The College and joint working groups have had their say in a draft proposal, so here is mine.
Intubation isn’t a game. It’s not fun and it’s not without risk. All clinicians who are trained in it accept this. It’s not something we do often, and in some places it’s not done at all unless you’re “old school” or a Clinical Team Leader equivalent.
Patients who need tubes will need them. They cannot wait for a “specialist” to do it, be that 5minutes away or 25. If you can’t secure someone’s airway using a tube, then they can’t be sufficiently oxygenated, and subsequently they will come to harm. This isn’t dramatization it’s fact. Common sense in fact…
Burns Victims, Suicide attempt Victims, drownings, non fasted Patients, difficult extraction Patients, all of these need tubes. Even the people who make the i-gel put in their brochure that it’s designed for “Fasted patients”.
How many pre-hospital Patients are fasted? I’d say as a guess- less than 0.1%.
“But the data shows tubes are paralleled to worse outcomes” I hear you cry. Well yeah…. durr… because we only tube the sickest Patients because we have to. The ones who aren’t so sick don’t get tubed- not exactly rocket science is it?
So you are now faced with a dilemma. Your patient needs a Tube to secure their airway because it’s full of vomit/blood/burns and the supraglottic won’t work. You’re told the person available to do it is 15minutes away. What do you do?
- 15 minutes without proper ventilation and they’re dead anyway
- 15 minutes of no or minimal efficacy ventilation and at best they’ll be severely brain damaged and will never recover.
Do you stop? Give up? Not even bother because you know the outcome will be poor/inevitable?
You look to the resus guidelines for assistance. “Likely poor outcome”- a key theme. So…. don’t start? Don’t continue?
Intubation is key to sustaining life in patients who’s airway is compromised where a supraglottic airway is not suitable. Take It away as an option for EVERY Paramedic, and people will die.