agency, which oversees ambulance contractor American Medical Response, that AMR amend how it conducts rapid sequence intubation for 120 days, pending study. Called RSI, the procedure temporarily paralyzes a patient so a paramedic can insert a breathing tube.

The ESA board said it wanted AMR to do the procedure only when a doctor is supervising by phone, rather than under standing orders as had been the norm. AMR agreed to the change.

The debate emerged after ESA board member Marilyn Gifford, Memorial Health System's emergency chief, didn't approve of how an AMR paramedic used RSI in July. A subsequent state investigation cleared the paramedic.

On Oct. 3, several physicians told the board that phoning a doctor would delay lifesaving treatment. Those concerns prompted the agency to seek a recommendation from the medical committee, comprising doctors and paramedics.

Meeting Tuesday, the committee unanimously agreed that firefighter paramedics should be briefed in RSI criteria and that they and AMR medics should reach consensus on the need for it before RSI is performed. If consensus is reached, a doctor wouldn't be called. If they cannot agree, AMR medics would call an emergency room doctor before using RSI.

Firefighter medics would undergo four to five hours of training but would not perform RSI themselves.

"We hope that by providing similar training to the Colorado Springs Fire Department medics and updating our paramedics, the medics on scene will have a better understanding of what we're doing," said David Ross, AMR's physician advisor and a member of the Medical Control Committee.

"I think you can get consensus on scene very quickly," he said.

He said the new method also will provide an avenue to "sit down with the Fire Department and review cases and discuss our mutual needs and interests."

Until the ESA board meets on Nov. 7 to consider the proposal, RSI will not be performed in the field unless a doctor is on the line, Ross said.

Also Tuesday, the ESA board amended its 2008 budget after the Colorado Springs City Council rejected it as too high.

The new proposal calls for spending $220,000 next year, down from an earlier $438,000 plan.

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