Emergency physician-verified out-of-hospital intubation: Miss rates by paramedics

James Jones, Michael Murphy, Robert L. Dickson, Geoff G. Somerville, Edward J. Brizendine

Research output: Contribution to journalArticle

159 Citations (Scopus)

Abstract

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 (ETCO2), 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 (ETCO2 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.

Original languageEnglish
Pages (from-to)707-709
Number of pages3
JournalAcademic Emergency Medicine
Volume11
Issue number6
DOIs
StatePublished - Jun 2004

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Allied Health Personnel
Intubation
Emergencies
Physicians
Equipment and Supplies
Emergency Medical Technicians
Urban Hospitals
Wounds and Injuries
Emergency Medical Services
Trachea
Carbon Dioxide
Teaching Hospitals
Physical Examination
Observational Studies
Hospital Emergency Service
Prospective Studies

Keywords

  • Airway
  • Intubation
  • Laryngoscopy
  • Out-of-hospital
  • Prehospital

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency physician-verified out-of-hospital intubation : Miss rates by paramedics. / Jones, James; Murphy, Michael; Dickson, Robert L.; Somerville, Geoff G.; Brizendine, Edward J.

In: Academic Emergency Medicine, Vol. 11, No. 6, 06.2004, p. 707-709.

Research output: Contribution to journalArticle

Jones, James ; Murphy, Michael ; Dickson, Robert L. ; Somerville, Geoff G. ; Brizendine, Edward J. / Emergency physician-verified out-of-hospital intubation : Miss rates by paramedics. In: Academic Emergency Medicine. 2004 ; Vol. 11, No. 6. pp. 707-709.
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