By 1980, the luer connector had become standard in the United States for connecting catheters to plastic tubing, according to a detailed history of the luer that MD+DI published in 2012. In Europe, however, the Record (also known as Rekord) was most widely used.
That might not have seemed like much of a problem, until a deadly airshow accident on Aug. 28, 1988, at the U.S. Ramstein Air Base near Kaiserslautern, West Germany. Three aircraft of the Italian Air Force display team collided in mid-air during their display, killing all three pilots, along with 67 spectators. Hundreds of other spectators were injured in the resulting explosion.
The incompatibility of the luer and Record connectors used on intravenous catheters by the American military and German paramedics compounded the magnitude of the disaster, writes Jim Brown, formerly a manager at Colder Products Company. According to Brown, the luer style became the global standard and the Record connector fell into disuse largely in response to the Ramstein airshow accident, although a single standard wasn't codified until 1995.
Adding to the popularity and widespread use of the luer connector was the fact that the devices were simple and secure. But, as Brown points out, the popularity raised the risk of misconnection between the various applications for which the connector is used. He cites a 2000 report published by the European Committee for Standardization that points out that in a coronary care unit there are as many as 40 connectors on the devices used with a single patient.
"And the widespread use of standard luer connectors is the reason for misconnections," Brown writes. "Devices, components, and materials that are used within a specific application will continue to come from different suppliers, so standardization within, but not across, applications will be the best solution."
Manufacturers of luer connectors have found ways to reduce the risk of misconnections though, primarily through matching connectors for each media and purpose. Manufacturers have adopted unique closure and fitting applications including color-coding, textured closures, and audible indicators, along with the use of radio frequency identification signals to warn of misconnections and to confirm good connections.