When Only Outlaws will Intubate…

Get on the band wagon!!! The NASEMSO is coming for your laryngoscopes and ET tubes!

If you are on social media and in EMS you have no doubt seen the posts today. They are coming for your tubes. Soon intubating will be outlawed and only outlaws will intubate. And it is out fault because we suck at intubating, or we haven’t trained enough, perhaps our QA programs have failed, and our education is inadequate. We are getting what we deserve.

Except that is either nonsense or speculation, or some of both at this point.

First, states can do whatever they want and the national scope of practice is not a law, it is not binding and to be honest, whatever, you should have gotten your critical care cert by now. If you want to complain about EMS education and training and have not done it yet, well…let’s just say that if you complain that we aren’t taken seriously but haven’t taken a board certification exam that you could have…get off your ass. Or don’t. I don’t know. Do whatever you want.

The part about removing intubation is under the “comments received for exclusion of practice” section…right next to the comment about removing PEEP. I am not respiratory guru but I think some of the ARDS patients I transfer are going to be unhappy with removing PEEP.  Does anyone think NASEMSO is going to remove PEEP? I do not think so. This may be the EMS equivalent of Yahoo Answers or it could be the real deal. I made a comment on the 2015 AHA/ILCOR guidelines asking them to remove epi from adult cardiac arrests and it is still in the algorithm. When organizations intend to change policy they solicit comments from the public. Not everyone in the public, how do I put this…think of how bright the average person out there is, now realize 49% of people are not as bright as them, but they do have internet access. Or risk losing all your faith in the human race and get on Yahoo Answers or read the comments below a YouTube video.

Who made these comments about removing intubation? No one knows? What is going to happen with the comments? Also unknown.

Which brings me to the bigger issue here; everyone is jumping to conclusions about this. We don’t know who said it and we do not know why they said it. Could it be that EMS is bad at intubating? It is certainly possible. But there are tons of other reasons as well that could exist. Perhaps it is a lack of evidence that ET tubes actually change many outcomes? It certainly seems problematic that one comment has caused mass condemnation in EMS.

Maybe it is time to think about ET intubation is simply a risky procedure and unless you are dropping 40+ tubes a year it is extremely dangerous. Perhaps the risk is simply too great when presented with the logistical challenge of getting all the paramedics in the country 40 tubes per year. Perhaps we have been too cavalier with the whole thing and we need to own up to we simply were allowed to do an unsafe act and we need to rectify that? It does not mean we are failures.

No reason or logic was given for the comment, but that did not stop folks from piling on with comments about how EMS is a failure and doomed, and this is what we deserve, and that they are leaving EMS and other rhetoric. If an anonymous comment is all it takes to push you out of EMS, it might be time to question your commitment to it in the first place.

Don’t get me wrong, I think intubation is a good skill to have and just like everyone else in EMS I am an above average intubator*.  I want to hang on to it because I think it is beneficial to some patients, but if I am putting patients at an unjustifyable risk, then I am okay with taking it away. There certainly is marked room for improvement in EMS education, QA and training. But before we know the facts here (if there are any at all because it may just be a nameless commentator) we should probably not condemn all of EMS. The sky is not falling; you do not need to start stock piling high capacity bougies and semi-automatic capnography monitors.

Perhaps this is the time to show that we are professionals, ask for more information, take feedback well and improve where needed.  Blaming does not fix errors.

* Dunning-Kruger