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

- Rogue Medic

What Does it Take to NOT Kill a Patient – Part V

Continuing to look at the review of major airway complications from the UK.

Poor planning contributed to poor airway outcomes. When potential difficulty with airway management is identified a strategy is required. An airway plan suggests a single approach to management of the airway. A strategy is a co-ordinated, logical sequence of plans, which aim to achieve good gas exchange and prevention of aspiration. Anaesthetists should approach airway management with strategies rather than plans.[1]

The highlighting is in the original.

This is the difference between following inflexible protocols and having protocols that are written with the understanding that the paramedic will use critical judgment to determine the appropriate treatment for the patient.

We will be faced with many types of patients with needs for different types of airway management.

The mindless application of poorly written protocols limits our options and kills our patients.

An example of a very simple plan is –

Less than 8 – intubate!

How many patients have been killed following that plan?

We don’t know.

Anaesthetists are assessing their bad outcomes. As Dr. Cliff Reid of Resus.Me puts it in the title of his post – they are washing their dirty laundry in public.

In EMS, we occasionally take a look at intubation.

We almost always end up with results that are embarrassing for us (evidence that we are killing our patients).

We make the bogus excuse that this does not apply to us.

We continue to kill patients.

We need to stop protecting our image and start protecting our patients.

We need to get rid of the administrators/bureaucrats who are more concerned with our image than with our patients’ reality.

We are killing our patients in order to be politically correct.

When we think that Plan A is all we have, we may find out that Plan B is a body bag.

See also:

What Does it Take to NOT Kill a Patient – Part I – 4/03/2011

What Does it Take to NOT Kill a Patient – Part II – 4/04/2011

What Does it Take to NOT Kill a Patient – Part III – 5/20/2011

What Does it Take to NOT Kill a Patient – Part IV – 5/23/2011

What Does it Take to NOT Kill a Patient – Part V – 5/30/2011

From EMCrit –

EMCrit Podcast 47 – Failure to Plan for Failure: A Discussion of Airway Disasters – 5/09/2011

From Resus.Me –

Anaesthesia’s dirty laundry – let’s all learn from it – 4/03/2011


[1] Major complications of airway management in the UK – 2011 NAP4
Royal College of Anaesthetists
Executive Summary (page 1/3)
Page with link to various full text pdf versions of report, press release, executive summary, and full report.



  1. […] Part V I mentioned that one of our problems is that most of us just have a plan – It puts the tube […]