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Pros and Cons of Prehospital Intubation

Roy Danks roydanks at hotmail.com
Mon Apr 17 04:17:38 BST 2006

To answer your question: Yes, there are studies.  Some done well, others retrospective and not so informative.  There is question as to outcomes of severe traumatic brain injuries intubated in the field.

I can tell you, having been in the field for 10 years (as a paramedic), I really thought that what we were doing was in the best interest of the patient.  Now, with sophisticated trauma systems, etc and being on the receiving end, I'm not so sure.

Again, I don't say this to take ANYTHING away from the excellent care that many levels of EMS providers give.  But we really must scrutinize what they're doing out there.  I'm an associate medical advisor for a paramedic program in Kansas and we spend a lot of time ("we": the course director, who is very bright with lots of field experience) thinking of ways to produce great paramedics who think and do the right think, not just react.  Maybe we teach them to think too much.

Pre-hospital research is finally coming around, but it's difficult to control studies.  But, it must be done.  The goal is prove Dr Mattox and me wrong.  We are providing a lot of info based on personal experience and, to some degree, clinical evidence.  At the same time, we have to proceed with studies that will either lend support to or shoot down our hypotheses.  

If you want to give me something to really chew on, tell me how to properly triage a trauma in the field so I don't get called to the trauma bay for a bogus trauma activation.  I think that most of the "activation criteria" are flawed and are not proven.  We need to take each one and work it out.  Otherwise, before long, we're going to be activated on every nursing home patient who falls and fractures a hip.  I KNOW!  I KNOW!  I've seen the studies.  God forbid.  The orthopods will never have to admit another isolated ortho trauma if this nonsense keeps up.

Enough of my rant.

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