Edwin Starr wrote a protest song in the 1970s called, “War,” y’all. It sold more than 3 million records, although it probably wasn’t much of a literary or artistic wonder. But in that time, when many pro-war thinkers derided their own draft-dodging children as traitors, the song’s staccato lyrics proclaimed that war was good for “ab-so-loot-ly nuthin.”
You can’t blame Starr’s view of a war that had no resemblance to that of his progenitors who fought to save the world in the late ’30s and early ’40s. But it turns out any kind of war—no matter how poorly conceived—actually produces one good thing. That’s new and better technologies to manage trauma. EMS itself was born of a number of them.
A short list of Vietnam’s contributions would include alkaline and ni-cad batteries; Narcan; small duplex radios; Teflon; the first truly portable DC defibrillators; the first federal ambulance specs; Transpore tape; ECG patches that really stuck to skin; over-the-needle flexible catheters; preloaded syringes; C-collars; conforming bandages like Kerlix, Kling and Coban; the plastic Stokes litter; plastic IV bags; PTSD debriefings; and the whole concept of a trauma system.
Great ideas evolve in all industries when somebody connects a seemingly insignificant fact to a really momentous implication. (You know you’re looking at a great idea when you find yourself saying, “Now, why didn’t I think of that?”)
Paramedic Jim Tenger had just such an idea and, prompted by his colleague, Chris Olson, he developed a new way to illuminate the cords during laryngoscopy. Tenger is a captain with the Rancho Santa Fe Fire Department in San Diego (Calif.) County. Olson, a former U.S. Navy corpsman in the triage unit on the USS Sanctuary in Vietnam and a legendary paramedic who is still practicing after 35 years, remembered using ultraviolet light to locate phosphorus in the wounds of soldiers. White phosphorus is an incendiary agent used in many weapons, and it glows in the presence of black light. Because of their high phosphorus content, so do bone, cartilage and other types of connective tissue—like the vocal cords.
So Tenger developed a laryngoscopic system around that black light idea, including new handles, fluorescent-coated stylettes and a set of 10 single-use unpolished stainless steel blades. Each blade is equipped with not one, but two, light sources (one high-intensity LED, for a three-dimensional perspective, and one black light, near the tip). His aluminum handles are curved and incorporate smooth finger notches. That curve approximates the 45-degree forward tilt of an attachment commonly used by anesthesiologists, called a Howland Lock, which is normally inserted between the handle and the blade of a standard laryngoscope.
A Howland Lock also adds about 30mm of space between the blade and the handle and is designed to keep your hand out of the way, so you can see the cords in a patient with a short, bull neck, or anteriorly displaced larynx. It’s also designed to minimize your tendency to pry against the lower incisors, prompting you to lift instead. Tenger’s c-shaped handle doesn’t incorporate the extension, but it does prompt you to lift, because its forward tilt makes prying feel unnatural.
Our paramedics are using this new laryngoscope system in the field, Life-Saver. So far, all of them think it’s a great idea. Some think it’s better than the one-size-fits-all video scope they’ve been using. The first time we tried it in vivo, the 54-year-old patient survived a cardiac arrest and went home to mow her lawn. The second involved a 3-year-old, and the paramedic thought the angle was too acute between the patient’s face and the pediatric handle—so there wasn’t enough space for his fingers.
The Intubrite’s blades are designed for single use. Crews generally consider that wasteful, opting instead to clean them and keep them in use. Maybe they’re right, maybe not. (Nobody’s ever found a way to clean the recess around the ball that latches the handle to the blade.)
Intubrite sells a set of two handles and 10 blades (five Mac and five Miller) in a nylon carrying case with adult and pediatric stylettes for about $400. Replacement blades run about $17 apiece. The handles each come with a 4.5-volt lithium-ion battery designed to last through 1,000 intubations and plenty of practice on the side. You could probably plan on just having to replace the battery pack once a year.
We’ve seen a lot of gizmos come and go over the years, you and I. This one seems important to me. What d’ya think? JEMS
This article originally appeared in July 2010 JEMS as “Follow the Phosphorus: Vocal cords glow in Intubrite’s black light”