Inexperienced Paramedic Incorrectly Intubates Patient

This case involves a middle-aged female with a history of diabetes who suffered cardiac arrest in her home. Emergency medical services arrived on the scene within 15 minutes and the decision was made to intubate the patient. The paramedic who intubated the patient was new to the team and had no prior experience intubating patients in the field. He accidentally intubated the patient esophageally and she expired in transport to the hospital.

Question(s) For Expert Witness

1. What is your experience intubating patients in the field?

2. What safeguards exist to mitigate the complications that occurred in this case?

Expert Witness Response E-117897

As a paramedic, I use intubation as a means of securing the patient's airway. As part of continuing education, I complete an intubation skill-check every two years. I have completed or participated in a significant number of intubation procedures over my career in EMS. As a paramedic instructor, I have instructed students on intubation technique in mannequins and in live patients. The gold standard in verification of tube placement is watching and documenting the tube passing the vocal cords. Next, we would assess for chest rise and fall to indicate that the tube is in the trachea. Third, we would auscultate over the epigastrium for air going into the stomach. We would then auscultate the lung field to assess for the passage of air in and out of the lungs. We can also assess capnometry or pulse oximetry, however, that assumes that the conditions for cellular respiration and perfusion exist. The protocols under which the paramedic operated would list which assessment tools that were to be used to detect an esophageal intubation. At a minimum, the provider should have been monitoring heart rate, skin color, pulse oximetry, capnometry and assessing lung before and after each movement of the patient.