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Medical Experts Suggest Intubation Procedures Could Help More Children

LOS ANGELES ( – Medical experts across the Southland are calling for changes to intubation procedures they say prevent paramedics from using potentially lifesaving technology on choking children.

Paramedics have two options to remove an obstruction from a child's airway in an emergency: They can put an oxygen mask over a child's face or insert a tube into his or her throat and force oxygen directly into the lungs.

A decision was made in the late 1990s not to allow L.A. County paramedics to use tubes on kids after county officials conducted a landmark and controversial study. When paramedics were called to a child who couldn't breathe on an odd day of the month, they were told they must use a mask – on the even days, a tube.

The study found the tubes could slip out of place and sometimes ended up in the esophagus by mistake. L.A. County officials decided to remove the tubes for kids from all of its ambulances as a result. Many other counties have since followed suit.

L.A. County's medical director at the time of the decades-old decision was Sam Stratton.

"We found that there's no difference in the two methods as far as the outcome of the child," he said.

San Bernardino County Fire Chief Mark Hartwig, who is also a paramedic, says technological advances have all but eliminated the complications L.A. County found in its research, however.

Tiny cameras with powerful lights now allow paramedics to see into the child's throat to make sure they slip the tube in between the vocal cords and into the windpipe. And a new technology called capnography sounds an alarm the moment a tube slips out of place.

"You insert the tube right through the cords there," he explained. "As you can see, it slips right into the cords."

Chief Hartwig says paramedics always start with an oxygen mask – but if the child's airway is blocked and the mask isn't working, the only option to provide life-saving oxygen his paramedics have is to insert a tube past the obstruction.

San Bernardino County's medical director ordered the tubes for kids removed from ambulances there in October. Hartwig wants them back.

Asked if he thought kids' lives could be saved if the tubes were placed back in ambulances, he said plainly: "Of course."

L.A. City Fire Department's Medical Director Mark Eckstine says it's time for another study in light of the new technology.

"I would love to do it," he said. "Because there is nothing worse than being that provider with a child who doesn't survive and think, 'Were it not for having this tool, he would have had a better outcome.'"

Pediatrician and former paramedic Daved van Stralen, Riverside County's former emergency medical director, is also calling for change.

"When tubes come back to the rigs, children who have been dying will no longer die," van Stralen said. "And they will go home to their families to play, they will go home to their families to grow up, they'll go to school, they'll have jobs, they'll have families of their own … I believe that, I know it."

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