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Should paramedics perform tracheal intubation?

100_0088

Well of course they should!
Its all in the training that makes the difference, not your job title!
Having a medical degree does not make you any more capable of performing prehospital intubation!

What is 18 inches long, black and hangs around an ass hole?
A Stethoscope!

Ok bad joke but my point is that medical doctors are not perfect and when it comes to prehospital intubation a well trained paramedic can do an even better job than many doctors I know!

And in the latest study to be thrown onto the controversy that is prehospital intubation, these UK authors report equal success between critical care paramedics and prehospital doctors in prehospital RSI

Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice.

10 Comments Post a comment
  1. Matt Shepherd #

    Absolutely agree- The level of knowledge, skill and clinical training that paramedics recieve now days has increased dramatically. A lot of the research about pre hospital paramedic intubation comes from the US and is quite dated. we need to start producing more current research highlighting our capabilities- Shep

    October 22, 2013
    • Thanks!
      Having said that
      God Forbid anyone letting you and Meadley loose with Rocketamine
      Just kidding..you two could tube my family any day!

      October 22, 2013
  2. Yes and no. This subject is always going to be hotly debated . However, there are plenty of evidence based papers out there concluding that paramedics should not be doing field intimations , and this is based on a number of factors that I won’t go into.

    However, if the potential intimated patient is a great looking grade 1 view, then by all means, then intubation, but anything less than grade 1 view , in my humble opinion other options should be pursued.

    October 22, 2013
    • have to disagree but appreciate the counter point being raised, so thanks!
      the evidence is mixed to say the least!

      October 22, 2013
  3. I just wrote sort of a research review of this very subject for uni if you would like to see it.

    Cheers,

    Mike

    Sent from my iPhone

    October 22, 2013
  4. I look forward to seeing a summary of the literature. My understanding (which may be flawed) was that the lit did not support prehosp intubation of corpses. Clearly restrictive protocols that allowed for paramedics to only ‘cold tube’ a GCS of 3 clearly won’t do well

    i don’t really care who intubates – so long as they are trained. This could be doctor, nurse, paramedic, SOT. As I understand it, several retrieval services (eg: medSTAR) are moving away from formalised job titles and to a ‘retrieval practitioner’ role.

    So long as whoever tubes has the technical skill, the right kit, predetermined SOP and uses the appropriate drugs, I don;t mind. Often times that will be a medico – with sig experience in prehosp care and familiarity with the agents used. Certainly ‘any doctor’ won;t do – there’s no place for enthusiastic amateurs in PHEC…right person, right place, right patient, right kit.

    Just so long as they use an RSI checklist !!!
    ;-)

    October 22, 2013
  5. Angrydoc #

    There’s a difference between a paramedic and a critical care paramedic. I think a better question would be “should a specifically trained critical care paramedic intubate”. It’s similar to asking “should a physician intubate” vs “should a cardiologist intubate”. If you’re trained to do it and are current then crack on. However, you rely on individuals having the insight to recognise when they are not current and, therefore, when to not intubate. And deciding not to intubate is harder than deciding to intubate.

    October 24, 2013
  6. Of course there is a place for intubation pre-hospital. That place is in a small group of Intensive Care/Critical Care Paramedics who can perform rapid sequence induction and who get a lot of on-going exposure and maintenance.

    The problem with the vast majority of the “bad” literature when it comes to both tracheal intubation in general and RSI is that they come from the United States where the number of Paramedics is very large and ongoing exposure and skill maintenance is generally very poor.

    Where the patient can be oxygenated adequately with a well fitting LMA if they are close to hospital/you can get the patient to hospital faster than RSI can come to you then just take the patient to the hospital.

    November 5, 2013

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