Can Paramedics Perform Tracheostomies or Cricothyrotomies?

In the field of emergency medical services, paramedics are trained to manage a wide range of critical situations, from stabilizing patients to providing life-saving interventions. However, the question of whether paramedics can perform tracheostomies or cricothyrotomies is often a point of confusion. Let's delve into the details.

Tracheostomy: A Complex Surgical Procedure

Tracheostomy is a surgical procedure that involves creating an opening in the neck and inserting a tube directly into the trachea to ensure a clear airway. This procedure is typically performed in a medical facility with specialized equipment and trained personnel. While paramedics play a crucial role in stabilizing patients and maintaining airway patency, they generally are not trained to perform tracheostomies in the field.

In emergency situations, paramedics may use alternative techniques to secure the airway, such as intubation or using advanced airway devices. These methods are usually employed to maintain airway patency temporarily until the patient can receive more definitive care in a hospital setting.

Cricothyrotomy: An Emergency Airway Alternative

In situations where tracheostomy is not feasible, paramedics may perform a cricothyrotomy. This procedure, while similar to a tracheostomy, is performed under emergency conditions to establish a secure airway.

A cricothyrotomy involves cutting through the cricothyroid membrane to insert a breathing tube. This technique is often used as a last resort when other airway management techniques have failed. While it is a life-saving procedure, it is significantly different from a tracheostomy in terms of the location and depth of the incision.

Paramedic Expertise and Training

Paramedics with advanced training, known as advanced practice paramedics, may have the skills to perform an emergency cricothyrotomy. However, the capability to perform this procedure varies by region and scope of practice. The training and procedures involved are subject to local protocols and regulations, which can differ significantly.

To provide a comprehensive understanding, I consulted my paramedic husband, who has served for 37 years. He explained that during a cricothyrotomy, the patient is usually already intubated or in a non-awake state where they do not require additional sedation. The procedure is performed to secure a critical airway when other methods have failed.

Paramedic Training and Practice in the US

From a US perspective, paramedics are trained annually or more on "front of neck airway access," a technique commonly known as a surgical cricothyrotomy. The Weingart "Scalpel-finger-bougie" method is considered the best approach for the pre-hospital environment.

In a system with approximately 30,000 calls per year, out of 999 and 150 providers, only about 1-3 cases require a cricothyrotomy each year. Most cases are managed effectively with endotracheal (ET) intubation or other techniques.

It is essential to emphasize that the frequency of these procedures is low and that paramedics focus on providing the best possible care within their scope of practice. Training and standardized protocols ensure that critical interventions are performed safely and efficiently.

Conclusion

In summary, while paramedics do not typically perform tracheostomies, they are equipped to perform cricothyrotomies under emergency conditions. The training and practice of these procedures vary widely depending on the region and the specific scope of practice. The goal of these interventions is to ensure a secure airway for patients in critical situations.