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Emergency Physician–Verified Out‐of‐hospital Intubation: Miss Rates by Paramedics
Author(s) -
Jones James H.,
Murphy Michael P.,
Dickson Robert L.,
Somerville Geoff G.,
Brizendine Edward J.
Publication year - 2004
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2003.12.026
Subject(s) - medicine , intubation , emergency department , endotracheal intubation , emergency medicine , emergency medical services , endotracheal tube , emergency physician , observational study , medical emergency , anesthesia , nursing
Objectives: To prospectively quantify the number of unrecognized missed out‐of‐hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement. Methods: The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end‐tidal carbon dioxide (ETCO 2 ), and physical examination. Results: During the six‐month study period, 208 out‐of‐hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO 2 or EDD) was used in three cases (25%) and not used in nine cases (75%). Conclusions: The rate of unrecognized, misplaced out‐of‐hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out‐of‐hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department.