Bryan Feinstein

flight paramedic, sar tech, EM and EMS boarded, live to ski. @seattlemtrescue medical committee.

[Bryan Feinstein @bfeiny]

@karimbrohi I thought those were life saving. Please come teach almost all trauma surgeons in the US!

[Bryan Feinstein @bfeiny]

@united Your staff at saint louis did not do this.

[Bryan Feinstein @bfeiny]

@united Thanks for spelling my name correctly. 🤨. About the same level of service I was treated with at DIA when you refused to let me on the flight that you had gate checked my passport and refused to try to remedy the situation

[Bryan Feinstein @bfeiny]

@united You literally treated me as a criminal for checking my passport

[Bryan Feinstein @bfeiny]

@united No I would like some type of compensation for the inconvenience

[Bryan Feinstein @bfeiny]

@united They did not do this. I worked an ER shift the previous night until 2am. I was treated as a problem.

[Bryan Feinstein @bfeiny]

@georgenh_ @ChrisRootMD Yes. EMS systems in St Louis are doing this and it’s reasonable with good training and active medical direction.

[Bryan Feinstein @bfeiny]

@_JaceMullen one of the best

[Bryan Feinstein @bfeiny]

@jducanto @_JaceMullen @AirwayLegend Too bad propofol freezes way before then. Had it happen in me once in Wyoming loading a patient into the ship at -25

[Bryan Feinstein @bfeiny]

@DitchDoc14 @cpatrick_89 Strong work sir. Just used a big slug of ketamine to induce a 7 year old in status after valium, phenobarb, and keppra loads who ended up having HSV meningitis.

[Bryan Feinstein @bfeiny]

@DitchDoc14 @EricJaegerTNG It by definition is emergent procedural sedation without consent.

[Bryan Feinstein @bfeiny]

@DitchDoc14 For sure. Tons of flights that happen out of convenience or no other options (ground ambulance ETA >7 hours) that are not medically warranted. It's tough for everyone right now.

[Bryan Feinstein @bfeiny]

@omarkandah @critconcepts But this opinion is literally implied with direct physician oversight so try again.

[Bryan Feinstein @bfeiny]

If a paramedic asks you if they can intubate your patient they brought to your ED who needs the procedure….the answer should always be yes

[Bryan Feinstein @bfeiny]

@michael22joseph @DanielRGerard @reverendofdoubt Thats completely different than a paramedic bringing you a patient or a flight crew picking up a patient. They are involved in that specific patient's care and are allowed to work under their scope of practice.

[Bryan Feinstein @bfeiny]

@DadDocGamER Yea I think residency training should take priority unless the residents on shift want to teach EMS and they make that decision

[Bryan Feinstein @bfeiny]

@joshmcgoo In the setting of an EM residency program, residents should always get first right of refusal.

[Bryan Feinstein @bfeiny]

@CSevareid @omarkandah And in the setting of an EM residency program, the senior residents are usually the best proceduralists in the ED. When's the last time your attending did an airway on their own?

[Bryan Feinstein @bfeiny]

If you disagree with my opinion, I encourage you to still allow them to be involved in the procedure. BVM ventilation is such a crucial life saving skill that needs practice and these can be powerful teachable moments.

[Bryan Feinstein @bfeiny]

It goes with out saying, any procedure outside their scope of practice, like awake intubations etc, do not qualify.