Intubation in Flight

[VentMonkey]

So an associated question - does your program make full use of methods to minimize on scene time for RSI? I have made use of Sydney HEMS material to try and advocate formal checklists , drilling where to place equipment, bougie every time (unless VL is used) etc. On a team by team basis some of us do this but it is not technically program wide. My whole reason for starting the thread was that I feel that some patients do in fact benefit from a rapid flight to a Trauma center, and we may be doing them a disservice by extending on scene times. Obviously this is not every patient flown from a scene, as we all know well.

Yes, and no. We're to my knowledge supposed to give it two DL's prior to VL, now, that being said there are ways to go around anything, but I think it goes without saying at our program that we shouldn't be fiddling with the airway forever and a day on scene.

This is something I have learned in general with EMS as a whole. I don't break rules, but may at times, but may bend them.

If I arrived and found a morbidly obese patient with the chin of a Pierre-Robin patient, I'm probably going to place pads, pillows or whatever I have at my disposal (again, adapt and overcome) and go straight to VL to optimize my chances of first time success. At minimum a "Kiwi grip" bougie is standard for even my first time ETI's regardless of the predicted difficulty of the airway. The way I see it, even a patient with a Mallampati score of 3 could probably benefit from a bougie being guided in to their trachea.

I agree, there are patients that benefit from rapid transport to definitive care, which we are not.

If the patient can tolerate, and will allow for mild sedation with even a pinch a Versed and is still able to protect their own airway, and this cuts down on scene time I see nothing wrong with this course of action either.