To Intubate or Not to Intubate?
The October 2010 Case of the Month column (“Airway Encounters: Which method would you choose?”) stirred some discussion on when it’s
necessary—and appropriate—for providers to perform endotracheal (ET) intubation in the field. Should this skill be replaced by using other adjunct airway devices, or should it remain the standard protocol?
It’s common for some paramedics to let their ego drive the desire to “get the tube;” these situations can be common and are usually detrimental to the patient’s outcome. I’m not saying to not be confident or aggressive or to try hard. I’m simply saying providers should be aware that the patient’s life is far more important than their ego or the statistics to back it up.
It’s quite disheartening to me, as a paramedic of 30 years, to see the trend now being followed by JEMS to discourage the use of ET tubes in securing airways. Sure, this patient was delivered to the hospital alive (there was no mention of follow-up on this case, i.e.: trauma versus medical).
Let’s not be too quick to start discouraging a time-proven procedure just because the training isn’t available for all new paramedics. Instead, let’s make facilities more available to specialize in intubation training. I also hope to see more articles written by providers who have confidence in their own intubation skills, as well as the knowledge and experience to understand the risks versus benefits.
Roy B. Covington
Alamogordo, New Mexico
Author Criss Brainard, EMT-P, responds:
I appreciate your comments regarding airway management and your views and concerns using the King versus ET tube. This kind of interaction is healthy and allows all of us the opportunity to view patient care from the perspective of another provider. I don’t discourage the use of ET tubes in the prehospital setting, nor do I discourage the use of other airway options.
I strongly encourage EMTs and paramedics to critically evaluate what is best for the patient presenting in front of them, now. You bring up great points regarding why an ET tube may have been a better choice from your perspective, and your desire to work toward a seamless transition from your field care to the emergency department certainly makes sense—when it’s the best avenue for that patient’s care. In this case, given the patient’s presentation, I was proud that the paramedics stepped outside their routine to do what they thought was best. Paramedics who choose the “alternate airway” where appropriate are setting themselves up to be successful when they encounter a difficult airway.
If it were my mother lying at their feet, I would hope the paramedic had actual experience with alternate airway devices prior to using it on her. On a final note, during my 30-plus years as a paramedic and the time I spent as an anasthesia corpsman, intubating every day, I believe in my abilities to manage prehospital airways. JEMS
This article originally appeared in January 2011 JEMS as “Letters.”