To Tube, Or Not To Tube? That Is The Question.

Ok, big one here. Do you see us as medics still being able to intubate in the future? Alot of docs out there are against medics intubating. Even the new AHA ACLS guidelines say if you get good ventalations with a Combi-tube, don't waste time with a tube. Are we going to be tubing in the future, or will it all be Combi-tubes and LMAs? All thoughts are welcome.

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Permalink Reply by Russell D. Henry on December 16, 2007 at 8:08pm

Our Department is participating in a study of a new product, called the king airway. It is a tube with only one inflatable cuff. It seems simple to use. You just shove it in and inflate the cuff, then pull back until you feel it pop into place.
I still prefer intubation, but it's not about me. I think that doctors are moving away from medics intubating in the feild, because studies show that there other ways of doing things, that have better patient outcomes. In the end, that's why we do what we do.
I hate to see medics lose our ability to intubate, but doctors are becoming more aware of the things that we can do, in the field. Everyday, there are studies that prove that rapid administation of drugs is beneficial to patients. We are being given oppotunities to more things as these studies prove our effectiveness.
I think that we are about to see alot of changes in EMS. Changes that will involve much more training, because they will give us much more responsibility.

Permalink Reply by Bill Heizer F/F E.M/T.-P on January 7, 2008 at 9:08pm

Our system has a modified RSI protocol, using Versed and Etomidate. Unfortunately it doesn't work very well in patients who have significant CHI. The doc don't mind the medics intubating and if the need arises and one of us is in the ER, the docs will let the medics perform the intubations. I am in the process of gathering information to put before the critical care committee to allow the medics to have a true RSI protocol , otherwise we use the Cobra PLAs as our rescue airway of choice, and they work fairly well. I've used them a couple of times with success

Permalink Reply by Chris Turner on January 14, 2008 at 1:02pm

I wish I could remember the source or even the exact numbers, but I was reading a study done not too long ago talking about EMS intubation success rates. basucally, it said that people who intubate about 1x per month har a success rate of near 95% on their first try...and people who intubate 1x per year or leass have near a 50% success rate!!! Big difference!!!

That same study siad that there was a progressivly lower success rate the more times you tried. So think baout it...if you haven't intubated in over a year and this is your third try, what kind of success do you really expect?

Permalink Reply by Amanda 11-33 on April 14, 2008 at 11:25am

Following the ACLS course that I just took this past weekend, I was taught that the AHA guidelines state that if you're getting good adequate ventilations with an oral airway then intubation is far down on the algorithm. Even as a paramedic student, I feel much more comfortable using ETT rather than the Combitube alternative that we have in PA. Unfortunately, PA is one of the only states that doesn't have orders for RSI but we can do sedation-assisted intubation. I would hate to see medics get intubating taken off of them especially when airway management is crucial in allergic reactions, severe burns, severe respiratory distress, etc. In those kind of situations, you have a small window of opportunity to get the advanced airway so why not put in an ET tube and be done with it.

Permalink Reply by Annette on April 19, 2008 at 11:30am

We use RSI in the field when needed now. An ET tube is THE definitive airway. I for one would much rather have a skilled Paramedic (note I said skilled) placed an ET tube thn have some EMT ram a PTLA down my throat!

Permalink Reply by Annette on June 28, 2008 at 10:25am

We have RSI protocol, which helps a great deal when your pt is clenched.....however....it takes a competent group of Paramedics to earn the trust of their Medical Director, those who don't have that - won't be doing visualized intubations for long, let alone administering RSI. I often think, if I were the patient, what would I want?....an ET tube placed gracefully by skilled hands would be my first choice.....I'd really rather not have that garden-hose of a combitube shoved down my gullet.....and I have unfortunatley witnessed a Medic just tearing the heck out of a patient's throat because they "Had to be Superman". For goodness sakes we were all EMT's before we became Medics, place an OP and gently bag, remember the basics! All trauma should stop when we arrive....and that encompasses our treatments.

Permalink Reply by Annette on June 28, 2008 at 10:26am

Hmmm....I'm repeating, repeating myself....I think I've had a stroke! lol

Permalink Reply by Jennica Stout on August 6, 2008 at 8:49am

Interesting topic...In Ohio, Combi's and LMA's are only for use when a regular tube isn't feasible. Second line, if you will. We don't have King tubes, not approved for use here.
If anything, they are getting more aggravated with us for NOT tubing...even our basics are required to intubate when necessary.
One thing though that may promote some change is the use of C-PAP. Most departments are still getting on board, like we're had the equipment just not the training. It will be wildly beneficial to prevent some anoxic injuries in conscience patients...or those with other issues making intubation not so practical.

Permalink Reply by Brittany on August 13, 2008 at 12:38pm

Brady!! That's my instinctive gut reaction... probably due to the fact that is what I went through Basic and Medic school with. Mosby is more technical (college level) and Brady is more user friendly (firefighter friendly...!!). Just my .02 cents. Good luck!

Permalink Reply by Shareef Abdu Nur on September 6, 2009 at 4:43pm