Paramedics and Pediatric Intubation


Riverside County paramedics are no longer allowed to insert breathing tubes in children under nine years old. Dr. Humberto Ochoa, medical director for the Riverside County EMS Agency, suspended the procedure on April 27. Los Angeles and Orange Counties have not used the procedure for years, however nearby San Bernardino County is still allowed to practice intubation on children.

The need to intubate a young child, technically called pediatric endotracheal intubation, is not a common practice among paramedics. The procedure is not simple and if done incorrectly (using the wrong size equipment, placing the tube in the esophagus instead of the trachea) carries a high risk of serious complications.

Instead of pediatric intubations paramedics are instructed to use bag valve masks. Ochoa referenced a well-known study in Los Angeles, albeit ten years old, that showed using bag valve masks outside of a hospital setting to help children breathe was just as effective as intubation.

Dr. Daniel Davis, professor of clinical medicine at UC San Diego and regional medical director for Mercy Air Medical Services, said that for every argument that suggests the procedure should not be used outside hospitals, there is another that suggests it should.

Davis noted that technology is always changing in regards to the well-known study Ochoa spoke of. For example, there is a device available to paramedics that monitors the concentration of carbon dioxide in exhaled breath and can show if the tube has been inserted incorrectly. While Davis agrees the mask is generally effective, there are situations, such as an allergic reaction which could cause the airway to swell shut before reaching the hospital, where intubation would be the better choice.

Each procedure has its pros and cons and has caused much debate. What if the nearest hospital is far away and the situation called for intubation, shouldn’t paramedics be able to go ahead with the procedure? What is the protocol at your department?