This is the next installment of our “Short Final” series. In this particular episode, we discuss a controversial topic regarding nurses’ qualification to intubate in the pre-hospital environment. We also discuss maintaining competency for all disciplines and whether your program’s minimum requirements are enough to remain proficient.
Tarasi, P. G., Mangione, M. P., Singhal, S. S., & Wang, H. E. (2011). Endotracheal intubation skill acquisition by medical students. Medical Education Online, 16.
Thomas, F., Carpenter, J., Rhoades, C., Holleran, R., & Snow, G. (2010). The Usefulness of Design of Experimentation in Defining the Effect Difficult Airway Factors and Training Have on Simulator Oral–Tracheal Intubation Success Rates in Novice Intubators. Academic Emergency Medicine, 17(4), 460-463.
First, thank you both for putting together this podcast. I find it very interesting and you have done well for the prehospital field especially with HEMS.
I listened to your podcasts including this one on intubation and believe there is something worth emphasizing. We tend to focus on endotracheal intubation and competence surrounding this procedure. However, we must remember this is only one portion of airway management.
In addition to measures such as BVM, NIPPV, and basic airway maneuvers, we have other methods to control the airway. Traditionally when it comes to placing a tube we think of supraglottic and endotracheal intibations. However, we must remember that if we are discussing airway control (especially for prehospital management) we need to discuss all viable options. This includes cricothyrotomy (usually surgical).
It is at least my belief (though I know shared by colleagues) that every time you take the airway you must be prepared for ALL possible outcomes. Simply having competence in endotracheal intubation is only one part of the picture.
This may sound trivial, and such advanced maneuvers are rare, but in a cannot intubate cannot ventilate (CICO) situation, you need to have all options available. It is not enough to simply be competent in endotracheal intubation. We all need to be competent in all aspects.
When it comes to competence, 20 a year seems to be a fair number as a minimum which can be performed any number of ways for endotracheal intubation practice. However, many are not keeping up such skills. I recently visited a very robust EMS agency that only had an average of 0.8 intubations per paramedic per year! Hard to keep up field experience but with the proper training still viable.
The key is that we cannot focus simply on endotracheal intubation. It is only one small part. We must look at the larger picture and that includes such measures as surgical airways. Anyone who wishes to be competent in airway management and wants to take that role must remember all of these factors.
By no means is this in any way against nurses having such opportunities. As you mentioned in your podcast, competence is key. There are paramedics who I trust and physicians who I do not trust managing an airway. It does not matter the title, but what you can do when it matters. I would be happy to discuss this more or clarify anything if needed. Thank you again for what you do.
Thank you for the positive feedback, Chip. Airway management is a multifaceted clinical area that provides multiple avenues for potential discussion. You bring up excellent points regarding this. Though we briefly mentioned supraglottic airways, this episode’s intention was a focused assessment of pre-hospital/nurse ETT insertion competency. We would love to cover the other methods you highlighted, especially cricothyrotomy, in a future episode. We never intubate without our cric kit readily available! Thanks for listening!