You are correct.
A cric is a last ditch effort and many medics will go their whole career without ever having done one, either due to the system/state not allowing it or the opportunity not presenting itself.
I myself have been in EMS since 1994 and I have done three crics. Two of them I knew was futile but it was my last ditch effort to say I had done everything possible for the patient. The third one actually saved the man's life and he was discharged without any defecits a short while later.
Crics just are not needed all that often in most typical environments, we have too many other tools at our disposal these days. However, if you are in a situation that warrants it, do not hesitate but be completely prepared before starting.
I am sad to hear about the case you presented because that was most unfortunate. I know of a service that went through the same situation, they ended up settling with the victim's family plus RSI was removed from their guidelines. How many patients will this effect in the future now that because of that one screw up by one medic, none of then no longer have the option to RSI.
There are other alternatives to dealing with combativeness besides RSI. One of my old ground sevrices used to carry Haldol (Vitamin H)..lol. It was most useful and sure beat the hell out of RSI'ing someone for no reason other than to gain compliance.
I would like more deatils about the incident, because it sounds as if there was a huge failure in the system overall. First, too many medics do not adequately prepare for accessing an airway. They think they push a few drugs and tube and easy as pie, all done. There is much thought process that should be done prior to an intuation especially an RSi situation. Prior to pushing any drugs, the airway should be assessed for difficulty. One tool is using the Mallampati scale, somethig which many medics will say "huh, the what?" Using this scale will predict how difficult the attempt will be. You also need to have backup plans already thought through and the equipment ready for use should it be needed. Scrambling through the cabinets after the fact does th patient no good.
Second, there are techniques to employ while intubating. You can let your partner pick the patient up by the arms, so the head hangs back, you can drop their head off the end of the stretcher, you can semi Fowler them and stand over them ( which is a great technique), you can use the two man intubation method. Not only should you try different positioning, you also use the BURP method. Too many people just merely apply the Sellicks manuever which is ok but all should know the BURP. Using this method usually shifts the cords into direct view. Very simply, its backwards, upwards, right pressure.
Finally, the last failure was the drugs pushed. When RSI'ing someone, we use a short acting and long acting paralytic. The reasoning is this: if you are unable to ventialte the patient after pushing the short acting drug, or you are unable to tube him..guess what?? It wears off within a minute or two!! No loss of life needed due to failure to intubate what was previously a concious patent airway patient. You do not push the long acting drugs until you are positive you have an adequate secured airway..period!
I am also surprised that a combitube was unable to ventilate the patient. Were there extenuating circumstances you have not divulged yet? Such as massive trauma, etc. Did the medic try to ventilate the other tube since one of them wasnt working? Just curious, as I was not there and I can only go on what you provide. This is a good learning scenario for all, unfortunately it cost someone their life.
). The child was taken to an ER then died enroute from hypoxia while enroute from one hospital to another. The airway was never secured in the original ER ?..