'ER' and intubation: Everyone's a critic!
In its 14 seasons on the air, NBC's path-blazing medical drama, "ER," may have taught you the signs of stroke, the importance of wearing seat belts and an appreciation for the perils of workplace romance. But if you were watching the show -- or any other TV medical drama -- for tips on proper intubation technique, a new study suggests you should have looked elsewhere. (And no, I do NOT mean "St. Elsewhere.")
Among physicians-in-training in Canada, a study published recently in the journal Resuscitation found that fewer than half positioned a patient's head and neck properly to prepare for the introduction of an emergency airway. A survey prepared for the Canadian Resuscitation Institute set out to explore why so many patients were positioned poorly prior to intubation. Many trainees reported they had received limited supervision or had effectively taught themselves how to intubate a patient, reports Dr. Peter G. Brindley of the University of Alberta Medical Center's Critical Care Division.
So how did physician trainees learn this skill, which can spell the difference between life and death? After "trial and error," Brindley and his colleagues were shocked to learn that medical dramas on TV were the second most often cited source of training of intubation skills. And the good docs at Chicago's County General -- the cast of "ER" -- were "by far the most common source," Brindley reports in a letter to the editors of Resuscitation.
And did "ER" -- hailed for tackling many medical problems with earnest verisimilitude -- do a good job?
Well, no, according to Dr. Brindley. In the 42 episodes that made up the 12th and 13th seasons of "ER," Brindley counted 41 intubation attempts. Of those, 22 were conducted on "patients" with no sign of neck or spinal injury and could be seen and assessed in video by resuscitation specialists (thank goodness you can now watch back episodes on your computer). Of those, none were done correctly -- which, by the way, involves flexion of the lower cervical spine, extension of the atlanto-occipital joint, and raising the ears anterior to the sternum. A few met one of those three criteria, but none met all three.
That "ER" showcases such poor technique, in spite of the fact that the show "retains numerous medical experts," suggests to Brindley and colleagues that optimal airway positioning for intubation is "poorly appreciated" among those who train emergency department physicians. The audit "highlighted the perils of leaving pulmonary resuscitation to the inexperienced or the unsupervised."
Or to people glued to their TVs on Thursday nights hoping, as this blogger has, for Dr. Ross to come back. (I'll bet HE knew how to put an emergency airway in correctly!)
-- Melissa Healy