Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Prehospital Advanced Airway – Should Paramedics Be Intubating? – comment II

In the comments to Prehospital Advanced Airway – Should Paramedics Be Intubating? – comment, keepbreathing wrote:

I love waveform capnography and I think it’s vastly underutilized.

What’s not to love about waveform capnography. For me, it was love at first complicated airway.

And for what it’s worth, I’ll defend EMS tube placement to the ER docs. I’ve yet to have a medic hand me an unrecognized esophageal intubation, and at the facility I work at we confirm tube placement prior to sliding the patient from the EMS stretcher to the ER bed. That way if the tube turns out to be in the esophagus later, we know it happened in the ER, not in the truck.

One of the nice things about waveform capnography is that it helps to decrease the incidence of esophageal tubes even for those most skilled at intubation. Actually, I don’t think it is fair to call anyone skilled at intubation if they choose not to use waveform capnography.

Checking the tube on the EMS stretcher is one of the variables that some airway researchers ignore, when evaluating EMS intubation. They claim that this does not make a difference, but they cannot prove this claim. Since there is no evidence to support their position, that the move to the ED stretcher is not a variable, the only reasonable thing for an objective researcher to do is to assess the tube placement on the EMS stretcher. Many do not.

Therefore, I believe that these airway researchers are not objective, or not reasonable, or maybe they just object to reason.

If one were to suggest to ED physicians, that their tubes would be evaluated after arrival in the OR, or ICU, or anywhere else, but not on their ED stretcher, they would probably not consider this suggestion to be reasonable or objective.

So, why the sudden onset of let’s make this research worthless in the places that refuse to evaluate the EMS tube on the EMS stretcher?

Few understand EMS. Even in EMS, few seem to understand EMS. Out-of-hospital care is different from in-hospital care. People only accustomed to in-hospital care may not grasp that there are essential differences, or they do not believe that the differences are significant, never mind essential.

The role of the researcher is to design the study to control for all of the potential variables possible. If you already know the result, maybe you should not be involved in the research.



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