Kelly Grayson of A Day in the Life of an Ambulance Driver, has written another must read article on intubation at EMS1.com.
Now, I’m a big fan of Sim Man, but he ain’t adequate replacement for live intubation practice. Anyone who believes otherwise might as well insist that proficiency at playing Call of Duty on your Playstation qualifies one to be an Army squad leader in Afghanistan.[1]
I disagree with this criticism of the SimMan. I have stated that I think that mannequin training can be enough to prepare medic students to treat real patients. I am not referring to the SimMan. I am referring to Fred the Head. The most basic airway mannequin.
What is important in airway education is the understanding of airway management, not the reality of the airway we learn on.
We do not need actual human airways to communicate this understanding to students.
Contrariwise, we can intubate hundreds of real humans, but still not understand airway management.
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One problem we have is that students do not want to put in the work that is necessary to understand intubation. I have had few students actually express an interest in spending more time working on intubation. Most consider anything less than a live patient as not worth their time.
Anyone too good to spend a lot of time practicing on mannequins is too arrogant to be allowed to touch real patients.
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Another problem is that we draw our instructors from the same befouled gene pool. We don’t have enough instructors who understand airway management.
We complain about the lack of OR (Operating Room) practice for medic students, but the real shortage is in competent airway instructors.
Where did all of the medics in the studies showing mass murderous rates of unrecognized esophageal intubation come from?
They came from our paramedic programs.
They passed our licensing exams.
They were signed off by our medical directors.
These are medical directors who blame fear of lawyers for not allowing medics to provide other, much safer treatments to patients. These same medical directors allow dangerous medics to kill patients with incompetent attempts at airway management.
We all fail/cripple/kill our patients.
We are all responsible for this airway mismanagement.
Can we legitimately claim that we don’t know how bad things are?
Can we legitimately claim that we are any better, if we do not track our own intubations?
Do we track our own intubations?
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Do we understand airway management?
Too often the answer is no.
Do we teach medic students to understand airway management?
Too often the answer is no.
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To be continued in
Part II,
Part III,
and Part IV.
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Footnotes:
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[1] Is it time we give up endotracheal intubation?
by Kelly Grayson
EMS1.com
Article
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I will agree that removing intubation in a prehospital care is not the answer but for prehospital care providers need to be more proficient at airway management. More time in training and education ought to be required in airway anatomy, physiology and pathphysiology. Including the etiology and pathphysiology of laryngeal spasms, inflammation responses to the airway epithelial tissues, mucosal production etc. Students as well as current providers need constant review of the landmarks for intubation including the cartilages that provide structure to the larynx. Just passing a tube in a mannikin is not enough nor is eliminating intubation altogether. The patient suffers from our lack of competency and education and review.