Unrecognized esophageal intubations

I couldn't begin to count how many hundreds of intubations I performed in 30+ years.  Anyone who attempts tracheal intubation understands that inadvertent intubation of the esophagus can occur - but it should never remain unrecognized.  An article in ProPublica provides some distressing information in that regard:

In the summer of 2018, Dr. Nick Asselin was doing research on cardiac arrests in Rhode Island when he made a horrifying discovery.  Hospital records showed patients had been arriving by ambulance with misplaced breathing tubes, sending air into their stomachs instead of their lungs, essentially suffocating them. At first, he said, there were four cases, then seven. More trickled in.

By the time Asselin presented his findings to a state panel in mid-March, he’d identified 11 patients with so-called esophageal intubations that had gone unrecognized by EMS providers over the previous 2 ½ years. All 11 had died.

Jason M. Rhodes, the state Health Department’s EMS chief, recommended a way to tackle the problem that aligned with national standards: restricting the practice of placing those tubes to paramedics, the most highly trained EMS providers. To Asselin and his colleagues at Brown University’s Department of Emergency Medicine, that approach made sense. Rhode Island is the only state in New England, and among a minority nationally, that allows non-paramedics to intubate patients.

But a coalition of Rhode Island’s EMS practitioners, municipal fire chiefs and a city mayor pushed back. They said the “ET tube,” as it’s known, saves lives. Taking it away, as one fire chief put it, “would be a sin.” A lobbyist for the firefighters union lambasted the doctors for not consulting more of its members before proposing such changes, saying, “We’re the experts ... not the doctors!”

The article is a discouraging longread detailing how the arguments over deciding best practice deteriorated into a turf battle. 

Photo credit Kayana Szymczak for ProPublica.