Interesting... Some of the responses or lack thereof have surprised me. Apparently we have a lot of different philosophical views on airway management in the hospital and the overall nature/skillset/purpose of EM. Well, call me a minority but I'm sorry guys and girls... I don't nor have I ever bought into the old derogatory descriptor "jack of all trades and master of none" applied by some to describe our specialty. I'm not a generalist. I'm a specialist. I'm also valued in the hospital because of my unique skillset as an EM doc.
Where I was trained, I was taught that we are indeed specialists in emergency medicine. I was taught that we are masters of the emergent airway, masters at resuscitation, masters at recognizing, diagnosing and managing the emergent and life threatening pathologies that span all subspecialties. We are masters at integration. I was trained that I should be just as good at managing these disease processes as other specialist in those early critical hours that take place in the ED. This was the purpose in creation of our "specialty". As for airway... I was trained to intubate messy, crashing, unstable patients. I'm trained to use a variety of tools including but not limited to laryngoscopes, cmacs, glidescopes, bougies, froyas, LMAs, intubating LMAs, fiberoptic bronchoscopes, blind intubations, retrograde intubations (at least in theory and on a cadaver, lol) , lighted stylet assisted intubations, awake intubation, rapid sequence intubations, and if need be... surgical cric and percutaneous trach. If there's one thing I've learned to respect, it's the airway. There is just so much that can go wrong, but if I can't ventilate a patient, then chances are another "specialist" would have a very hard time ventilating them also. I'm in no way the best, nor do I claim to be, but I was trained well and I'm confident in my abilities without being overconfident.
Does anesthesia intubate more than we do on the daily basis? Sure they do. I respect their sheer depth of expertise. They are better at fiberoptics than I am along with a ton of other stuff but I don't think that makes them a master at emergent airways. I don't think they intubate the traumatic, bleeding, crashing, rapidly decompensating pts as frequently as I do. That's just being realistic. They don't live in the ER. Unless you guys are working and training in a much different hospital environment, I have gone most of my career for the most part...never seeing anesthesia. We never consulted them in the ED in residency more than one one occasion that I can recall for airway assistance. I have consulted them a total of one time in my professional career and they never showed up until the airway was established (angioedema/cric). Actually, their CRNA showed up 30 mins later and looked incredibly grateful that he hadn't been around when the s*** hit the fan. I guess what I'm saying is... if you are so readily willing to hand the airway management mantle to anesthesia then where are they when it matters? I think they are great at what they do, in the environment where they do it but where is anesthesia at most floor or ICU codes? Who responds to most of those? The ER doc or the ICU doc. Have you ever known an anesthesiologist to be available or around at 2 or 3am in the ER when things get hairy? I haven't. I'll tell you who I call in those situations when I need a second set of hands or some assistance with a fiberoptic approach.... I call the pulmonary/cc guys. I'd personally rather have them on standby than anyone else. If I can't get them I'd rather have an EM trained colleague. That's just me. Everyone has their own skill set in the hospital and truth be told, nobody should be trying to be a cowboy thinking they are the best at something. Egos aside, it should always be what's best for the pt. If that's call anesthesia for backup in your facility then so be it but that hasn't been my experience. They are just never available.
So there, I said it. I don't think anesthesia is the intubation king. I think pulmonary/cc (or anesthesia/cc) working in the ICU and EM intubate more messy, crashing patients in suboptimal conditions than anesthesia does. That being said, I think they obviously intubate more frequently and are more facile at sophisticated and alternate approaches to airway management but I don't think that necessarily always helps them very much with intubation scenarios in the ER.