A video posted to the unofficial U.S. Marine Corps u/USMC Reddit channel on Tuesday has brought on a firestorm of comments about what happens when Marines get bored.
The video in question appears to show a dangerous attempt at demonstrating the use of an i-gel — an obnoxious-looking advanced airway device which the Marine, or a Navy corpsman, in the video is seen shoving down the throat of another conscious Marine. As an experienced paramedic who has used an i-gel or two in real life, I can tell you this procedure is a step down from endotracheal intubation and not something that should be taken lightly.
I don’t want to be a party pooper, but here’s the thing: an i-gel is meant to be used as an airway device that helps healthcare personnel breathe for another person or to completely take over their airway. No explanation can justify the amount of risk being taken in the video. For starters, there are zero reasons to train the use of an i-gel on a fully conscious person when there are manikins designed for exactly this purpose.
That being said, almost anyone with proper training can place one of these devices. Without going into exact details, the basic procedure is putting the provided gel on the seat of the i-gel, aligning it with the anatomy of the airway, and then pushing it down the airway until you meet resistance. The catch? The patient needs to be under some type of sedation or, at minimum, have no gag reflex (I apologize for what will happen to the comment section now).
The video posted to Reddit reveals very little about what happened before someone started recording, so we don’t know if any medication was given. But, the second Marine’s reaction is a groan, followed by an attempt to rip it out about three seconds after it was shoved down his throat. Whether he was agreeable to be the subject of the training or was ‘voluntold’ is unknown.
I worked as a paramedic in Minneapolis, Minnesota, for about five years, and have a total of ten years in EMS. I’ve intubated plenty of people as well as placed many i-gels. Here’s the deal: I’ve only ever placed them on unconscious and sedated patients — not someone fully awake.
There is a multitude of possibilities as to why the Marine lying on his back didn’t immediately dry heave or vomit once the i-gel hit the back of his throat. Several types of numbing agents can nullify the gag reflex, or some people just don’t have it.
Subscribe to Task & Purpose today. Get the latest military news and culture in your inbox daily.
Whether it’s the military or EMS, it’s common to practice certain medical interventions on someone else, like IVs or IOs. But, the one thing you don’t practice on a living person is oral or advanced airways because of the dangers associated with them.
Intersurgical, the manufacturer of the i-gel, details the dangers associated with the supraglottic airway in the instruction manual provided with the i-gel.
“Some of the known risks and complications of the use of supraglottic airway devices include laryngospasm, sore throat, trauma to the pharyngolaryngeal framework, gastric insufflation, regurgitation and inhalation of the gastric contents, nerve injuries, vocal cord paralysis, lingual or hypoglossal nerve injuries, tongue numbness, and cyanosis.”
You don’t need an instruction manual to know that’s a bad idea; plenty of kids have shoved a straw too far back and felt the immediate effects. Switch the straw out with a gel pillow, and that’s what is going on in the video. The difference between a straw and an i-gel is one will block vomit and potentially cause airway aspiration while a straw is unlikely to do that.
It’s downright dangerous, and no mother wants a letter home about their kid being braindead following a botched demonstration of an i-gel. Don’t just take my word for it. The manufacturer specifies exactly what not to do with the i-gel:
- Do not use it on a “conscious/semi-conscious patient.”
- Patients not under adequate levels of anesthesia may cough, buck, have excessive salivation, retch, have a laryngospasm, or breath holding.
- Don’t use excessive force to insert the device or nasogastric tube.
- Don’t forcibly remove the i-gel, especially if the patient’s mouth isn’t fully open.
One of the most dangerous things that can happen is laryngospasm, which occurs when a person’s vocal cords snap shut, blocking off the airway or significantly reducing the ability to breathe.
Marines, play with crayons and not advanced airways. Placing an i-gel is a medical procedure that should only be executed in an emergency or in an anesthesia setting to protect the airway.