“If we have the technology, why would we not want it in the field, especially if it’s the best thing for the patient?” asked Los Angeles Fire Department (LAFD) Medical Director Dr. Marc Cohen, who has seen firsthand the challenges of managing airways in both hospital and field settings.
When the Emergency Medical Services (EMS) Bureau sought funding from the LAFD Foundation for video laryngoscopes, the purpose was far greater than just adopting a new piece of equipment. “Securing these video laryngoscopes was only possible because of general operating support from our donors,” said LAFD Foundation President Liz Lin.
Contributions from LAFD Foundation donors became the catalyst for transforming LAFD paramedicine and setting a new standard for emergency response.
Last year, members of the LAFD’s EMS Bureau team responded to a call for an individual who was shot in the face on Skid Row.
Upon the patient’s arrival at the hospital, the trauma team’s priority was securing their airway and ensuring they could breathe. However, the immense bleeding and anatomic changes posed significant challenges.
Before entering the hospital an emergency physician, moving quickly, attempted to secure the airway using direct laryngoscopy. This method of intubation involves looking down the patient’s airway to insert a breathing tube. When the airway is obscured, as is often the case when intubation is required, this task can be particularly difficult due to little or no visibility.
Near the doctor was a video laryngoscope (VL), an intubation tool that provides full airway visualization despite anatomic obstructions. After two unsuccessful attempts at direct laryngoscopy, complicated by misplacing the breathing tube into the esophagus, the doctor forewent the old method and opted to use the VL.
The airway was easily visible for everyone in the room to see, and the patient was intubated within seconds.
That’s when EMS Bureau Captain Jacob Raabe and Dr. Rombod “Rom” Rahimian realized that video laryngoscopy was safer for the patient, faster for the user, and eliminated the complications that arise with traditional direct laryngoscopy.
Under the mentorship of Dr. Cohen, Dr. Rom helped champion the VL initiative, recognizing airway management as a cornerstone of EMS.
In critical situations, like severe trauma or cardiac arrest, the ability to quickly secure an airway can be the difference between life and death. However, performing this procedure without direct visualization of the airway often led to complications.
The VL has allowed paramedics to visualize the airway in high definition to improve success and make intubation a safer procedure.
VL technology was already well established in the Emergency Department, Intensive Care Unit, and Operating Room, but the challenge was bringing it into the pre-hospital setting where conditions are significantly more unpredictable and resources are limited. The purchase of VLs by the LAFD Foundation positioned the LAFD as the largest department in the country to employ this modern technology.
“With the Foundation’s backing, we’ve been able to take this truly life-saving technology where it’s needed most,” Dr. Rom emphasized.
As the second-largest fire-based EMS agency in the world, the next step was rolling out the training to more than 1,000 paramedics. The response was overwhelmingly positive.
“The paramedics were riveted,” said Dr. Cohen, who attended some of the trainings with Dr. Rom and Captain Raabe. “This is the kind of engagement you rarely see in this field.”
In his 30 years with the Los Angeles Fire Department (LAFD), the proudest moment of Chief Scott LaRue’s career was being part of the team that secured VLs for the LAFD’s EMS Bureau. He emphasized that the journey of introducing these innovative tools to the LAFD began with Dr. Rom, who initially joined the Department as an EMS Bureau fellow with a passion for pre-hospital care.
“Bringing in the video laryngoscope is the biggest thing we’ve done for paramedicine since introducing 12-lead electrocardiograms (EKGs),” Chief LaRue explained. “We’re saving lives with this piece of equipment.”
The VL technology was first tested on the LAFD’s Advanced Provider Response Units (APRUs), and the feedback was immediate. “This is an amazing tool for us,” one paramedic remarked. “I’ve only used it once in a cardiac arrest, but I love it.”
“It’s like going from low-definition to high-definition,” another shared. “I was able to easily intubate the patient without ever losing visualization,” another added.
The LAFD’s commitment to advancing paramedicine has continued far beyond the initial rollout of the VLs. EMS leadership has implemented a robust quality improvement process, tracking usage, gathering feedback, and continuously refining their approach. This feedback loop ensures that they are constantly improving, which in turn elevates patient outcomes.
“You have LAFD members that are very invested in their practice, and they’re invested in their patients. They want to perform at their highest level, and we want to help them achieve that,” Dr. Rom shared.
As the LAFD continues to lead the charge in EMS innovation, other agencies will undoubtedly follow suit, ensuring that paramedics across the country have the tools and training needed to save lives with confidence.
The groundbreaking success of VLs for LAFD paramedics serves as a powerful reminder that “pre-hospital medicine is medicine,” as Dr. Cohen said. Paramedicine is a vital, dynamic field—one where continuous improvement, technological advancement, and a shared commitment to patient care make all the difference.
