New Intubation Method Emerging From A Terror Attack in Israel

50% of EMS initial attempts of intubation in the field fail. When Gastroenterologist volunteer encountered a severely injured casualty from a terror attack in Israel, he sets out to change the practice of emergency airway management.

“My name is Ishay Benuri. I am a pediatric gastroenterologist, married and father of seven amazing children, and I reside in the City of David, Jerusalem.

“I live next to the Old City and am a volunteer first responder with United Hatzalah. Unfortunately, I encounter many trauma cases including many terror attacks, the most recent of which was this past Saturday when a stabbing attack occurred in the old city. Whenever I respond to one of these attacks, and whenever I treat a patient, I always review the situation in my mind after the fact and try to assess what I could have done better.”

One such instance lead Benuri to create an entirely new method for intubating patients. The incident occurred on November 5th, 2014. There was a car ramming attack in the near Zvil square on Highway One next to the old city. At this attack, there were two locations where people were injured and those in need of emergency care lay injured on the streets. Benuri arrived at the scene in under a minute and understood it was a terror attack as he saw the soldiers running and one of them shouted, “the terrorist has been neutralized and is laying on the street.”

“I rushed to the most severely injured victim, a wounded teenager who was unconscious. I began attempting to secure the patient’s airway spinal column and open his airway while stabilizing his neck, but due to the injury it was very difficult to intubate. After inserting the laryngoscope and assuring that it was in the proper position, the endotracheal tube I introduced entered his esophagus instead of his trachea. When I realized that I was unable to intubate him properly, I switched to alternative methods utilizing a BVM mask. I was able to keep the patient alive and breathing for 7-10 minutes until the ambulance was able to arrive and take over treatment during transport to the hospital. The speedy delivery of oxygen

allowed the victim to survive an extra 48 hours, which his family regarded as a great miracle as it enabled them to say goodbye and come to terms with the situation.

I learned that day to search for a solution that will prevent the difficulties that I experienced in the field. When I began to research the topic, I was confronted with statistics that shocked me. I found out that 50% of EMS initial attempts of intubation in the field fail. That is far too much in my opinion. The intubation method that we are using today are outdated and simply not effective enough in the field. Almost as worrisome is that emergent hospital intubations also have a failure rate of up to 30%, even with advanced digital imaging, which is also staggeringly high,” Benuri added.

Part of the problem Benuri recognized is that the methods of intubation as well as the apparatus used in the procedure have not been updated in a very long time. Since the 1940’s, when Macintosh developed the method, not much has changed. With more than 50 million intubations done worldwide annually, many of which are done in emergency situations, Benuri felt that this failure rate is simply too high.

After a year of research I developed and patented a device that is presented here:

I therefore felt a certain confidence that I would be able to make some improvement and innovate a new method for the intubation process as well.

Over the past two-and-a-half years, I made progress and developed a new model of the laryngoscope that will help EMS teams in the field, as well as doctors and nurses in hospitals perform the intubation process with more success. Less than a month ago I posted the new intubation method on YouTube. A medical device presented on YouTube, usually receives no more than several thousand entries over an elongated period of time. Over the past 3 weeks, there have been well over 10,000, which astonished me. I was very touched by the realization that my quest to improve the survival of the of the severely sick or injured is shared by many others.”

Benuri explained how his volunteering helped put him in the proper frame of mind to innovate the new device. “United Hatzalah is special because they invite EMTs, paramedics, and Doctors, from all fields to work to come together and respond to emergencies. Each of these people bring with them the expertise that they acquire in their profession and apply them to the mission of savign lives. So when we take a gastroenterologists and put him in EMS situations and he is among the first responders at a trauma scene he looks at that scene with the expertise that he has acquired from his own specialty and that enables applying techniques and possibilities that would have never been utilized by medical personnel accustomed to the routine practice of EMS. Since I use loops to grab objects in the gastrointestinal system, it was only natural for me to utilize a loop here as well and make the intubation process easier by putting a loop at the end of the laryngoscope which grabs the endotracheal tube and diverts its natural direction from the esophagus to the trachea.”

The loop is added to the laryngoscope can also enable successful intubation when visualization is disturbed by secretion or bleeding, since a small magnetic strip connected to the plastic loop can adhere to a dedicated endotracheal tube, thus enabling blind intubation. This process creates a situation in which the tube slides cleanly in the trachea and significantly cuts down, if not eliminating altogether, the ability for the tube to slip into the esophagus. Through tests done on specially designed medical mannequins, with the intubation process being done by people who have never done an intubation before, the success rate was 100% at intubating the patient.

The patent for the new design is protected by a Notice of Allowance, from the Israeli patent office and a PCT protects it internationally. Benuri completely self-funded the development of the device.

“United Hatzalah is always thinking out of the box, and utilizing new ideas from its volunteer base of 3,200 EMS responders to improve medical techniques and medical technology. Dov Maisel, the Vice President of International Operations developed a new model for the BVM a few years back that is more compact and easier to use. This type of development and continual effort to improve EMS treatment is one of the things that makes United Hatzalah unique, and I am happy to be a part of this organization, whose innovate thinking I very much share,” said Benuri.

“I see both myself and the organization as being representative of the goodness of Israel and fulfilling the mission that G-d intended for us when he brought us out of Egypt some 3,300 years ago. We are here to make the world a better place and help our fellow man, and that is what both I and United Hatzalah are dedicated to.