If an EMT encounters a patient with an obstructed tracheostomy tube and no effective ventilation/oxygenation is possible, can the tube be removed?

In a situation where an EMT encounters a patient with an obstructed tracheostomy tube and effective ventilation or oxygenation is not possible, it is appropriate to remove the obstructed tube. The rationale behind this action lies in the urgency of restoring the airway and ensuring adequate ventilation for the patient. A tracheostomy provides an airway directly into the trachea; however, if the tube is obstructed due to secretions, mucus plugs, or other blockages and rescue techniques do not succeed, removing the tube allows for direct access to the airway.

Once the tube is removed, the EMT can perform additional interventions to clear the obstruction, such as suctioning the airway, or they may create an artificial airway if necessary. In emergency care, the primary goal is to secure the patient’s airway, and removing an obstructed tracheostomy tube can be a critical step in achieving that objective. This approach aligns with protocols that prioritize patient survival and immediate care interventions over preserving the existing airway device when it is non-functional.