Field Endotracheal Intubation by Paramedical Personnel

Drug-Assisted Intubation in the Prehospital Setting (Resource Document to NAEMSP Position Statement)

“…8,9 Endotracheal intubation of the awake or unrelaxed prehospital patient has been recognized as a difficult procedure because of the presence of intact protective airway reflexes. 10−12 Sedation-facilitated intubation and nasotracheal intubation have been proposed for these patients in both prehospital and in-hospital settings but with mixed results.…”

Prehospital Endotracheal Intubation: Elemental or Detrimental?

“…drug administration, interventions traditionally provided in the in-hospital setting by expert physician specialists [1][2][3][4][5][6][7][8][9]. Paramedic skill portfolios ranged from basic spinal immobilization and extremity splinting to the more advanced skills of electrocardiographic (EKG) interpretation, defibrillation attempts, ETI, i.v.…”

“…The skill of ETI had become the definitive airway control for most critically ill and injured patients, be they in the operating room, in the early phases of an intensive care unit (ICU) hospitalization, or in the out-of-hospital setting [2][3][4][5][6][7][8][9]11]. The presumed presence of significant physiological derangements (e.g., hypoxemia, hypercarbia, hypoperfusion) in cardiopulmonary arrest, head injury and hemorrhagic states made ETI an intuitive procedure to perform as soon as feasible in the critically ill and injured [4,5,9,11].…”

“…In addition, there were other clinical care imperatives (e.g., airway protection, ventilatory control, end-tidal carbon monoxide monitoring, drug administration and airway suctioning) that drove a strong philosophy that EMS personnel should provide a definitive airway as soon as possible in the out-of-hospital setting for cardiopulmonary arrest, severe trauma and other life-threatening emergencies [2][3][4][5][6][7][8][9]11]. Nevertheless, although these invasive skills were now being provided by paramedics and nurses, for the most part they were still being delegated under the direction of accountable physician supervisor experts in out-of-hospital care [12].…”

An Evaluation of Out-of-hospital Advanced Airway Management in an Urban Setting

“…Placement of endotracheal tubes (ETTs) by paramedics in the outof-hospital setting has been considered a standard of care for a long time, and a number of studies have shown this airway technique to be safe [1][2][3] and to improve survival in a variety of clinical settings. 4,5 A relatively recent increase in the attention focused on out-of-hospital interventions and the effect they have on patient outcomes has raised important issues and called into question some practices, such as endotracheal intubation, that many have considered standard out-of-hospital practice.…”