Ok, I admit that the current intubation debate is, on some level, about intubation.

But it is also about much more than that. I can remember having discussions in the early 2000s about if medics should keep this skill. Before that, I know the topic was discussed at great lengths in the mid-1990s as well. Pre-hospital intubation as a skill has been debated for a long time.

I have an opinion. I’m not going to share it, but I do have one. For me the issue at hand is bigger. If you are on the side that hard core supports pre-hospital intubation, you have an obstacle to overcome. That obstacle is evidence based research. I don’t say that to sound snooty. It is simply the way things are. Now, if you are in this camp, you are fortunate in that there doesn’t appear to be enough evidence to absolutely show that the skill should be pulled. The problem is that there is LESS evidence that indicates we should keep the skill. Even the Emergency Cardiovascular Care (ECC) Committee has been de-emphasizing the skill for all clinical levels for almost 15 years now.

To top this off, if you read the blog posts and opinion articles out there, there is an awful lot of mudslinging going on. I have read comments from physicians that basically said ALL paramedics are harmful and the profession should “go away.” I have also read comments from street level providers who throw rocks at “eggheads who sit in offices and make clinical policy.” This debate (at least for some) isn’t about pre-hospital intubation. It has become about who feels like they know what is “best” for pre-hospital care. Additionally, it has become about who can prove their point better and get signatures on petitions.

What saddens me is that I see policy makers and physicians using scientific research to support their points (rightly or wrongly), but what we often get from EMS providers is largely anecdotal at best. It’s the argument of “People will die if you take this skill away from us.” I honestly don’t know if that is true, but what I do know is that I have not seen many pre-hospital providers produce or reference a single scholarly work to support their claims. The debate becomes anecdote vs. science and if it continues, science will eventually win. It always does. It doesn’t matter if the debate is about pre-hospital intubation, long spine board immobilization or orange stripes on ambulances. Science will always trump anecdotes, petitions and opinions. We, as pre-hospital providers, must realize this if we are ever to successfully do battle for the things we are passionate about.

Passion is good. That response from your gut is a good thing, but you must move beyond that. When you get that gut response, that’s just the beginning of your journey. Now it’s time to do the research. Learn stuff you don’t already know. This will either make you feel more strongly about the issue or soften the edge as you discover new viewpoints. Either way you will be in a better place to argue your position.

Once you have done the research, you are ready to do battle. Science vs. science, but don’t forget that it doesn’t have to be “all or none.” After doing your homework, you might discover that a compromise might be in order. It might look something like this, “I have found research that indicates that there is value in intubating patients with airway burns, but I can’t find any evidence to support intubation in pediatric cardiac arrest. Let’s consider keeping the skill for airway burns and other traumas, but maybe limit its use in pediatric cardiac arrest patients.” It might also help to cite the articles you researched. In this article, I am not advocating for or against the treatment position statement I just made; it is merely an example of how one might compromise their once strong and emotion charged opinion.

You see, the intubation debate is not just about intubation. It is about that and every future debate in pre-hospital medicine. If we don’t learn to fight science with science, we will continue to lose battles that we are passionate about.

Don’t be afraid to challenge your own ideas and stay safe out there!


Tim lives in Columbia, SC with his wife and four children and is a contract instructor with DistanceCME. He is the lead faculty for public safety related leadership courses at Columbia College (SC). Tim has over 20 years of public safety and leadership experience and volunteers as the Executive Director of the South Carolina Institute of Leadership and Success (http://www.scleaderinstitute.com). Tim can be contacted by emailing: tim@scleaderinstitute.com.