The doc on the phone in that scenario picked up on the esophageal tube. Remember how convinced the medic sounded that it was in the trachea? Makes me wonder if the folks in the back of that ambulance would have done anything different if they had some kind of ETCO2 indicator. Especially after blowing a bunch of gas into that kids stomach with the bag.
And this is exactly why simply mandating another piece of equipment isn't enough to prevent this kind of thing.
I don't know if they didn't have Etc02 available, or if they had Etc02 available and just didn't use it, or if they had it available, used it, and ignored the results because it didn't match their ideation that the tube was properly placed. It really doesn't matter; I've seen it go down each of those ways.
I'll (sort of) give the crew the benefit of the doubt and assume that they did not have Etc02 available. But given everything else, I kind of find it hard to believe that it even would have mattered much. To start with, the person holding pressure said "I don't feel you". Secondly, the intubator obviously did
not actually see the cords, but was convinced that she did. Next, the BVETT feels completely different when you are ventilating the esophagus vs. the trachea. Also, in a thin 13 year old, breath and/or epigastric sounds should have been easy to auscultate. Then the Sp02 started to fall. Then it fell further. Then it kept falling, and the HR followed. Given that the crew chose to ignore each of these tell-tale signs, I'm think we have no reason to believe that one more sign (etc02) would not have been ignored also.
When you combine all of that with some of the other things that happened and were said (giving vec without a sedative, "I'm sure it's just all the pressure in his head" when his sats kept falling, etc.), a picture is painted of a crew who simply had no idea what they were doing, and had no business transported an intubated patient, never mind performing it themselves.
There are other problems here, too. Why was this kid intubated in the first place? Maybe there was a good reason, they never say in the videos, but supposedly he was awake and lucid and cooperative in the referring ED, and was just intubated "for transport". I have long thought that "well, ya know, they might need it later" is a stupid reason to perform a potentially hazardous medical procedure when it isn't indicated. Also, why wasn't a long-acting NMB used? I know my opinion on this is unpopular, but this very scenario is exactly why I always argue every intubated patient should be paralyzed for transport.
If that video is an accurate portrayal of what actually happened in that ambulance, then IMO that crew's actions were so incompetent, and so negligent, that they should probably be considered a criminal act.
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