Sunday, June 24, 2007
Annals of Emergency Medicine reported last year:
“Many researchers, emergency medical service (EMS) providers, and emergency physicians are increasingly viewing ground transport, out-of-hospital endotracheal intubation with skepticism.”
There are people on both sides of the argument. Some think that endotracheal intubation should continue for the outpatient while others think that there is not credible evidence that out-of-hospital endotracheal intubation contributes meaningfully toward the reduction of morbidity or mortality in ground transported EMS patients.
“In the spirit of seeking system-level improvements, one cannot ignore the question, Should we intubate at all? For apneic or near-apneic patients, alternate airways such as the Combitube (esophageal-tracheal twin-lumen airway device; Kendall, Inc., Mansfield, MA) and laryngeal mask airway (LMA North America, San Diego, CA) have appealing characteristics and are supported by some data. These devices are conceptually simpler than endotracheal intubation, easier to insert than endotracheal tubes, require less training, and are less subject to skill delay. These devices have been extensively used as primary and secondary airway management devices. There is wide experience with the use of these devices by nonphysicians and even basic-level rescuers. Combitubes and laryngeal mask airways offer ventilation and oxygenation comparable with endotracheal intubation in controlled and field settings. Current advanced cardiac life support guidelines recommend the use of these devices when rescuers have only limited endotracheal intubation experience.”
In Peoria, the Peoria Fire Department (PFD) can oxygenate and ventilate the patient with the bag-valve-mask (BVM). The PFD cannot endotracheally intubate the patient regardless of the literature in support of this technique. Also, the PFD does not use the alternate airway techniques described above. With the blessing of the local Project Medical Director, employed by OSF-SFMC, Advanced Medical Transport (AMT) can use the BVM or select to endotracheally intubate the patient at the determination of the AMT paramedic on scene.
It has been a serious mistake not to educate the PFD in airway control that could supercede the BVM that they use now. The Combitube and the laryngeal mask airway (LMA) are two alternate airways that could and should have been used by the PFD for many patients in respiratory distress.
The local Peoria Project Medical Director, the three Peoria hospitals that influence decision making in the city, Advanced Medical Transport, PAEMS, and the City Council all need to support and encourage the PFD to develop these skills.