transcript of Interview of troy smith
Jamie Davis: Hi, Jamie Davis, the Podmedic, here in Dallas at the EMS Expo 2010. We were brought in here by Physio-Control to interview some of their Learning Center instructors that are here at the Expo doing educational sessions during the exhibit hall hours. I have Troy Smith here from Snohomish County Fire District 7 in Washington State. He is going to be talking about capnography in the talks later today. Actually, you’ll be able to see that presentation over at Physio University in their Learning Sections there. Troy, first off, I want to know a little bit more about how did you get into becoming a paramedic? How did you become passionate about taking care of our patients the best way we can?
Troy Smith: It all started actually back from the YMCA camp. When I was 15 years old, I was hanging out with the EMTs that worked there. They talked about this job they had and I was like, “Wow, it’s so interesting.” That built inside of me this desire to look into that. After I graduated high school, I got into EMS and started working right out of high school. I worked at Central Washington University in 1993 and the rest is just basically history at that point.
Jamie: You’re going to talk a little bit later on about capnography and it’s something I’m passionate about. I often refer to it as the red-headed stepchild of our EMS tools. I think it’s one of the most underutilized and yet most important tools that we have in our tool box. People just don’t understand it. It’s not just for tube placement anymore, right?
Troy: Yes. That’s the big misconception. If you’re just using it for tube placement, that’s the tip of the iceberg. It does so much more. People would ask me, “Hey, what is it going to do for me? How does it help me at 2 a.m. when I’m not running the call?” It’s plain and simple. It is the earliest detection sign that we have of the patient’s changing condition, plain and simple. Everything else—it’s not the only thing, don’t get me wrong, you still have to use all of the other tools, assessments—but it is the earliest sign that we’re going to see that the patient is changing.
Jamie: It really is potentially another vital sign.
Jamie: It really could be used that frequently because we see so many things change. Gas exchange at the cellular level is really what it’s all about. If that’s not happening efficiently and exchanging the lungs, we’re not going to see a healthy patient.
Troy: Yes. The challenge that we look into when we talked about capnography is it is any change in perfusion, metabolism, or ventilation. If you have any different from capnography, it is going to be traced back to one of those three things. The challenge for the medics is trying to figure out which one of those three or two or all of them it is but it really does point you in the direction, yes.
Jamie: It also gives you an idea and indication of the effectiveness of interventions.
Troy: Yes. Like when we talk about asthma specific, when you look at the change of waveform, that is going to be the first indication your treatment is working or, worse, it’s not working and we’re going to do something different.
Jamie: Actually, I’m seeing this—you can actually be better prepared to know if you’re going to actually need to get that tube out. When you let that asthmatic, that’s just not responding to anything you’re doing despite your best efforts and you’re watching that wave worsen and worsen and you’re seeing that gradient change, you get a better indication. I think you’re better prepared.
Troy: Yes. In our system, we really moved a lot of protocols to the use of capnography. It’s written in there saying, “Hey, we want to use it on these patients. These are the types of patients.” Our narcotic overdoses anymore, we don’t titrate Narcan to mentation. We all joke about as medics. You give them that last little bit of Narcan when you’re rolling to the ED.
Jamie: [Laughter] By the way, the ED nurses love that.
Troy: [Laughter] Yes. In our protocols now it basically says, “Hey, you titrate Narcan specific to ventilation, [tied off] capnography.” As long as you’re good there, let them go ahead and sleep.
Jamie: Okay. I just think we need to use it more. When you’re going to be talking later, what’s the message you want this people to take home? It’s a half-hour session. It’s really a starter, of course, on capnography. There’s so much more depth involved there. What do you want them to take home from the session?
Troy: I want them to take home the message of: this is something that can help you make determinations about your patient well before a lot of other assessment data that we have. I want to spark that interest for them to go back and learn more because you’re half-hour is not nearly enough to spend time on capnography.
Jamie: I noticed you have a lot of case studies in there which I love. I really think we learn by picturing that patient in our minds. Case studies really, at least for me, I can picture that patient. When you describe to me a case study I can sit there and go, “Okay, this is what I’m thinking. This is what I want to do.” I love that about your project. You really painted some good pictures there. What do you see is important for instructors that maybe watching this and maybe wanted to do more of capnography? Do you have anything to say about building the case study patients for these things?
Troy: The key to capnography is really just using it. I tell our guys, “You won’t know abnormal until you know normal.” Use it on patients. “Well, I can just use a nasal cannula.” Yes, I know you could but you have to use it on a regular basis. If you only did six 12-leads a year because that’s kind of what intubation is like, the average medic probably less than ten intubations a year. I tell the guys, “If you only look at six to ten 12-leads a year, how efficient would you be at reading that twelve-lead?” They all say, “I wouldn’t be.” That’s my point. We can’t just use capnography on the intubated patient and expect to be proficient at it six or ten times a year. You’ve got to use it to understand what’s normal first and then you can start to identify what’s abnormal.
Jamie: Well, thanks. That’s it, Troy. I think everybody’s going to get a lot of the sessions later this afternoon. Of course, we’re going to be recording your session. It will be up on the Physio University site and we will be able to get some feedback on people that couldn’t make it to Expo this year. We’ll still be able to learn a little bit about capnography, so thanks a lot.
Troy: Great. Thanks. I appreciate it.
Jamie: I want to thank all of you. Make sure you head over to Physio University site and, of course, keep following the “Innovations in Patient Care.”