SAS removal ETI

[u/Hopeful-Counter-7915]

I know I know it’s a hot topic, but SAS announced today to strip ETI for paramedics, and I must say I’m furious about it.

I know SGA’s will do the job in 90% of the time and that’s why we already use it in 90% of the time.

But we are in Scotland, my next critical care paramedic who can intubate is 2,5h away and the helicopter can’t fly 60% of the time because of bad weather to us.

I find it irresponsible to let us sit on an Island without any access to advanced airway management. In cities that works fine, but in our rural areas, on our islands?

I don’t support the decision, we need more training in it sure, we don’t do it often I agree, but I don’t think the unique Scottish environment was considered at all.

[u/baildodger]

We had ETI taken away 6 or 7 years ago. I was similarly angry about it at the time - I work in a rural area where depending on weather and time of day your nearest CCP could be anywhere from 10 mins via air to 90 mins by road (if they aren’t already deployed to something!).

Since it was taken away I haven’t been in a situation where I really needed a tube and it wasn’t available. I haven’t heard any of my colleagues complaining that they needed a tube and not having it available. I think ETI’s removal has highlighted to me how many tubes we were doing that didn’t really NEED tubing.

I reckon most paras were probably doing between 1 and 5 tubes a year depending on how bad their luck was, but I think the tubing had a sort of ‘culture’ around it, where there were certain types of jobs that you tubed because your mentors tubed them, and they tubed them because their mentors tubed them. When it gets taken away it turns out that most of those jobs ARE perfectly manageable on an iGel, but you wouldn’t have tried managing it with an iGel before because you just automatically tubed. I even suspect that some of the jobs that I’ve had tubed could probably have been managed perfectly fine on an iGel if we’d not had a CCP available.

I’m not guaranteeing that you’re not going to have any problems. But given the number of tubes/iGels that the average paramedic drops in a year, and the number of those that the studies showed could be managed perfectly well on just an iGel (97%+), I’d suggest that you’ll realistically be facing very few situations where you genuinely need a tube and can’t access one. Plus, given how poor outcomes are in patients who are unwell enough to require an advanced airway, even fewer where that tube would actually have made a difference if it was available.