title: Emergency physician-verified out-of-hospital intubation: miss rates by paramedics.
abstract: OBJECTIVE
  To prospectively quantify the number of unrecognized missed out-of-hospital intubations by ground paramedics using emergency physician verification as the criterion standard for verification of endotracheal tube placement.
  
  
  METHODS
  The authors performed an observational, prospective study of consecutive intubated patients arriving by ground emergency medical services to two urban teaching hospitals. Endotracheal tube placement was verified by emergency physicians and evaluated by using a combination of direct visualization, esophageal detector device (EDD), colorimetric end-tidal carbon dioxide (ETCO(2)), and physical examination.
  
  
  RESULTS
  During the six-month study period, 208 out-of-hospital intubations by ground paramedics were enrolled, which included 160 (76.9%) medical patients and 48 (23.1%) trauma patients. A total of 12 (5.8%) endotracheal tubes were incorrectly placed outside the trachea. This comprised ten (6.3%) medical patients and two (4.2%) trauma patients. Of the 12 misplaced endotracheal tubes, a verification device (ETCO(2) or EDD) was used in three cases (25%) and not used in nine cases (75%).
  
  
  CONCLUSIONS
  The rate of unrecognized, misplaced out-of-hospital intubations in this urban, midwestern setting was 5.8%. This is more consistent with results of prior out-of-hospital studies that used field verification and is discordant with the only other study to exclusively use emergency physician verification performed on arrival to the emergency department.
authors.affiliation: Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA. jhjones@iupui.edu
authors.forename: James H
authors.initials: JH
authors.lastname: Jones
authors.forename: Michael P
authors.initials: MP
authors.lastname: Murphy
authors.forename: Robert L
authors.initials: RL
authors.lastname: Dickson
authors.forename: Geoff G
authors.initials: GG
authors.lastname: Somerville
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Brizendine
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004635:Emergency Medicine / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D007196:Indiana; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000706:statistics & numerical data*; D011446:Prospective Studies