Uh… Duh? I don’t understand how this is even a question.
Did people seriously think that waiting to help someone who can’t breathe would have a more favorable outcome?
The issue is not “oh, that will not do good”,but more “does the risk outweight the benefit or not”.
Intubating a patient is always a delicate procedure, doing so with an emergency patient (who obviously has not fasted, has a acute reason for being intubated,etc.) is even more difficult and doing so prehospitally is even more risky. It’s dark, cramped, loud, there are other enviromental factors (I once failed because my hands were shaking to much from the cold), etc. And,in case of a medically assisted intubation before you can intubate you kick out the patients breathing reflexes so they will sure as hell die if you do not suceed. A so called “cannot oxygenate (=Cannot ventilate)/cannot intubate” situation is a nightmarish situation which gives seasoned anaesthesists nightmares. . This makes intubation a skill hard to master - you need around 100 intubations to learn it and 15 per year to keep that skill. Seperatly for adults and children. (The later is even hard to uphold for anaesthesists)
While out tooling has improved and made it FAR easier and safer (videolaryngoskopy, capnography,etc.) than 20 years ago, it is still debatable how safe it is when performed prehospitally. (A recent German study showed a first pass rate - the rate how sucessful a intubation is on first try- of 60% for all professions,including paramedics, anaesthesists,etc.)
Additionally it takes a lot of time - which will occupy a team. While in hospital more people can do other things at the same time. So it’s worth considering “hey,we take 10min of scene time to tube a patient. A hospital is 10 min away. Is jt worth to make a run there and tube then with a better enviroment, while other people can do labs,run blood,etc.?”
The question therefore is more than valid and not as easy to answer - it is always a consideration of patient status, location, resources and enviromental factors. (How bad is the patient? How hard will he be to intubate? How far away from hospital am I? Do I have a intensely trained team I work with every day or am I a solo responder working with a EMT crew that is barely holding it together? How sure am I that I can intubate this patient? How up to the task am I really? How is the truck,the scene?) It’s often a very tough decision. And I saw countless patients die from providers developing a “tuberitis” - the tube needs to go in, no matter what.
Don’t get me wrong - the UK for example has a lack of prehospitally available qualified providers who can properly intubate and I am a old fuck who in doubt will intubate the patient (unless it’s a child, no longer doing these). But I have far more training in that than the average provider. (Currently a high three digit count in the logbook, thanks to working in anaesthesia part time for years)
Source: Am a critical care paramedic, for almost 25 in EMS, have done research on this.
Not all trauma patients “can’t breath”. And this is just an AI model predicting which severe trauma patients would benefit from intubation.
Trauma patients urgently requiring a breathing tube are more likely to survive if the tube is inserted before arriving at hospital compared to insertion afterwards, suggests a modelling study led by researchers at UCL and the Severn Major Trauma Network.
That doesn’t indicate the patient “can’t breath”. Trauma victims can be intubated to help them manage polytrauma.
If a breathing tube is “urgently required”, then the patient is having trouble breathing in some way.
“can’t breath” v. trouble breathing aren’t the same.
