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Fri, 5 Apr 2002 14:22:22 +0930

Matt Dunn wrote:

. 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

Intubation is not as difficult as some people would make it seem. I'm sure
you can cite examples of unrecognised ETT placements & other complications,
probably as many as i could cite for successful ETI's, etc..,. 

My point is, i have never found it that difficult - sure some patients are
more challenging than others, but come on ... it's sticking a piece of
plastic through a hole - the correct one, of course ;o) - you can teach a
monkey to do that skill. It's the thought process and the knowledge behind
the intubation that is more challenging. I just wanna debunk this "holy
grail" mentality that some people seem to have about the physical procedure.
...it aint that special! Yes, Matt i agree with you about the
appropriateness of the procedure being performed at the expense of timely
surgical intervention, and that ETI without the need for drugs has abysmal
outcomes, and also that RSI has inherrant risks that could unneccessarily
complicate or compromise care if used by people who aren't abreast of the
issues, of which i can assure you, most paramedics at intensive care level
are well abreast of. Grant us the courtesy of knowing these issues and
employing the wisdom in decision making that comes with the knowledge we
have. Now, i would be lucky to perform a dozen ETI's a year, but i was
trained well by competent anaesthetists who taught me well. We have back up
procedures that must be used to confirm tube placement, etc.., and i haven't
screwed one up yet. I am not disputing the knowledge gap between our
professions, nor trying to belittle the skills, i'm just trying to point out
that the physical skill of intubating isn't that hard. 

Chris Cotton,
Intensive Care Paramedic
South Australia.

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