EMS technology is ever-evolving, especially when it comes to airway management. We asked our Facebook community to engage in a little crystal-balling and tell us what they see as the future of airway and breathing management in EMS. Add your own thoughts in the member comments.
Combitubes
“We really need to push Combitubes. You get 100 percent placement, they don’t dislodge as easily as ET tubes and the only advantage to an ET tube over a Combitube is the four drugs you can put down them. However, with IO you really have no need to put drugs down an ET tube anyhow.” - Michael Grant
“...Combitubes can be a bit more time-consuming than ET tubes. Yes, you get better placement with Combitubes; however, to an EMT assisting a paramedic with a respiratory distress victim, fidgeting with the Combitube can be a bit of a hassle. I have seen it happen before.” - Krystin Cedarwall
“I feel the future of airway management will most likely be Combitubes. They are easier to use, have few contraindications and are less time-consuming. But before we all go to just using Combitubes, I think things such as the S.A.L.T. device will dramatically change the intubation process. I’m pretty sure laryngoscopes will be a thing of the past.” - Josh Falgoust
ET and King
“ETI is still the gold standard of airway management. With proper initial and ongoing training, experience, use of medications when indicated and use of technology, ETI will continue to be the gold standard. Video/optical assisted ETI is indicated in most intubation attempts. - Fred Ellinger
“ETT is the best airway... People just need more training and work on their skills instead of jumping on the “It’s easy and idiot-proof” bandwagon.” - Jason Highside Tuck
“Combitubes cause an awful lot of trauma, especially with the inexperienced. If we must move away from the ETT, the King LT seems a better option. However, if intubation is still going to be the gold standard, then I think instead of trying to find better alternatives, why not spend just as much research effort on identifying the mistakes being made and trying to be proactive in increasing the success rates? Whether it’s the provider’s technique, on an assist device, the S.A.L.T., video laryngoscopes or whatever.” - Bill Davis
LMA
“...I like the path EMS is taking, starting with the basics, and having the options of ET, CPAP, alternative airways such as the King or Combi or the last-ditch cricothyrotomy. I believe LMAs will find a place in EMS someday.” - Jordyn Mehl
“LMAs have no place in EMS. They are to be used in surgery where a patient had been NPO for 12 hours and had a pre-dose of atropine to dry secretions. - Jason Highside Tuck
Back to basics
“There needs to be a strong push to start with the basic airway adjuncts. Start simple. BVM, oral and/or nasal airway, then consider the advanced more invasive airways. Everyone gets over-excited and rarely tries the simple fix first. Remember, we have to crawl and walk before we can run.” - Tiggo Nickles
“Back to the basics — doing things right. How about we learn how to effectively use a BVM with an OPA or NPA on adults AND kids? Start there, and train EVERYONE who will have contact with the patient. In more than 20 years of work, I have found that if I can bag someone effectively with no problems, then I’m much more likely to get the results I need without having to resort to something more complex and possibly unnecessary. ET tubes and intubation have their place and hopefully always will.” - John Cork
REALLY back to basics
“Unfortunately I see us reverting to BLS only. Recent studies in Australia and the United States are finding outcomes actually improve with no intubations vs. intubation. It’s something we don’t do enough. I want us to keep the skill but have found that the people who control our licenses are wanting more BLS. OPA and BVM. I think more emphasis should be placed on capnography, rate, rhythym and quality. I find that too many people hyperventilate, increasing intrathroasic pressures and impeding heart performance and stroke volume. I am a believer in using all my tools to save a patient. We need a BVM that can control how fast and how much air we put into a patient.” - Matt Carr
“Waiting to unload the pt for ‘one last try’ on the tube. I believe BLS will be the trend of the future. Scene times are always extended for multiple tube attempts. I don’t think ETT will ever — nor do I think it should — go away, but I think the emphasis will be on OPA/NPA BVM and transport until camera-assisted intubation is standard of care.” - Rez Medic
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