- © 2004 Canadian Medical Association or its licensors
The recommendation of Richard Verbeek and associates1 that paramedics not intubate patients with SARS-like symptoms in the prehospital setting and that such patients be transported to the nearest emergency department derives from the flawed premise that all situations necessitating definitive airway management are identical in terms of the level of inherent threat to paramedics. This is not the case.
Part of the preparation for performing any endotracheal intubation in the field is a risk–benefit assessment of the procedure in that instance. The paramedic must determine whether the patient is likely to benefit from the procedure, whether the patient is likely to suffer an adverse outcome without it and whether performing the procedure in the field poses an unacceptable risk to paramedics and others.
The difficulty posed by SARS is that the risk of disease transmission during endotracheal intubation seems high, yet it cannot be quantified, and reports of widespread vector transmission with resultant disease outbreaks among medical staff in attendance at these procedures are anecdotal.
Ultimately, I believe that the final decision on intubation of patients with SARS-like symptoms should rest with those charged with the responsibility for performing the procedure, the advanced care paramedics, just as it does for all other procedures and types of care that they render every day. Paramedics are well trained and generally proficient in making critical decisions under enormously stressful conditions. Furthermore, they are held accountable for their actions and accept this scrutiny as part of their work environment.
Stephen L. Urszenyi Advanced Care Paramedic Toronto EMS Toronto, Ont.
Reference
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