A common theme around hospitals and the latest ACLS guidelines suggest that intubation should no longer be considered a high priority. Instead it is now recommended that high-quality CPR and early defibrillation take priority over all other ALS interventions. I for one feel differently when it comes to pre-hospital care.

According to the American Heart Association, other procedures like IV access and medication adminstration can be performed before intubation if adequate ventillations are taking place by means of a bag-valve-mask. While I certainly agree with the concept, I do not feel that it is very practical for situations when EMS is involved. Unlike hospital settings, EMS workers have to deal with bumpy roads, tight corners, environmental factors and limited room in most ambulances. It can be extremely difficult to maintain a good seal and adequately ventilate a patient in those conditions.

Early intubation frees up hands, limits the amount of time suction is needed and allows paramedics to focus on interventions like chest compressions, defibrillation and medication adminstration.

I am not saying that I completely dissagree with the new ACLS guidelines. I simply feel that pre-hospital care was not taken into consideration when they were released. I would be interested to see how much of the Heart Association’s research was done on pre-hospital cases.

As always, feel free to e-mail me with any questions or comments.