Prehospital use of a prototype esophageal detection device: a word of caution!

OBJECTIVE: To determine the effectiveness of a prototype esophageal detection device (EDD) during use in the prehospital setting. DESIGN/SETTING: Prospective convenience sample in a prehospital setting. POPULATION: Intubated adult patients. INTERVENTIONS: The study device was used to determine esophageal or endotracheal placement of endotracheal tubes in intubated patients. Clinical means were used to confirm tube location. A data sheet was completed for each patient. RESULTS: Of 105 uses of the device, 17 of 17 esophageal tubes were identified correctly (100% sensitivity). Sixty-five of 88 tracheal tubes were correctly identified (78% specificity). There was intermediate reinflation of the device on 13 of the 65 tracheal tubes. Five tests were indeterminate. There were no false negatives (negative predictive value 100%), but 18 false positives (positive predictive value 48%). CONCLUSION: This prototype EDD adequately identifies esophageally placed endotracheal tubes. Correct identification of endotracheally placed tubes was less sensitive. Much work needs to be done regarding the use of negative aspiration devices to identify placement of endotracheal tubes.

Kaisen. EMS as theater of the streets. Part two.

Passing an EMT or paramedic course is a considerable achievement, as you have had to acquire a huge and fascinating volume of medical knowledge. But, did the program teach you acting skills? Acting? Whoever said that EMS professionals need to know anything about acting? We submit that you do; prehospital workers can gain many unanticipated benefits by using various acting skills and tactics in the field. One such benefit is the avoidance of the "complacency trap," or the boredom that can develop if you adopt the viewpoint that one crisis is much like another. But, more importantly, you will be more effective at delivering prehospital care, and you'll have a lot more fun on the job.