Okay, I guess an old timer will chime in... Intubation should not be removed from the curriculum. It is the Gold Standard and our patients should expect only the best... but be performed by the best. Unfortunately, we (EMS) have failed horribly! Alike ACLS education... uh... training... uh... demonstration...resuscitation componets have been so watered down, one should only expect poor outcome(s) and poor skill demonstration.
Amazing, we still want to avoid the "source" of the problems, instead we want to substitute and "avoid" the real problems of why we have a decrease in success. When I was taught intubation over 30+ years ago, we were taught the same airway techniques at a physician level... (you’re performing a physician level skill, you need physician level understanding of the procedure).. We were assigned to "Code Teams" and were not allowed to intubate for the first 15 minutes, carefully monitored by the anesthesiologist/physician. We had to demonstrate that we could control the airway successfully by basic techniques of positioning, basic airway adjuncts, suctioning without any side effects such as gastric distention.. etc. Why? One should master the basics before proceeding to advanced procedures.
We were taught not all patients need to be intubated, when deciding to intubate there is more to it than ... "dropping a tube"... A thorough but quick assessment of potential problems such as Mallampati scoring, hypomental distance.. (etc) so it was not a "Surprise" when you received an airway from Hates. The provider with a very good knowledge and skills of basic airway management could provide airway management no matter what!
Yes, King and all other supplemental airway adjuncts (substitutes) are a good back up and should never be considered as the gold standard for those that will need a long term secured airway.
This is where will we see a change and unfortunately, most of those in EMS (especially students and even instructors) fail to recognize cardiac arrest (cardiac origin) patients primary etiology and successful outcome criteria is not the lack of airway or even ventilation. Something of mind changes from decades of previous thinking.
What I do foresee is intubation to be totally removed from the procedure of resuscitation of a cardiac arrest (cardiac etiology) and supraglottic airways (King/Combi etc) to be used due to the ease and truthfully the results will not change the outcomes. I do look for those patients that have a ROSC to be intubated for long term treatment (post resuscitation, hypothermia protocols, etc)... In other words, save aggressive treatment for those that demonstrate a potential of having a + outcome.
Placing simplistic airways such as King and so forth is not a highly advanced skill. Anyone with more than two digits (fingers) can do such. A monkey could perform the procedure. Unfortunately, we have "pushed" placing these in lieu of truly teaching EMS students on primary airway control with the ability to master these techniques and then to use devices as an adjunct. Again, we rush and push through essential education and we have seen the results, poor outcomes.
R/r 911
