Paramedic ETI ? - JRCALC Airway working group

[Melclin]

http://www.scribd.com/doc/29409381/JRCALC-Airway-Working-Group-Commentary

Therefore, rather than removing the skill of intubation for all paramedics the focus should be on ensuring a proportion, for example, those in senior or advanced roles, are given the opportunity to acquire the necessary
experience.

And from the following commentary from Mark Fitzgerald, the head honcho of trauma here in Melbourne and trauma consultant to the ambulance service:

After reviewing the evidence available, the Joint Committee has therefore concluded that tracheal intubation without the use of drugs has little value as a baseline standard for prehospital care and that tracheal intubation can no longer be recommended as a mandatory component
of paramedic practice.

I know these ideas are nothing new, but there has been a bit of a flurry of literature on the topic lately in response to high level position papers, so I thought it might be a more interesting read than my last news post - "Dog does CPR" B) .

 

[EMSLaw]

There seems to be a general move away from intubation. The ACLS guidelines, for example, say if you can keep the patient adequately ventillated with a BVM, you should. I suspect that when the new version comes out, there will be even less reliance on the ET tube.

However, I'm curious to know whether this study is discussing the routine use of ET tubes, or all uses. For example, in a patient with facial trauma, it may be impossible to use any other means of ventillation.

I don't see paramedics turning in their larangyscopes any time soon, but I think they might start getting a little dusty from not coming out of the case so much.

 

[MrBrown]

Brown is appalled and deeply dissapointed that the article says in-the-patients-proximal-endotracheal intubation is the most important skill surveyed Paramedics list that they can perform

I think most people can be managed with a laryngeal mask or other supraglottic airway device.

If they start to puke simply suction and turn the patient on thier side.

Most of our LMAs are used in cardiac arrest and we all know that survival from cardiac arrest depends on more than intubation. The rest of the time LMAs are used in things like respiratory arrests or unconscious patients who are spontaneously breathing anyway.

Of the intubations I've seen prehospital they have all been in cardiac arrest patients who are very, very deeply unconscious but even then it's not a given that you can intubate.

There are those patients who do need to be intubated such as crashing asthmatics or CHFers who have not responded to regular treatment, patients with airway burns, poor airway who will not tolerate an LMA or who are not improving despite an LMA etc. This is where an Intensive Care Paramedic who has been authorised to perform rapid sequence intubation is needed.