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?

  1.  15 minutes without proper ventilation and they’re dead anyway
  2. 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.

2 thoughts on “Intubation

  1. Agree with the sentiment.

    Anyone who embarks upon high risk procedures like this shoulders the heavy responsibility of ensuring they know what they are doing. This can be extremely challenging, particularly in low volume skills. Intubation is one of the few skills where we have a (limited) understanding of what it takes to maintain your proficiency – and its a rather large number, unachievable for most of us non-anaesthetists.

    Ensuring you’re executing as well as you can requires practice, monitoring, and refreshment of skills. Many of us struggle with this, so a platform like http://Osler.Community can help manage the process.

    As you say, not every procedure can be performed by an expert, so the rest of us need to find creative ways of doing the best we can.

    Liked by 1 person

  2. Totaly agree with your comments. It is just one string in the bow that allows us to meke a diiferece. It seems to be academia is taking over and any ‘facts’ that can be interporated and used to deskill paramedics and other NHS staff, will be used in that way. Intubation is linked to seriously injured or ill patients and not many survive e.g. ooh cardiac arrest. As you say few if none of the patients we see are fasted, more often over eaten and engorged with exess fluid intake (aka drunk outside fast food outlet). If this skill is not used that often then we need extra refresher training in its use not withdraw it. We have many other skills that are not often used; are we going to see those stripped away as well. This is basically the same argument as was put forward in the 1980’s when the introduction of the Paramedic ( or advance trained ambulace person) was starting to be considered. It was stated that the ambulance Technician scooping and running had better patient outcomes than a Paramedic staying on scene to use their skills (staying and playing) but what was not highlighted was that Paramedics were generally called to the more seriouse incidents as there werent many about so the patients they dealt with had less chance of survival in any case. I work in a very rural area and airway management en route to ED is challanging and I will always prefer the ET tube to the i gell. I must be one of the difficult old guard but I have years of experience behind that judgement and refer not to experiment with peoples life. I think all Paramedics should be able to choose which piece of kit fits the nedds of the patient and receive enough CPD around their use to make it safe.


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