June 22nd, 2010 
Sean 
I cringe every time that I read an article regarding governing boards considering pulling intubation from a paramedic’s scope of practice. It floors me how such an easy (yes easy) and essential skill can find itself on the chopping block time and time again. What I don’t understand, is why there are paramedics out there that can’t seem to get it right.
I took a job as a paramedic supervisor about 3 years ago. Since then, the amount of calls that I run have decreased by more than half. I went from intubating multiple times a month to once every 4-6 months. While my anxiety level has gone up in fear of being out of practice, I still manage to successfully intubate pretty much every time. It’s just not that hard.
Let’s take a look at other skills that we perform far more often than intubation and compare the level of difficulty.
I’ll start with the everyday task of starting IVs. This is arguably more difficult than intubating. The only reason people don’t freak out over it is because it’s not a life-or-death procedure. There are far more people out there with bad veins than there are people with difficult airways. Paramedics miss a hell of a lot more IVs than they do intubation attempts. Sure, you can argue that the volume of people that require IVs is much greater, therefore the numbers are skewed. But think about this: If we start so many IVs every day, shouldn’t we be really good at it? Likewise, if intubation is a skill that is considered to be difficult AND we don’t get to do it very often, then why do so many areas have success rates in the high 90 percentile?
I’ll even take it down a notch and compare intubation to a BLS skill, the traction splint. I will argue any day that applying a traction splint is far more difficult than intubating. Dealing with a screaming patient who just broke a femur exceeds visualizing vocal cords hands down.
I really wish that we would look at solutions to these problems other than taking away the skill. If we have people in the field that can’t handle the simple task of securing an airway, then maybe they shouldn’t be paramedics.
Anyone care to argue?
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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.
