And what’s the first rule of medicine: first do no harm.

No matter the system, there’s the issue of practice. On real people. In the OR. AND HARDLY ANYONE GETS THIS OPPORTUNITY ONCE OUT OF SCHOOL. Until EMS systems understand that intubation is a perishable skill, and an overrated way to manage the airway given the tremendous risks associated with it, EMS needs to really think about how safe it is.

I agree with you 100% that the aspiration myth is overhyped, overrated, and WAY overblown. I can’t remember the last cardiac arrest patient I saw who didn’t aspirate BEFORE I GOT ON SCENE. What’s the point in intubating then? What’s done is done. I am so tired of hearing that “airway X doesn’t protect against aspiration as effective as intubation.” Please. Look at the structure and design of the LMA supreme, the Combitube, the King. These are actual mechanical barriers that occlude the esophageus. If they did not, the device would not function. There are studies talking about aspiration and alternative airway devices. And as I recall, the risk was nonexistent. They did in fact work to prevent aspiration.

EMS has far too long held hold of this dream of intubation without ever doing anything to keep the skills sharp. I don’t know if it some “this is what makes us special” thing or what. But if prehospital intubation is to be preserved, so too do the skills necessary to perform it properly. That means regular, structured, and appropriate training to work with real patients.