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Hot Take: if your paramedics intubate, they should have access to paralytics and not just sedation. 1/
Having worked the spectrum of inner city ALS (transport time 3-8 minutes on average) to suburban / semi-rural (20min-1+ hour transport), the idea that emergent airways can be delayed due to hospital proximity is a problem. 2/
What causes airway delays in the ED from EMS drop-offs (especially urban/inner city)?
unforeseen delays in triage / business of ED
access to physicians for immediate intervention
sadly, doubt of ALS provider’s reports about severity of airway/illness
3/
unforeseen delays in triage / business of ED access to physicians for immediate intervention sadly, doubt of ALS provider’s reports about severity of airway/illness 3/
Paramedics are trained extensively in emergency airway rescue, and can bridge a crucial gap in patient care for emergent or crashing airways. Fear of use of paralytics should not be the hard stop - this can get fixed with mandating intubation standards, continuing ed, etc 4/
In summary, to do the job right you need all the tools at your disposal. Why allow ALS to have multiple intubation adjuncts, cric kits, and sedation, but leave out the paralytic? Raise the standards of education / intubation requirements / continuing ed - it’s best for the pt. /5
