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Tue, 2 Apr 2002 17:49:06 -0700

Your right.

Only doctors are qualified to intubate. Paramedics should only intubate if
the patient is not dying.

I guess that is one way to make sure doctors get enough practice to be
sufficiently qualified for your comfort level.

Nick

____
Nick Nudell, NREMT-P
Education Coordinator
Glacier County EMS
www.glacierems.com
Northern Rockies Medical Center
Cut Bank, MT
nick@glacierems.com

----- Original Message -----
From: "Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR"
<matthew.dunn@swarkhosp-tr.wmids.nhs.uk>
To: <trauma-list@trauma.org>
Sent: Tuesday, April 02, 2002 8:13 AM
Subject: RE: LMA

> > <<The whole benefit of prehospital intubation in trauma patients is
> > unclear.>>
> >
> > Really? I don't think that it is unclear at all. It must be
> > performed as
> > early as possible (when indicated) by a competently trained
> > practitioner of
> > whatever level -- physician, paramedic, whatever.
>
> No, it remains unclear. There is little/ no evidence for its benefit.
> (Efficacy- yes: you can find individual cases where prehospital intubation
> probably saved a life. Effectiveness- no: there is not the evidence that
> introducing prehospital intubation as a skill improves mortality. If
> anything, the UK experience at least shows critically ill and trauma
> patients to do better when attended by crews without these skills).
> Prehospital intubation certainly carries some very real risks that may
> cancel out (on a population basis) its benefits in the cases where well
and
> correctly applied. It delays transfer to a definitive care facility; is
> usually carried out by practitioners less experienced and with less backup
> (including more advanced surgical airway skills, fiberoptic laryngoscopes,
> other staff); and in a more hostile environment than in hospital
intubation,
> so the likelihood of complications is higher.
> A patent airway can usually be maintained by simple techniques (chin
lift).
> If you have a patient who requires to have their airway secured; you have
a
> practitioner at scene; there are no other problems that are likely to
> deteriorate due to delays in transfer for intubation ( concealed
haemorrhage
> etc); and transfer times are long, intubation is probably intubated. In
> cases with short transfer times to facilities where there is a more
> experienced practitioner with better backup on site; the patient has
ongoing
> uncontrolled haemorrhage; it is a difficult intubation etc. you should
> consider whether it is appropriate to intubate on scene. It is unlikely in
> many EMS setups that many individual practitioners will be able to
maintain
> competence at intubating rapidly with use of drugs and without
complications
> simply by normal day to day practice (if restricted to patients who will
> benefit from prehospital intubation). You therefore have to question how
> much time (and risk to patients) should be taken up by providing ongoing
in
> hospital experience to those practitioners. Of course, this argument does
> not apply to setups where physicians who regularly work in anaesthesia or
> emergency medicine rotate to spending time responding prehospital (often
by
> helicopter).
>
> Matt Dunn
>
>
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