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Pros and Cons of Prehospital Intubation

CHRISTOPHER MASSA cmassa1 at jhu.edu
Mon Apr 17 16:37:46 BST 2006


My thoughts as a biomedical engineer, basic EMT and not physician:

1)  Studies must be done to assess not only the accuracy of intubation done in the field, but also the INDICATION for which intubation occurs.  Is the threshold for intubation different pre- vs in hospital?  If so are these margins acceptable and justifiable given the various differences between the two environments and constraints placed on providers in both situations.  Another thing to assess (will differ depending on on-line vs off-line medical direction for intubation by state or region):  do receiving physicians agree with the judgements made in the field regarding intubation. 

2) Get REAL data.  Not just outcome data, which is great for correlating a phenomenon with a result, but less than enlighting in terms of mechanism.  Grab a pressure transducer, pneumotachometer, A/D converter and a signal processing guru then correlate outcomes in the pre-hospital setting with measures of peak airway pressure, peak inspiratory flows, PEEP, etc.  I am not aware of any study that has made these measurements in the field, however I believe they are priceless to measure.

As a subgoal of suggestion #2, I think that the data should be looked at with the intent to alter the training practices of your hospital.  The next step beyond this is testing your training approach to see if medics can be un-taught the elements that may be contributing to deficits in outcome.

I think its a wonderful thing to study and wish you luck.  Please let me know if I can be of any help.

Christopher Massa
The Johns Hopkins University 
Student - Dpt of Biomedical Engineering
Research Assistant - Dpt. of Anesthesiology and Critical Care Medicine
Crew Chief - JHU Emergency Response Unit

----- Original Message -----
From: Michael Ferker <xg2k2 at yahoo.com>
Date: Sunday, April 16, 2006 3:41 pm
Subject: Pros and Cons of Prehospital Intubation

> I'd have to say that prior to coming onto this list, I've held the 
> opinion that intubation by EMTs is an extremely important pre-
> hospital procedures. However, after readings accounts and 
> testimonials from many of the people on this list, most recently 
> those of Drs. Danks and Mattox, I've begun to ponder whether 
> intubation by people that for whatever reason may not be adequately 
> trained, or even equipped in terms of actual physical devices and 
> working environment, may do more harm than good. 
>  I know that we've discussed this topic up and down for many 
> months now, but I was wondering whether any empirical studies have 
> been done recently on morbidity and mortality rates as a result of 
> improper intubatin, as compared to successful pre-hosp intubations 
> that saved lives. My university provides grants for honors research 
> projects, and so I thought that this may be an interesting topic 
> for me to research and write about. Any thoughts, comments, 
> suggestions would be highly appreciated.
>  -Mike F
> ---------------------------------
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