The Controversy & Complexity of Out-of-Hospital Intubation

Street Science


 
 

Keith Wesley | | Wednesday, June 27, 2007


Review of: Wang H, Yealy D: "Out-of hospital endotracheal intubation: Where are we?" Annals of Emergency Medicine. 44(5):439-450, 2004.

The Science

Every week, there seems to be more information coming out on the issue of out-of-hospital intubation. How do you decide what is or isn't reliable? In this article, Wang and Yealy try to answer this question. The authors review the current state of the art of out-of-hospital intubation. They examine the methodological flaws and weaknesses of the science, while providing guidance for future research. Wang and Yealy shed light on the lack of understanding that we have on the intricate complexity that is prehospital intubation, and they do so in an unbiased and scientific manner.

The Street

I don't know what the right answer is to the question of whether or not prehospital intubation is right or wrong. We all accept the fact that the procedure is different in the street than it is in the ED. Several recnet studies clearly show that it can be harmful but why? Why do some patients do better if we wait until they get to the ED before intubating them? Is there something in the training and education? Is the quality of medical oversight a factor? Is there a lack of basic airway maintenance skills by ALS providers?

Again, I don't know. These questions have stimulated debate and have fueled report after report of "excellent" intubation success rates in various programs. However, few of these reports have documented the clinical outcome of the patients. Traumatic brain injury has very well-defined outcome measures and therefore has been the focus of recent research. How many COPD and other respiratory distress patients have benefited from prehospital intubation? How do you measure that? Can we extrapolate the information from brain injury patients to those with other conditions?

These are just a few of the many questions regarding prehospital intubation. What I do know is that these two authors are experts in the field of prehospital airway management. Reading this article and pondering the questions they raise will provide you a fundamental understanding of its controversy and complexity.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Airway and Respiratory, Research

What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS





 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Innovation & Progress

Follow in the footsteps of these inspirational leaders of EMS.
More >

Multimedia Thumb

University of Pittsburgh STAAMP Trial

Trauma experts launch tranexamic acid trial.
Watch It >


Multimedia Thumb

New York Ambulance Service Begins Using Power Cot

Service is first in county with new technology.
Watch It >


Multimedia Thumb

Traffic Cam Captures Wisconsin Ambulance Crash

Driver of ambulance cited for failing to operate safely.
Watch It >


Multimedia Thumb

New Mexico Hospital Mourns Helicopter Crash Victims

TriState CareFlight pilot and crew killed in crash.
Watch It >


Multimedia Thumb

Moscow Subway MCI

At least 20 dead and 150 injured in subway derailment.
More >


Multimedia Thumb

Hands On July 2014

Check out the latest products and innovations in JEMS.
More >


Multimedia Thumb

Wounded Veteran Resiliency

Marine is one of many in quality of life study.
More >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


More Product Videos >