This is what the military does. They come. They check your pulse. No pulse – next. You know, we’re going to be leaving bodies behind, which is the exact opposite of what’s the oath we took.[1]Oren Barzilay EMS Local 2507 President. Also identified by the news as a paramedic. If so he should know better. What does the protocol state?


Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, Walker T, Std BP, Myles P, Murray L, David, Taylor, Smith K, Patrick I, Edington J, Bacon A, Rosenfeld JV, Judson R. Ann Surg. 2010 Dec;252(6):959-65. doi: 10.1097/SLA.0b013e3181efc15f. PMID: 21107105Here is some of the evidence showing either a lack of benefit from intubation or evidence showing harm from intubation:
Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Katz SH, Falk JL. Ann Emerg Med. 2001 Jan;37(1):32-7. PMID: 11145768 Free Full Text PDF Rapid sequence intubation for pediatric emergency patients: higher frequency of failed attempts and adverse effects found by video review. Kerrey BT, Rinderknecht AS, Geis GL, Nigrovic LE, Mittiga MR. Ann Emerg Med. 2012 Sep;60(3):251-9. doi: 10.1016/j.annemergmed.2012.02.013. Epub 2012 Mar 15. PMID: 22424653 Free Full Text from Annals of Emergency Medicine. A is for airway: a pediatric emergency department challenge. Green SM. Ann Emerg Med. 2012 Sep;60(3):261-3. doi: 10.1016/j.annemergmed.2012.03.019. Epub 2012 Apr 19. No abstract available. PMID: 22520991 The article above is a comment on the previous article. Prehospital intubations and mortality: a level 1 trauma center perspective. Cobas MA, De la Peña MA, Manning R, Candiotti K, Varon AJ. Anesth Analg. 2009 Aug;109(2):489-93. doi: 10.1213/ane.0b013e3181aa3063. PMID: 19608824 Intubation by Emergency Physicians: How Often Is Enough? Kerrey BT, Wang H. Ann Emerg Med. 2019 Dec;74(6):795-796. doi: 10.1016/j.annemergmed.2019.06.022. Epub 2019 Aug 19. No abstract available. PMID: 31439364 The article above is commentary on the article below: Procedural Experience With Intubation: Results From a National Emergency Medicine Group. Carlson JN, Zocchi M, Marsh K, McCoy C, Pines JM, Christensen A, Kornas R, Venkat A. Ann Emerg Med. 2019 Dec;74(6):786-794. doi: 10.1016/j.annemergmed.2019.04.025. Epub 2019 Jun 24. PMID: 31248674 Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA. JAMA. 2018 Aug 28;320(8):779-791. doi: 10.1001/jama.2018.11597. PMID: 30167701 Free Full Text from PubMed Central® (PMC) Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. JAMA. 2018 Aug 28;320(8):769-778. doi: 10.1001/jama.2018.7044. PMID: 30167699 Free Full Text from PubMed Central® (PMC) Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest. Andersen LW, Granfeldt A. JAMA. 2018 Aug 28;320(8):761-763. doi: 10.1001/jama.2018.10824. No abstract available. PMID: 30167679 Interruptions in cardiopulmonary resuscitation from paramedic endotracheal intubation. Wang HE, Simeone SJ, Weaver MD, Callaway CW. Ann Emerg Med. 2009 Nov;54(5):645-652.e1. doi: 10.1016/j.annemergmed.2009.05.024. Epub 2009 Jul 2. PMID: 19573949 Association of prehospital advanced airway management with neurologic outcome and survival in patients with out-of-hospital cardiac arrest. Hasegawa K, Hiraide A, Chang Y, Brown DF. JAMA. 2013 Jan 16;309(3):257-66. doi: 10.1001/jama.2012.187612. PMID: 23321764 Free Full Text from JAMA No evidence for decreased incidence of aspiration after rapid sequence induction. Neilipovitz DT, Crosby ET. Can J Anaesth. 2007 Sep;54(9):748-64. Review. PMID: 17766743 Link to Abstract and Free Full Text PDF Download from Can J Anaesth The Great Prehospital Airway Debate August 31, 2018 Emergency Medicine Literature of Note by Ryan Radecki Article EM Nerd-The Case of the Needless Imperative August 31, 2018 EMNerd (EMCrit) by Rory Spiegel Article Intubation or supraglottic airway in cardiac arrest; AIRWAYS-2 The Resus Room Podcast with Simon Laing, Rob Fenwick, and James Yates with guest Professor Jonathan Benger, lead author of AIRWAYS-2. Podcast, images, and notes Variation in Survival After Out-of-Hospital Cardiac Arrest Between Emergency Medical Services Agencies. Okubo M, Schmicker RH, Wallace DJ, Idris AH, Nichol G, Austin MA, Grunau B, Wittwer LK, Richmond N, Morrison LJ, Kurz MC, Cheskes S, Kudenchuk PJ, Zive DM, Aufderheide TP, Wang HE, Herren H, Vaillancourt C, Davis DP, Vilke GM, Scheuermeyer FX, Weisfeldt ML, Elmer J, Colella R, Callaway CW; Resuscitation Outcomes Consortium Investigators. JAMA Cardiol. 2018 Sep 26. doi: 10.1001/jamacardio.2018.3037. [Epub ahead of print] PMID: 30267053 Free Full Text from JAMA Cardiology Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest. Kellum MJ, Kennedy KW, Ewy GA. Am J Med. 2006 Apr;119(4):335-40. PMID: 16564776 Cardiocerebral resuscitation improves neurologically intact survival of patients with out-of-hospital cardiac arrest. Kellum MJ, Kennedy KW, Barney R, Keilhauer FA, Bellino M, Zuercher M, Ewy GA. Ann Emerg Med. 2008 Sep;52(3):244-52. doi: 10.1016/j.annemergmed.2008.02.006. Epub 2008 Mar 28. PMID: 18374452 Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. Bobrow BJ, Clark LL, Ewy GA, Chikani V, Sanders AB, Berg RA, Richman PB, Kern KB. JAMA. 2008 Mar 12;299(10):1158-65. doi: 10.1001/jama.299.10.1158. PMID: 18334691 Free Full Text at JAMA Passive oxygen insufflation is superior to bag-valve-mask ventilation for witnessed ventricular fibrillation out-of-hospital cardiac arrest. Bobrow BJ, Ewy GA, Clark L, Chikani V, Berg RA, Sanders AB, Vadeboncoeur TF, Hilwig RW, Kern KB. Ann Emerg Med. 2009 Nov;54(5):656-662.e1. doi: 10.1016/j.annemergmed.2009.06.011. Epub 2009 Aug 6. PMID: 19660833 Cardiocerebral resuscitation is associated with improved survival and neurologic outcome from out-of-hospital cardiac arrest in elders. Mosier J, Itty A, Sanders A, Mohler J, Wendel C, Poulsen J, Shellenberger J, Clark L, Bobrow B. Acad Emerg Med. 2010 Mar;17(3):269-75. doi: 10.1111/j.1553-2712.2010.00689.x. PMID: 20370759 Free Full Text from Acad Emerg Med. And more.That is a big difference. There is nowhere near enough evidence to justify allowing paramedics to intubate. Footnotes: [1] Grim New Rules for NYC Paramedics: Don’t Bring Cardiac Arrests to ER for Revival By Tom Winter Published April 2, 2020 • Updated on April 2, 2020 at 8:32 pm nbcnewyork.com Article with autoplay video [2] TEMPORARY Cardiac Arrest Standards for Disaster Response NYC REMAC Advisory No. 2020-08 Issue Date: March 31, 2020 Effective Date: Immediate Protocol in PDF format [3] Use of Alternative Airways NYC REMAC Advisory No. 2020-05 Issue Date: March 20, 2020 Effective Date: Immediate Protocol in PDF format .
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