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We agree that unrecognized esophageal intubation should be a “never event.” The prehospital endotracheal tube placement confirmation technique with ultrasound proposed by White-Dzuro et al1 is very thorough and intended to improve patient care. From a practical standpoint, however, we want to highlight operational, educational, and other implementation challenges in order to continue dialogue and innovation in the prehospital setting.
Emergency Medical Services (EMS) is very heterogenous in the United States, and each system is designed to best serve their communities based on available resources. An EMS response to a critically ill patient requiring airway intervention will ideally involve a large team of prehospital providers, whereas in reality only a couple of providers are caring for the patient in the first 10 min of care.2,3 In these cases, airway management may occur before additional team members arrive on scene, with one provider at the head of …
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