Expert: Ronald Levy, M.D. - 4/26/2007

Question
When my husband was waiting to have surgery several different people came in to talk to him, his two doctors,
the person who would administer the anesthesia, etc. Then,
a young man came in and told us that he was studying to be a paramedic and needed so much time in the classroom and so much time in the hospital to graduate. Then, he said that he would be intubating my husband. I had just looked up what that meant when I was looking us anesthesia, but my husband did not know what it meant.  He had my husband open his mouth and stick out his tongue and he looked down his throat and I told my husband what intubate meant. Then, he said that he had brought a paper for my hushand to sign allowing him to do this and my husband signed the paper.  Then, he came to me and asked me if I would sign it as a witness, so I signed it to.  Then, he left.  This upset me because I had read that when you intubate someone
if you get the tube in the wrong place you can block the person's airway and I hoped that the young man knew what he was doing. I did think that the anesthesiologist was going to be supervising him... I hope he did.  I wished last night that I had asked him him if he had ever intubated anyone before and I really think that if they are going to have a student do something like that, then they should ask you several weeks before the surgery if you would consent to having a student do that and not wait until they are getting ready to take someone to surgery
and have someone come in and drop this in your lap and get you to sign a paper allowing it.  Do you think the way they handled this is normal procedure?  

Answer
First, to alleviate your worries, the paramedic was ABSOLUTELY supervised as he did it and we have numerous ways to make sure the tube is in the right place (and if it isn't, it is easy enough to fix). Now for your other questions...

Each state is different. In many states, students (be they paramedic, CRNA, medical students, etc) don't get a separate consent (so you would never know that he was intubated by someone other than the anesthesiologist). So consider yourself lucky that at least you were informed. In ALL cases, a fully trained anesthesiologist is present and supervising the intubation and making sure that everything goes well. As for asking weeks in advance, this is not practical because you would not know on any given day whether a paramedic, etc would be doing the intubation. Remeber also that you have the right to request no students/residents etc and the surgical team should have no problem with that and it will not negatively affect your care.

Hope this helps,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston