MCGLYNN_EMTP
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I keep reading articles on intubations in the field and how studies are really leaning towards simply using sup. O2 and BVM verses actually intubation the patient. What do you guys think about this???
Intubations dissapearing?
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Shishkabob
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Still alive and strong here from what I see, but
Dallas FD and a few other FD's send their new recruits to the medic school based out of UT SouthWest medical center... and rumor has it that they are going to drop intubation from the curriculum.
Dallas FD and a few other FD's send their new recruits to the medic school based out of UT SouthWest medical center... and rumor has it that they are going to drop intubation from the curriculum.
Lifeguards For Life
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I had heard this waas being considered while up at a conference in jacksonville. It is still in every local protocol that i know of. i don't know of any local agencies that have stopped doing it.
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MCGLYNN_EMTP
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I just became a paramedic and we were still taught intubation for airway management in class....I'd sure hate to see intubations go...but I guess if that's what's best for the patient then that's what we'll have to do....It's still alive in louisiana in the company I work for (Acadian Ambulance)
el Murpharino
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Some literature regarding prehospital intubation...perhaps we're doing more harm than good in spending countless minutes on a tube than rapid transport and a BLS airway. I personally consider intubation to be the gold standard of airway management, but there is much damage that can be done by a poorly trained and inexperienced provider - which our profession is saturated with.
Out-of-Hospital Endotracheal Intubation: Where Are We?
Wang HE, Yealy DM
Annals of Emergency Medicine
June 2006 (Vol. 47, Issue 6, Pages 532-541)
Meta analysis of 15 intubation studies (published from 1997 - 2005) that appeared in peer-reviewed medical journals.
Introduction:
Paramedic out-of-hospital endotracheal intubation originated in the 1970s from efforts to improve outcomes from cardiac arrest and major trauma.1, 2, 3, 4, 5 At that time, the best available methods for paramedic out-of-hospital airway management and ventilation were bag-valve-mask ventilation and the esophageal obturator airway.6, 7, 8, 9 Bag-valve-mask performance was perceived to be inadequate, and esophageal obturator airway use resulted in many complications, including inadequate or delayed ventilation, aspiration, pharyngeal and esophageal injury, gastric rupture, tracheal occlusion, and inadvertent tracheal intubation.6, 8, 10, 11, 12, 13, 14, 15 Out-of-hospital endotracheal intubation offered an alternative method to optimize care, promising superior airway protection, efficient ventilation, and a route to deliver endobronchial medications.16 Endotracheal intubation was also the standard for in-hospital resuscitation, classified as a “definitely helpful” intervention by then-current Advanced Cardiac Life Support guidelines.17 Several authors reported groundbreaking efforts to implement out-of-hospital endotracheal intubation in Boston, Columbus, San Diego, and Pittsburgh.1, 2, 3, 4
Despite its accepted role in clinical practice for more than 25 years, a growing body of literature suggests that out-of-hospital endotracheal intubation is not achieving its intended overarching goals. In selected cases, the intervention may cause harm. In this article, we provide an overview of recent data evaluating the effectiveness, safety, and feasibility of paramedic out-of-hospital endotracheal intubation.
Is Out-of-Hospital Endotracheal Intubation Effective?
The fundamental test of a medical intervention is whether it improves the outcome of the targeted patients.18 In this light, the overarching goal of out-of-hospital endotracheal intubation is to reduce mortality and morbidity for those in need of airway support. Several investigators have evaluated survival and neurologic outcome after out-of-hospital endotracheal intubation19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 (Table). These studies largely involve retrospective analyses of predominantly injured patients. Although 2 studies identified increased survival from out-of-hospital endotracheal intubation, the remaining efforts found either decreased or no effect on survival. No studies have identified improved neurologic outcome from out-of-hospital endotracheal intubation.
Conclusion:
The current literature highlights shortcomings associated with out-of-hospital endotracheal intubation. Few studies affirm current practice. Few studies have demonstrated improved outcome from out-of-hospital endotracheal intubation in any disease group, and several studies describe worsened outcomes. In many studies, adverse events and errors associated with out-of-hospital endotracheal intubation are frequent. Out-of-hospital endotracheal intubation may inadvertently interact with other physiologic processes key to optimizing resuscitation. Significant system-level barriers limit opportunities for endotracheal intubation training and clinical experience. Scientists, medical directors, and clinicians must strive to better understand and ultimately improve this key intervention.
el Murpharino
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Volume 47, Issue 6, Pages 542-544 (June 2006)
Out-of-Hospital Endotracheal Intubation: Half Empty or Half Full?
John H. Burton, MD
published online 27 February 2006.
[Ann Emerg Med. 2006;47:542-544.]
Many researchers, emergency medical service (EMS) providers, and emergency physicians are increasingly viewing ground transport, out-of-hospital endotracheal intubation with skepticism. On one side of the debate are those who continue their support of this practice and read the medical literature with concern that the data are incomplete and not exhaustively studied—the glass is half full. This side of the table expresses confidence in the “A-B-C” mantra, cites the progress in out-of-hospital airway management practice, and advises no change until more conclusive data are brought to the subject.
On the other side of the debate are those who see the glass as half empty, with no credible evidence that out-of-hospital endotracheal intubation contributes meaningfully toward the reduction of morbidity or mortality in ground transport EMS patients. The discourse from this side has a certain crescendo momentum of late because the evidence has increasingly indicated that out-of-hospital endotracheal intubation may cause more harm than benefit.
In this issue of Annals of Emergency Medicine, 2 important contributions appear that add to the discourse: Jacoby et al 1 and Wang and Yealy.2 Jacoby et al 1 describe a clinical trial evaluating midazolam and etomidate for induction agent–facilitated intubation of adult EMS patients. The stance communicated by the investigators in this trial would suggest that they reside on the half-full side of the out-of-hospital endotracheal intubation debate. Wang and Yealy,2 in contrast, weigh in with the half-empty view of the debate as they exhaustively review the medical literature that has attempted to assess the outcomes associated with out-of-hospital endotracheal intubation.
To place the debate about out-of-hospital intubation practice into the proper context, we must first accept the reality of emergency department (ED) endotracheal intubation. Many patients will require a period of mechanically assisted ventilation during hospitalization. The ED is often the point of initial contact, evaluation, or diagnosis for these patients, necessitating the importance of endotracheal intubation skills for the emergency physician. Modern emergency medicine practice incorporates a host of techniques for facilitating endotracheal intubation in the ED. Rapid sequence induction is the primary accepted means of optimizing intubation success rates associated with this procedure.
The practice of out-of-hospital endotracheal intubation, then, would appear to rely on 2 precepts, with the overriding principle of what is good for the patients in the ED must be good for the patients before they get to the ED. The first precept is that the resource expenditure necessary to train and maintain effective out-of-hospital provider intubations skills is a worthwhile investment, given the limited training, oversight, and financial resources inherent in many EMS systems. The second precept is that out-of-hospital endotracheal intubation will improve, and certainly not worsen, patient morbidity or mortality compared to an EMS practice without these interventions.
The first precept, the utility of the resource investment, is one open to debate and may depend on the EMS setting, resources, and the patient population. The emphasis of this precept is on the size of the investment relative to the resources available and the derived patient benefit.
As Wang and Yealy 2 describe, teaching endotracheal intubation takes a great deal of time relative to other EMS skills, requiring didactic and practical skills-based training incorporating mannequins or live models. As one adds medication-assisted or rapid sequence induction strategies to the provider skill set, the investment increases precipitously. The potential for harm induced by the use of neuromuscular blocking and induction agents necessitates a substantial infrastructure investment in training, skill maintenance, oversight, and, in the opinion of most, a live-human, large-volume training environment (usually the operating room).
Few would argue that we should invest limited EMS resources in skills or interventions that will seldom be used or confer no benefit. Two populations in which this principle can be applied are rural EMS patients and cardiac arrest patients. We have previously demonstrated that EMS providers in our rural state uncommonly use intubation skills.3 For any given calendar year, less than one third of the licensed EMS providers in the state of Maine will use their adult intubation skills. Worse, less than 1% of providers in this rural state will annually use their pediatric intubation skills. These findings lead one to the conclusion that out-of-hospital endotracheal intubation training investments in a low-volume or rural EMS setting offer a very poor return for EMS systems, unless it can be demonstrated that these uncommonly used skills translate to a patient survival benefit.
Out-of-hospital intubation of the cardiac arrest patient assumes dramatic relevance when one observes that approximately one half to two thirds of all out-of-hospital intubation encounters will be in cardiac arrest patients.2, 3 The question of the benefit of out-of-hospital endotracheal intubation to this population has been addressed by Stiell et al,4 who found no survival benefit derived from out-of-hospital endotracheal intubation. Their findings lead one to the conclusion that despite our continued recitation of the “A-B-C” mantra, the data demonstrate that “D” (defibrillation) and “C” (circulation/compressions) have far greater importance than “A” in the out-of-hospital cardiac arrest patient.
We are left with the second precept: that survival outcomes associated with out-of-hospital endotracheal intubation will improve, and certainly not worsen, morbidity and mortality. To address this question, Wang and Yealy 2 consider the multitude of populations and potential approaches to EMS intubation practices. Their review includes investigations devoted to understanding outcomes associated with intubation of the out-of-hospital head-injured trauma patient, with or without rapid sequence induction. Also addressed are focus populations, including cardiac arrest and pediatric patients.
Wang and Yealy 2 conclude that the current scientific evidence “suggests that out-of-hospital endotracheal intubation is not achieving its intended overarching goals” and that out-of-hospital endotracheal intubation as an intervention may cause harm.2 They leave us with the many formidable challenges that lie ahead for those attempting to chart the future course for out-of-hospital endotracheal intubation, including the replacement of out-of-hospital endotracheal intubation with alternate airway management techniques such as the Combitube and laryngeal mask airway.
... detailed analysis of both articles ...
The articles published in this issue of Annals add resounding thunderclaps into what should be a storm of debate surrounding the utility and efficacy of ground transport, out-of-hospital endotracheal intubation. Indeed, the historical arguments laying the foundation for this practice viewed through the lens of these contributions should motivate the half-full and half-empty sides of the out-of-hospital endotracheal intubation debate to craft a unified strategy for the future of EMS practice.
Out-of-Hospital Endotracheal Intubation: Half Empty or Half Full?
John H. Burton, MD
published online 27 February 2006.
[Ann Emerg Med. 2006;47:542-544.]
Many researchers, emergency medical service (EMS) providers, and emergency physicians are increasingly viewing ground transport, out-of-hospital endotracheal intubation with skepticism. On one side of the debate are those who continue their support of this practice and read the medical literature with concern that the data are incomplete and not exhaustively studied—the glass is half full. This side of the table expresses confidence in the “A-B-C” mantra, cites the progress in out-of-hospital airway management practice, and advises no change until more conclusive data are brought to the subject.
On the other side of the debate are those who see the glass as half empty, with no credible evidence that out-of-hospital endotracheal intubation contributes meaningfully toward the reduction of morbidity or mortality in ground transport EMS patients. The discourse from this side has a certain crescendo momentum of late because the evidence has increasingly indicated that out-of-hospital endotracheal intubation may cause more harm than benefit.
In this issue of Annals of Emergency Medicine, 2 important contributions appear that add to the discourse: Jacoby et al 1 and Wang and Yealy.2 Jacoby et al 1 describe a clinical trial evaluating midazolam and etomidate for induction agent–facilitated intubation of adult EMS patients. The stance communicated by the investigators in this trial would suggest that they reside on the half-full side of the out-of-hospital endotracheal intubation debate. Wang and Yealy,2 in contrast, weigh in with the half-empty view of the debate as they exhaustively review the medical literature that has attempted to assess the outcomes associated with out-of-hospital endotracheal intubation.
To place the debate about out-of-hospital intubation practice into the proper context, we must first accept the reality of emergency department (ED) endotracheal intubation. Many patients will require a period of mechanically assisted ventilation during hospitalization. The ED is often the point of initial contact, evaluation, or diagnosis for these patients, necessitating the importance of endotracheal intubation skills for the emergency physician. Modern emergency medicine practice incorporates a host of techniques for facilitating endotracheal intubation in the ED. Rapid sequence induction is the primary accepted means of optimizing intubation success rates associated with this procedure.
The practice of out-of-hospital endotracheal intubation, then, would appear to rely on 2 precepts, with the overriding principle of what is good for the patients in the ED must be good for the patients before they get to the ED. The first precept is that the resource expenditure necessary to train and maintain effective out-of-hospital provider intubations skills is a worthwhile investment, given the limited training, oversight, and financial resources inherent in many EMS systems. The second precept is that out-of-hospital endotracheal intubation will improve, and certainly not worsen, patient morbidity or mortality compared to an EMS practice without these interventions.
The first precept, the utility of the resource investment, is one open to debate and may depend on the EMS setting, resources, and the patient population. The emphasis of this precept is on the size of the investment relative to the resources available and the derived patient benefit.
As Wang and Yealy 2 describe, teaching endotracheal intubation takes a great deal of time relative to other EMS skills, requiring didactic and practical skills-based training incorporating mannequins or live models. As one adds medication-assisted or rapid sequence induction strategies to the provider skill set, the investment increases precipitously. The potential for harm induced by the use of neuromuscular blocking and induction agents necessitates a substantial infrastructure investment in training, skill maintenance, oversight, and, in the opinion of most, a live-human, large-volume training environment (usually the operating room).
Few would argue that we should invest limited EMS resources in skills or interventions that will seldom be used or confer no benefit. Two populations in which this principle can be applied are rural EMS patients and cardiac arrest patients. We have previously demonstrated that EMS providers in our rural state uncommonly use intubation skills.3 For any given calendar year, less than one third of the licensed EMS providers in the state of Maine will use their adult intubation skills. Worse, less than 1% of providers in this rural state will annually use their pediatric intubation skills. These findings lead one to the conclusion that out-of-hospital endotracheal intubation training investments in a low-volume or rural EMS setting offer a very poor return for EMS systems, unless it can be demonstrated that these uncommonly used skills translate to a patient survival benefit.
Out-of-hospital intubation of the cardiac arrest patient assumes dramatic relevance when one observes that approximately one half to two thirds of all out-of-hospital intubation encounters will be in cardiac arrest patients.2, 3 The question of the benefit of out-of-hospital endotracheal intubation to this population has been addressed by Stiell et al,4 who found no survival benefit derived from out-of-hospital endotracheal intubation. Their findings lead one to the conclusion that despite our continued recitation of the “A-B-C” mantra, the data demonstrate that “D” (defibrillation) and “C” (circulation/compressions) have far greater importance than “A” in the out-of-hospital cardiac arrest patient.
We are left with the second precept: that survival outcomes associated with out-of-hospital endotracheal intubation will improve, and certainly not worsen, morbidity and mortality. To address this question, Wang and Yealy 2 consider the multitude of populations and potential approaches to EMS intubation practices. Their review includes investigations devoted to understanding outcomes associated with intubation of the out-of-hospital head-injured trauma patient, with or without rapid sequence induction. Also addressed are focus populations, including cardiac arrest and pediatric patients.
Wang and Yealy 2 conclude that the current scientific evidence “suggests that out-of-hospital endotracheal intubation is not achieving its intended overarching goals” and that out-of-hospital endotracheal intubation as an intervention may cause harm.2 They leave us with the many formidable challenges that lie ahead for those attempting to chart the future course for out-of-hospital endotracheal intubation, including the replacement of out-of-hospital endotracheal intubation with alternate airway management techniques such as the Combitube and laryngeal mask airway.
... detailed analysis of both articles ...
The articles published in this issue of Annals add resounding thunderclaps into what should be a storm of debate surrounding the utility and efficacy of ground transport, out-of-hospital endotracheal intubation. Indeed, the historical arguments laying the foundation for this practice viewed through the lens of these contributions should motivate the half-full and half-empty sides of the out-of-hospital endotracheal intubation debate to craft a unified strategy for the future of EMS practice.
OP
OP
MCGLYNN_EMTP
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It's really hard to study this subject. One can not really prove that the intubation made the outcome better or worse even in a collection of patients who were intubated and who were not...who's to say those patients intubated wouldnt have died anyway regaurdless of simple BVM or intubation?
I do see a shift toward combi-tube happening in the near future, but we would still have to carry ET tubes due to some patients needing intubation with an active gag-reflex. I'm still curious to see what the future holds for intubations.
My ambulance service is looking into a device called the "S.A.L.T." (click here for link to its website) it is inserted like an OPA and can be used as an OPA....but when it is time to intubate, the ET tube is slipped into a hole in the "S.A.L.T." and the tube is almost always guided into the trachea...The tube would then be confirmed by normal methods and restrained by the usual methods as well...
I deffinately see this being used in the near future as well...
I do see a shift toward combi-tube happening in the near future, but we would still have to carry ET tubes due to some patients needing intubation with an active gag-reflex. I'm still curious to see what the future holds for intubations.
My ambulance service is looking into a device called the "S.A.L.T." (click here for link to its website) it is inserted like an OPA and can be used as an OPA....but when it is time to intubate, the ET tube is slipped into a hole in the "S.A.L.T." and the tube is almost always guided into the trachea...The tube would then be confirmed by normal methods and restrained by the usual methods as well...
I deffinately see this being used in the near future as well...
Smash
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I am deeply, deeply suspicious of anything authored by Henry Wang as it is very clear that he has an agenda, for whatever reason that seems to be about denying medics the ability to control airways.
One of the oft cited 'studies' into the alleged deleterious effect of prehospital intubation is Wang's Out-of-hospital endotracheal intubation and outcome after traumatic brain injury, Ann Emerg Med 2004.
I challenge anyone to read this study with anything other than tears, either from laughter, because it is clearly a joke, or from sadness that this tripe is held up as a shining beacon of prehospital research.
Prehospital ETI certainly needs more research into it, however I see the downside of ETI not being whether it is good or bad, but whether medics do it well or poorly. If we continue to hand out laryngoscopes to people who are only hitting the mark 80% (or less) of the time, then of course we are going to have undesireable outcomes.
All that the research currently shows is that airway management done badly is of no use.
However if we actually give a damn, educate and train medics appropriately, allow them to gain experience and give them the tools (such as RSI) to properly control an airway, then we can start carrying out some decent prospective, randomized trials and get some answers.
One of the oft cited 'studies' into the alleged deleterious effect of prehospital intubation is Wang's Out-of-hospital endotracheal intubation and outcome after traumatic brain injury, Ann Emerg Med 2004.
I challenge anyone to read this study with anything other than tears, either from laughter, because it is clearly a joke, or from sadness that this tripe is held up as a shining beacon of prehospital research.
Prehospital ETI certainly needs more research into it, however I see the downside of ETI not being whether it is good or bad, but whether medics do it well or poorly. If we continue to hand out laryngoscopes to people who are only hitting the mark 80% (or less) of the time, then of course we are going to have undesireable outcomes.
All that the research currently shows is that airway management done badly is of no use.
However if we actually give a damn, educate and train medics appropriately, allow them to gain experience and give them the tools (such as RSI) to properly control an airway, then we can start carrying out some decent prospective, randomized trials and get some answers.
Personally I don't see the issue as a lack of training/poor training but (for many) a lack to use the skill. I don't think anyone would argue there is a huge difference between tubing dummies in a class room, versus getting ETT in the OR and then translating that to some of the situations we deal with in the field, then doing enough field intubations to remain completely proficient. Most of the research (not just Wang as I agree with you about him) shows that as a whole we don't hit tubes as often as we think and more frightening we don't recognize the fact we have misplaced a tube. For me personally, after getting access to prehospital CPAP about the only time I ever go with an ETT anymore is cardiac arrest. As with most anything trauma related the best thing you can do for your patient is expediting transport. Now do I mean skip treatments? No, of course not, but in a trauma situation were the patient may be going downhill quickly I think we are better off placing blind airways, and letting the hospital handle more appropriate airway management (this is also a little simpler for me as we do not have RSI were I work).
el Murpharino
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The unfortunate part of all of that is they provide minimal education regarding it. How many live intubations do you have to do before you can be "cleared"?
el Murpharino
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Some systems are adopting this practice, and I wouldn't be surprised to see this as a standard in the near future.
'Nuff said really. But just so everyone get's the point clearly, here goes.
Prehospital ETI should NOT go away; while there have been some studies that showed no change in morbidity/mortality or pt outcomes (and some that showed a increase in poor outcomes; get to that in a minute) it does not change the fact that ETI still provides the most secure airway, short of a crich, allowing for better ventilation, suctioning, airway protection, and without some of the side-effects of alternate airways (King, LMA, combitube) such as airway trauma, gastric inflation and aspiration (regardless of how you define aspiration, I think most will still agree that an ETT still provides better protection versus other's). When done correctly and appropriately there are more benefits to doing it than there are negatives. Unfortunately, when done incorrectly, which can be done very easily, it can, and often is, disastrous.
Right now the ball is in our court if we want to continue to intubate in the field. (and yes, it is still in the current national curriculum and the new one that will be in effect soon) Like so many things in EMS, the initial education and training, and then continuing education are sometimes, often times, not up to the standard it should be at. Which means there are paramedics out there who are very bad at intubating and recognizing esophageal intubations. This doesn't mean that everyone should lose the ability, just that, as usual, we need to take a long look at how we teach new medics, and how they maintain their skills
As well, take a look at the vast majority of studies done on intubation (anything really). You'll notice that many are done in very urban, high call volume areas. You'll also notice that many of those areas have a very poor reputation as far as EMS in concerned and don't always field good medics. Think there could be a correlation between the outcomes found in intubation studies and who was doing the intubation? Both Boston EMS and King County Medic 1 (the Seattle Fire division) have recently done similar studies on intubation to Wang's and others...and both had drastically different results. From talking with a medic from Idaho, Ada County EMS has done the same. Apparently if you demand a high level of competency and knowledge, the number of problems you create goes down. Who'd a thunk it? Of course, that doesn't matter if 1-nobody knows about it, and 2-the average medic still can't appropriately intubate someone.
So how do we fix this? If you work for a service that has a great success rate at intubation and have a progressive medical director...get with it! Start putting the numbers together and publish your own study. Get the information out there that intubation can, and is done appropriately by paramedics, and get the info on WHY that happens out there. If people only get one side of an issue, then they can't make the right decision. Once that's done...get ready for a real fight, and start lobbying the change the initial educational standards for paramedics.
If we actually want EMS to survive and thrive, it's time to start taking an interest in it; stop letting people outside the field dictate what happens and start thinking for ourselves.
Dominion
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I think it is a combo of a lack of practice and a lack of education. I mean we hear and see studies about intubation in pre-hospital but I haven't really seen much on the study of intubation in outlying/rural hospitals. Where I have personally seen a transport from a rural hospital in which the intubation was all jacked up and my medic ended up doing it himself before leaving. (Of course was a one time situation for me)
You get situations where at my service you might get one intubation every couple months maybe a couple a month in rare situations. A county over a medic might get one or two tubes a week and maybe one tube every couple weeks nasal.
ETT is still the gold standard and I think it should be more closely monitored for skill (maybe adding the requirement of clinical hours every year or a specific number of intubation attempts on live patients). There are always other options for airway management. We do two attempts at ETT, combitube/LMA, BVM with NPA or OPA. We get it pounded into our heads that a patient doesn't die from a lack of intubation but from a lack of ventilation.
You get situations where at my service you might get one intubation every couple months maybe a couple a month in rare situations. A county over a medic might get one or two tubes a week and maybe one tube every couple weeks nasal.
ETT is still the gold standard and I think it should be more closely monitored for skill (maybe adding the requirement of clinical hours every year or a specific number of intubation attempts on live patients). There are always other options for airway management. We do two attempts at ETT, combitube/LMA, BVM with NPA or OPA. We get it pounded into our heads that a patient doesn't die from a lack of intubation but from a lack of ventilation.
medichopeful
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I don't take it as being arrogant. You can't choose what they teach you.
However, is it a skill you will actually be able to use? Is it in your protocols? Or are they just teaching it to you for fun? If it's just for fun, you may want to bring that up with your instructor, and say that you would like to learn about stuff you can ACTUALLY do.
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MCGLYNN_EMTP
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We still intubate with my service and it doesn't seem that intubations are going anywhere anytime soon. We intubate quite often where I work with a very large call volume compared to other services in the area. In a 12 hour shift we run about 10 emergencies so of course the likely hood that we will intubate is higher than other areas because we are exposed to a possibility of more calls that require intubation.
I was just curious to see what other people thought about the studies out there to see if intubations are actually worth it or not and to see what other services out there are doing right now as far as protocols go.
I was just curious to see what other people thought about the studies out there to see if intubations are actually worth it or not and to see what other services out there are doing right now as far as protocols go.
Summit
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It could go away from a district or two, but it won't go away from schools for a long time.
Rumor has it DFR want to bring Paramedic training in-house, I hear too many Firefighters are failing and costing them money to send them there again
Anyway, intubation is still on the cards for our Intensive Care Paramedics but I don't really know what our success rate is for standard intubation or what the average intubation : officer ratio is (we have had 95-95% success with RSI)
We do use laryngeal masks at the BLS and ILS level, some ICPs use them first others were ICPs before LMAs came in so have never really "adapted" if you will to having them (we've had them for about 6 years) and still perfer to intubate everybody
cfd3091
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I don't think your arrogant, learning the skill of ETT does not take much and I'm sure you'll learn it. Intubation is more then the how to. What do you do when the heart rate drops? How do you know? Please don't say pulse ox. A paramedic has the knowledge of Physiology and Pharmocology to handle the situation when the SHTF. I'm sure they are teaching you so you can assist a Paramedic.