Definitive pre-hospital airway control with an ET tube, if indicated, save many more lives than the relatively rare complications highlighted in the article.
An undetected ET tube in the esophagus is malpractice and unnecessary with modern equipment. Proper training and careful selection of paramedic candidates will reduce that problem to near zero.
Could you give a reference to the modern equipment - I remember reading something about a tube that if it went into the esophagus, you just inflated the ballon that blocked the esophagus and proceeded with respiration/resuscitation.
"You can become a paramedic in Texas with less than 700 contact hours, but it takes between 1,000 and 1,500 [to get a license] to cut hair," said Jay Cloud, an EMS instructor at San Jacinto College in Pasadena. "What's wrong with this picture?"
The protocols under which these providers practice are designed not just to save lives, but to limit liability and protect the EMS personnel as well.
There are very good reasons for the apparent slavish obedience to protocols and procedures found in EMS.
I have to ask a question of the writer of this article, “If they hadn’t tried to insert the tube, would the patient have been able to breathe on their own? Would they have gotten sufficient oxygen or would they still have suffered brain damage?” They were unable to breathe before the medics attempted to insert the airway so it seems to me they were doomed to oxygen starvation either way.
Seems to me the risk are outweighed by the consequences of not intubating. Also, there are but a handful of cases described here, no numbers are given but much speculation on how many cases go unreported with no proof that any go unreported. Typical liberal type scare tactics.
Man, there are so many things to comment about in this article...but I do want to address your point made here.
While I agree with your first paragraph completely, the second paragraph I do not agree with.
An undetected ETT in the esophagus in a medical center setting is indeed malpractice considering the training involved for the providers involved and the equipment you mention. But I'm not certain that in an 'out in the field' setting that necessarily applies.
There are few things that can be as harrowing as trying to establish a patent airway in an emergency setting...it is often a very difficult thing to do. Conditions are rarely optimal, and often patients are already in extremis. If you have a lot of experience in this setting and are making this claim, more power to you...but to say that the problem can be resuced to 'near zero' is in my medical opinion suspect.
It would be nice if we could send highly trained anesthesiologists who are the most expert in performing intubations out on every ambulance run...but it ain't going to happen. To hold EMT's, who while trained, to the same malpractice standards as much more highly trained individuals while operating in some of the most demanding situations is just not right.
Rapid sequence intubation should be done oNLY in an OR by an aneasthesiologist. Plain intubation in the field can be argued, I favor an LMA as I have seen too many EMT’s mess up an airway beyond retrieval with repeated attempts to intubate which wastes time and slows transport. Most pts can be adequately bagged, and an LMA is almost idiotproof.
Giving succ in a moving ambulance is stupid beyond belief.