Is emergency tracheal intubation outside the operating room the responsibility of the anesthesiology department?

At present, there are still many hospitals that retain the anesthesiology department responsible for emergency tracheal intubation throughout the hospital.

In terms of ability, anesthesiologists do have comprehensive knowledge and skills. They are proficient in endotracheal intubation. However, the current situation of the industry is that there is an extreme shortage of anesthesiologists in China. Almost all hospitals are short of anesthesiologists. The existing anesthesiologists are basically overloaded with workload.

Anesthesiologists are not only responsible for anesthesia in the operating room, but also for painless diagnosis and treatment tasks in comfortable medical care such as labor analgesia, painless abortion, and painless gastroscopy. Overall, the various tasks outside the operating room are not easy, and the work content is even more than that in the operating room.

In addition to emergency surgery, doctors on duty also have to deal with emergency tracheal intubation that may come at any time. When they receive a call from the emergency department, they almost jog all the way to the emergency department. After the intubation, the other work is handed over to the emergency department to continue the rescue. If there is a difficult case, they may also join the rescue team.

After tracheal intubation, we have to ask: Is emergency tracheal intubation outside the operating room the task of the anesthesiology department? However, it seems to be a historical legacy.

This matter has to start with the development and nature of anesthesiology:

Decades ago, anesthesiology was a branch of surgery. At that time, the main job of anesthesiologists was to provide anesthesia. However, the anesthesia process is risky, so the work of ensuring the safety of surgical patients fell on anesthesiologists. In addition, ensuring patient safety requires the use of many theories or technologies. For example, endotracheal intubation is a key technology to ensure the safety of the patient's airway.

Over time, anesthesiologists have become more and more proficient in this technology, while the surgeons performing the surgery have become more and more focused on doing the surgery well.

As the saying goes, "use it or lose it," endotracheal intubation technology and first aid technology are mainly concentrated in anesthesiologists, critical care physicians, and emergency physicians.

However, we should not forget one thing: endotracheal intubation technology is not only an important basic skill in the clinical physician and nurse qualification examinations, but also a basic first aid technique that all clinical medical staff must master and be able to perform immediately according to the patient's condition.

In other words, not knowing how to do it is not a reason why you should not undertake the task of intubation.

Another important question: Since intubation is required, the patient must be critically ill. The rescue of critically ill patients is a race against time and life. Even if the anesthesiologist on duty is notified immediately, the anesthesiologist needs to run from the department to the emergency department. The time on the road, the time to prepare intubation items and drugs, the time to perform intubation assessment in the shortest time, and the time to understand the on-site situation, all together, it takes more than two or three minutes.

As we all know, if the patient stops breathing and the heart stops beating, the golden rescue time is only 4 to 6 minutes. If the first person who contacts the patient can intubate the patient, it is possible to save the patient a few precious minutes.

Furthermore, the current medical care is rough and is developing from rough medical care to refined medical care. One of the reasons is that people's awareness of rights protection and high demands for medical care are increasing.

Take tracheal intubation as an example: Does tracheal intubation need to be signed first? Should it be signed by the qualified physician in charge of the intubation?

If a doctor from another department is involved in the diagnosis and treatment, is a consultation necessary?

In addition, is there a possibility of failure in tracheal intubation? In reality, the lack of more intubation equipment outside the operating room and poor muscle relaxation will increase the difficulty of tracheal intubation. If it fails, will it be questioned by emotional family members or even turn into a dispute?

In summary, although it is necessary for anesthesiologists to participate in the in-hospital emergency consultation and rescue of critically ill patients, from a legal perspective, the emergency service model and management system in which anesthesiologists are responsible for all emergency tracheal intubation work in their hospital has service defects.

The key to improving this service is to require the first-visit physician to learn tracheal intubation skills. This will also allow the "First-visit Responsibility System" to be firmly implemented and allow medical care to take a solid step towards refined development.

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