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

- Rogue Medic

Irresponsibility and Intubation – The EMS Standard Of Care

 

There is a petition to save EMS intubation, but it claims to be a petition to save patients. The petition is not to save patients.
 


Image source
Details here and here.
 

The petition states that its intent is to protect patients, but it does not provide any evidence. It only makes the same claims that every other quack makes to promote his snake oil.

We are worse than homeopaths, because homeopaths do not actively harm patients by depriving patients of oxygen, as we do when we intubate.
 

 
We are the quack, witch doctor, homeopath, horseshit peddlers Dara O’Briain is describing.

 

Today we are possibly facing the removal of the most effective airway intervention at our disposal as paramedics, endotracheal intubation.[1]

 

Most effective?

There is some evidence that intubation can be – in limited situations, by highly trained, competent people – beneficial. There is also plenty of evidence that intubation is harmful. It is easy to kill someone by taking away the patient’s airway.

Most effective?

No.

This petition does not mention evidence, so it has no credibility when it comes to claims of whether intubation is effective. This petition expects us to believe in a faerie tale of magical improvement with intubation. This petition wants us to clap for Tinkerbell, because If we believe hard enough, it just might come true. Grow up.
 

Please sign this petition so that these patients have a chance to live[1]

 

Prove that requiring higher standards for intubation would take away a patient’s chance to live.

Prove that intubation improves outcomes.

This is a petition to keep standards low for paramedics.

This petition does not mention competence, or even what is involved in competence, because this petition is opposition to competence.

This is the Protect Incompetent Paramedics from Responsibility Petition.

Responsibility is for professionals. In EMS, we reject responsibility.

We are more concerned with whether our shoes are shiny, than whether we are harming, or helping, our patients. The reason EMS exists is to improve outcomes for patients.

We don’t deliver competent care, but only the appearance of competence. We are medical theater, putting on a fancy show. The TSA (Transportation Security Administration) is the same – all appearance and no substance.

Most effective? Maybe intubation is the most effective theater.

The outcomes of our patients are affected, but we refuse to learn if we are helping, harming, or doing equal amounts of harm and help.

We actually oppose learning. We are willfully ignorant – and proud of our defiant stand for ignorance.

How much hypoxia do we cause in our attempts to place the so called gold standard? The actual gold standard is helping the patient to protect his own airway, but who cares what’s best for the patient? Not those who sign the petition.

How much vomiting, and aspiration, do we cause?

How much airway swelling do we cause?

How many airway infections do we cause?

How much harm do we cause?

We don’t know. We don’t care. We oppose attempts to find out.

We are EMS and we believe that our actions should be protected from examination, because we are beautiful and unique snowflakes who demand our participation trophies without doing real work required to be competent.

Go ahead, snowflakes, demonstrate your incompetence by signing the petition, because this protect intubation petition is really a protect incompetence petition.

If we want to continue to intubate, and we want to improve outcomes for our patients, we need to demonstrate that intubation by EMS provides significant benefit and which patients are most likely to benefit. We can’t do that because we don’t care enough about our patients.
 

Brian Behn has a different reason for not signing the petition for low standards – Why I am Not Signing The Petition About Intubation.

Dave Konig also comments on the petition for low standards – Is ET Intubation Joining Backboards In Protocol?

Footnotes:

[1] Allow paramedics to continue to save lives with endotracheal intubation!
Anthony Gantenbein United States
Petition site

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Comments

  1. Yes but…
    The petition is a political statement, not a medical one: petitions are not a forum for nuance.
    Had the document by NAEMSO contained more than a one line about the possibility of removing ETI, there may have been a more cogent, reasoned response. You do not put out a document “for comment” with entire sections missing and bullet points (e.g. “comments received for removal from the practice mode–endotracheal intubation”) with no explanation.
    So while I won’t defend many of the comments made by my colleagues, to use their reaction as further evidence of why we shouldn’t intubate is a bit unfair.

    • You are writing about the NAEMSO request for comment, while I never even mentioned it.

      If you want to write about the NAEMSO request for comment, I may write about it. Then it would be relevant to comment about it.

      So while I won’t defend many of the comments made by my colleagues, to use their reaction as further evidence of why we shouldn’t intubate is a bit unfair.

      I used this appeal for defense of incompetence to critize incompetence.

      This petition is an excellent example of the kind of incompetence that keeps us from providing high-quality patient care.

      Maybe you missed my final point. Maybe highlighting the text is too subtle.

      If we want to continue to intubate, and we want to improve outcomes for our patients, we need to demonstrate that intubation by EMS provides significant benefit and which patients are most likely to benefit. We can’t do that because we don’t care enough about our patients.

      We need to stop harming patients with treatments that do not work.

      If we want to claim that a treatment works, we need to provide valid evidence, not emotional appeals to vanity.

      We need to stop defending incompetence.

      Other than individual words, I only highlighted two other sections –

      There is some evidence that intubation can be – in limited situations, by highly trained, competent people – beneficial. There is also plenty of evidence that intubation is harmful. It is easy to kill someone by taking away the patient’s airway.

      and –

      This is a petition to keep standards low for paramedics.

      Well, this petition is to keep standards low, because it is a petition to protect the egos of patients at the expense of the health of patients.

      If you have valid evidence to the contrary, provide it.

      We need to stop imitating the frauds of alternative medicine, promoting wishful thinking based quackery.

      We need to stop making excuses for these dangerous people in EMS.

      .

  2. You may never see true evidence. Not many want to do studies, when there is no profit coming out of it. A lot of the studies that have been done in EDs are flawed in their approach and outcomes. I would love to see a full study done on ETI in the field. Now we just need to find someone to find one!

    • Perhaps the way to get EMS to behave responsibly find out if we are harming patients, is to prohibit intubation outside of well-controlled clinical truals until after there is clear evidence of how much harm/benefit we are producing. .

      That would be one way to force us to be a little less irresponsible.

      It is unlikely, since the only thing that appears more important to us, than intubation, is irresponsibility.

      .

  3. You’re forgetting about the rural medic out there. Where we are with our patients for more then a hour, not 5 mintues. Sometimes air- craft isn’t available if its raining or on another call.. You want us to use a bvm and take chance of filling the patients stomic up for over a hour.. Yes we can be extremely careful and do everything in our power not to fill the stomic but there’s some patients out there who have difficult airways where bagging can be extremely difficult and or impossible. Rsi does save patients in rural areas, we need intubations.. Do I believe that Rsi is risky and their is some medics out there who would rather make the patient more hypoxic then before until they give up and go to a secondary airway..absolutely.. But to take it away from Rural Medics when we can have anything to burn patients to anaphylactic reactions and to take our ONLY definitive airway;away from us.. I think you’re out of your mind. In the city, I can maybe defend you. But the studies need to be done out in the sticks as well. I believe that we should have to go outpatient surgery every year or 2 or have number set of how many we need in that time period successfully to keep our skills sharp.. After a Rsi and I have no one in the back but myself for over an hour.., I can place the patient on a vent and care for my patient. If RSI is taken away. I loose the capability to monitor my patient, and would be more focused on bagging my patient, or making sure the secondary away isn’t failing and I’m filling the stomic on the vent, because it can happen.

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