After several post that I saw on the list. I want to rise the question about the roll of the Anaesthetist in the E.R.. In our center in the past the E.R. physician was the one that had the first try of intubation whether it was adult or a child. If he didn't succeed the anaesthetist was called from the O.R. to help. This protocol cost in time and in difficulty intubation on the third and fourth try. Today the protocol change if intubation is anticipate before the patient arrive or if it is a child. The anaesthetist call before the patient arrive. If the patient arrived without announce and there is time before the intubation, again the anaesthetist is calling. The E.R. physician do the intubation on emergency when ther is no time to call the anaesthetist. In the mean while a call for the anaesthetist is going to the O.R.. I will like to know what are the protocol in your units.

In our unit, when the hospital is notified that a serious trauma is arriving, the anaesthetist is called. In fact two are, to ensure that one can respond. They look after the airway, and intubate if they think necessary. Also, my hospital bleep also goes off, and I normally respond to keep an eye. I regard the only people as competent in intubate in an emergency are those doing it regularly. This means anaesthetists or ICU staff.

We had an anesthesiology fellow on our Trauma service for 9 months. He was invaluable. Not for intubations but for pain control. He was great at regional anesthesia for fracture reduction, etc. In our ICU he had all of our chest trauma patients on continuous epidural and they loved him. He was also a good resource when it came to sedation of our agitated patients.

I must disagree strongly with the posts I have read so far on this topics. What letters follow ones name does not make them proficient. What matters is skill training and skill use. Pediatric intubations were critically looked at by our pediatric trauma surgeon. The Emergency Medicine Specialists and residents in our large emergency department had a 100% success rate with NO significant adverse outcomes from the intubation. As I recall, no intubation required more than two attempts. I can easily say that during my training I have intubated more premature babies than any anesthesia resident in the hospital. The residents and staff in the emergency department at my hospital also intubate far more trauma patients than do the anesthesiologists or ICU staff. Once again it does not come down to what letters you have after your name, but rather to what experience, training, and practice environment you have been a part of. If the doctors in your emergency department have not been trained and / or do not get experience, is it really surprising that their skills might not be up to those who have and do. Titles do not open airways, training and experience do.

The only reason that one can have 100% SUCCESS in intubation is not doing enough.

Any one that work in the OR. know that there is always the patient that is difficult and some time cannot be intubate. If the intubation was no problem, there was no nee for the crycotomia or other surgical air way management. You just have to see how many books was written about air way management to understand that there is no 100% SUCCESS.

One anesthesiologist evaluates every patient ( 2 are present if the patient is known to be unstable ie gunshot wound to the chest) at the University of Maryland Shock Trauma.

All patients meeting the criteria for a "trauma code" are intubated by an anesthetist (in house) who is part of the "team" , unless the patient arrives before the anesthetist and the ER physician then intubates as required.

I am sorry you have misunderstood the post that I placed on this server. It simply states that in one study, over a ? 4 year period, no intubations were unsuccessful in this specific population. Anyone who intubates knows that there will be patients who are very difficult or impossible to intubate. These are the patients who need more advanced airway procedures. I would hope that you would agree that these advanced procedures should be performed by caregivers who are properly trained and experienced. This is the point I was making: Training and experience are important, letters after one's name are not. Where you get your experience is less important than the quality of that experience.