I think that by definition the emergent airway falls into the realm of emergency medicine because the EM physician is going to be faced with the patient first when they come into the emergency room. As you know, airway comes first. Anesthesia is often to as a lifestyle specialty because of the more regular hours, more time off, etc. So anesthesia isn't always readily available at many hospitals. I'm not saying that the emergent airway doesn't fall in the realm of anesthesia as well -- after all, all of the codes on the floor or in the unit at our hospital are tubed by anesthesia. The patients in the emergency room are ours -- that includes the traumas, the cardiac arrests, burn patients, respiratory failure, etc.
Now in terms of literature -- the references you cite are regarding mostly paramedic intubations -- paramedic success rate is going to be much worse for many reasons -- field intubations are by definition done in an uncontrolled environment; paramedics don't have access (oftentimes) to RSI as an adjunct; paramedics don't intubate on a daily basis; etc. However, it seems that you are trying to equate paramedics to emergency medicine physicians who are residency trained in emergency medicine. Probably more relevant studies regarding emergency department intubations come out of NEAR (National Emergency Airway Registry) -- the definitive registry looking at this specific issue. (
http://www.near.edu) The registry demonstrates an overall success rate of 99% for RSI in more than 4,000 patients. The concern is that 1% -- luckily, most of these folks can be bagged. I'm also glad to have LMAs as a backup. I've also done crikes, used lighted stylets, used the fiberoptic -- I haven't used, but I'm excited about some products that are out there like the glide scope (
http://www.saturnbiomedical.com/home.htm), the shikani seeking stylet, intubating LMAs.
In terms of intubations, I feel like they're pretty easy to do in the average patient who you can prepare for -- what makes them hard is the situation, the environment, the thick/short neck, the blood gushing out of their mouth, the transected trachea, the missing lower jaw, etc. While I admit that I would probably rather have anesthesia (perhaps Ovassapian) intubate me, if I have a burn injury to my cords, an expanding neck hematoma, respiratory arrest, ACE angioedema, etc. I would rather not wait for anesthesia to excuse themself from the OR find their way to the ER in order intubate me -- especially with the EM physician (hopefully Ron Walls) readily available -- just please give me lots of benzos.
