Episode 4: A Finger in the Chest Beats a Needle in the Bush

Listen here or download on iTunes, Podcast Addicts, or Podcast Republic. 


Let’s start off by talking about what is really important. On July 4th, 2015, we lost one of the greatest resuscitationists of our time, Dr. John Hinds. He was progressive, cutting edge, and funny as hell. We know that the work we do is novice in comparison, but we hope to carry on your work. RIP, brother. Without your work, we wouldn’t even be considering ST in prehospital care.

Studies in the U.K., Italy, and Greece show that in the prehospital theatre, needle decompression fails upwards of 50-65% of the time; whereas ST has a success rate of 91.5%.


  1.  Inappropriate placement in the anterior fields.
    1. There is very important vasculature in the anterior chest! Poor placement can have catastrophic effects on patient outcome.
    2. EMCrit released a study following EM physicians and where they believed the appropriate landmarks were… let’s just say that if men/women that go to school for 8-12 years learning the intricacies of the human body can’t place it properly, a bunch of blue collar medics that spend all of 1-2 weeks covering anatomy, are bound to fuck it up. When in doubt, go lateral. There are less risks or improper placement, but you sacrifice the lack of adipose tissue to puncture through. Take a breath and reconfirm proper placement; slow is fast and fast is smooth.
  2. Too much adipose tissue!
    1. We get bigger BP cuffs, stretchers, CPAP masks… We don’t get larger needles. Too much tissue means you will not get down where you need to be…
  3. We use catheters that are too small.
    1. Coagulated blood clogs catheters. Plain and simple. If you stick someone once, you will most likely end up sticking them 3-4 times.


If we can’t identify (or act upon) tension pneumo/hemothorax in the field, why would physicians continue to allow us to have more tools in the toolbox? Secondly, our educational standings are embarrassing as a field. We perform highly technical procedures comparable with many EM physician with 1/8 of the training. If we can’t maintain proficiency at the skills we are already allowed to perform, why add more? It’s time to strongly consider making prehospital medicine a degree program. This calls for personal discipline and legislation changes on how we train our new employees and students coming into the field. More on that later.



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