Endotracheal intubation is simply a clinical intervention. In and of itself, it is neither good or bad. It all depends on the scenario.
[I believe this was already addressed. That it is a case by case basis of what airway control is needed for the pt in front of you.]
The problem is that for a long, long time, paramedics had drilled into their heads that any sick patient who had any type of respiratory or airway compromise needed to be intubated ASAP, and that any other manner of airway management was inferior and would only be used by a paramedic of inferior skill. Which of course is false in so many ways, but the idea still became a big part of EMS culture. That's why the ability to intubate is one of the first things that many paramedics bring up in the paramedic vs. RN debates.
[ This may still be the case in some areas. I for one have seen a major change in the way medics are educated and trained. That mindset is in the past.]
It seems that this hard line has been softened quite a bit, but underlying everything is still the idea that ETI is "the gold standard" in every case, and that the more "clinically aggressive" you are (i.e. the more interventions you do) the better paramedic you are. To this day that attitude still very often trumps any research based or well-reasoned recommendation for a more conservative approach.
[ I practice and teach to be as least invasive as possible in all treatments. You do what the pt needs. Some only need minor treatments, some need invasive treatment right from the start. Whether you are in or out of hospital, ETI is still " The Gold Standard" as some like to put it. It is the most secure airway we can achieve on the pt. It is not needed in most pts, but those that need it, need it.]
This study is just the latest in a LONG series of research that fails to support routine early intubation in most scenarios that paramedics do airway management in. Yet still, just look through the responses here. Instead of much discussion even taking place about the study, we get knee-jerk reactions against it. I bet most of the commenters didn't even read it, but are still quick to make nonsensical claims about how quickly they can do an RSI, and how anyone can consistently intubate faster than they can place an SGA, etc. I don't thing many anesthesiologists and CRNA's are as confident in their airway skills as many paramedics are.
[ There are many studies that look at statistics only. There are too many varibles for them to provide evidence based medicine. Most studies like this will state the same, just as this one did. When you look at controlled research studies, they provide the best evidence for any practice. Am I perfect on airways? No, no one is. That is why we practice to stay proficient. Through Sin labs, cadaver labs, and OR time. That is how you stay confident in your abilities. I believe someone stated That they intubate daily. I find this hard to believe, but if that is what they stated, maybe somehow they do. I do not know many medics that value their practice off how many tubes they can get. Those medics never make it too far.]
On the whole, EMS only respects research that supports them doing what they want to do anyway. Anything that questions a sacred cow is quickly dismissed as flawed
[ Seriously? EMS lives off evidence based research now a days. Most just know not to take many studies with much salt. A lot of studies published today do not support what they claim to. That is why we research the studies and the evidence before making major changes to anything.
