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Rescue Airway Techniques

paul.middleton paul.middleton at usa.net
Sun Apr 9 10:13:25 BST 2006


That was a marvellous summary and an exemplar of clear thinking. Some of
your more experienced colleagues might learn something by listening. The
sooner you get out on the road full-time the better for the patients in your
neck of the woods!

The argument truly should be about how the patients threatened airway may
BEST be protected until they arrive at the safest situation for more
definitive management (if needed), and not about the laboured justification
of only one way to manage the situation. These conversations would, in a
world less dominated by entrenched positions and rigid thinking, contain
more about how we can ALL innovate / research / improve other alternatives
that don't have the associated iatrogenic morbidity and mortality. For
goodness sake, it doesn't all have to be about ETT's and laryngoscopes, and
it shows little respect for other people on this list to start making
childish comments about Daddy's car or such other nonsense. It also shows
little capacity to understand the whole reason for evidence based health

The nonsense about some dark medical conspiracy to keep "tricks" in hospital
and away from anyone else is such patent bullshit it should be in the pages
of the National Enquirer or the Fortean Times, alongside the UFO's and
alligators in the sewers of Brisbane!


Dr Paul M Middleton

Emergency Medicine
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Ashton Treadway
Sent: Sunday, 9 April 2006 5:08 PM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Rescue Airway Techniques


I'd like to pile onto this excellent message (thank you for a
brilliantly written contribution, Scott), I recently completed an ACLS
course at which this topic came up in side discussion.

For me, with my admittedly limited perspective as a paramedic student,
the debate over whether or not we (EMS) should be performing
intubation breaks down into a long, but pretty clear question:

"Is it in the /patient's best interest/ for prehospital providers to
be attempting and often failing ETT insertion, especially when there's
strong evidence that excellent BLS skills with a BVM and/or other
adjucts such as the CombiTube and LMA provide the same effective
airway stabilization with much less risk?"

I will also point out an elephant in the room: it seems to me that a
non-trivial percentage of medics are fighting against losing
intubation not on medical or evidentiary grounds, but on the grounds
that it erodes their scope of practice, and makes them, if you will,
less powerful. To put it bluntly, that's a crappy reason, and, for me
at least, it calls into question the credibility of anyone making that

I also have problems with the argument that we (EMS) are "just as good
as" in-hospital providers at intubation: we are not, based on all the
available evidence. And, in this case, not being the worst does not
stand in some rank of praise: even if we aren't killing more people
than those folks in the hospital, our success percentages are dismal.


As a cohort, we are failing, approximately, 1 out of 4 intubations in
the field, with dire consequences. I'd submit to you that, in the face
of the evidence that good BVM and BLS skills can do just as well as an
ETT, and that other airways such as the CombiTube and LMA can provide
comparable protection, the question is no longer how we improve
intubation percentages.

The question is, instead, "what's in the patient's best interest?" Are
we serving that interest, or serving our own?



On 4/6/06, HAXScott at aol.com <HAXScott at aol.com> wrote:
> Melissa,
> I'm a paramedic, and while I empathize fully with some of your
> I must respectfully disagree with several of your points.
[eloquence trimmed]

> In a message dated 4/6/2006 8:53:17 AM Eastern Standard Time,
> mmarkey at hallrender.com writes:
> With all  due respect, I have a different suggestion - how about
> anesthetists and  anesthesiologists willingly sharing their knowledge and
> giving paramedics  more chances to practice intubation in a controlled
> setting

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