The use of rapid sequence intubation by ambulance paramedics for patients with severe head injury

Abstract

Objective: To determine the effects of rapid sequence intubation in patients with severe head injury performed by paramedics on a helicopter emergency medical service. Methods: The patient care records for patients with severe head injury who underwent rapid sequence intubation between November 1999 and February 2002 (inclusive) were examined. Data were extracted on the demographics of the patients, as well as the physiological changes before and after rapid sequence intubation. Results: There were 122 patients with severe head injury evaluated at the scene during the study period. Rapid sequence intubation was attempted in 110 patients and was successful in 107 (97%). Intubation was associated with improvements in systolic blood pressure, oxygen saturation and end‐tidal carbon dioxide levels, compared with baseline levels. Conclusion: Rapid sequence intubation in patients with severe head injury may be safely undertaken by helicopter‐based ambulance paramedics and is associated with improvements in oxygenation, ventilation and blood pressure. Further studies of this skill undertaken by road‐based paramedics are warranted.

Critical care paramedics: where is the evidence? a systematic review

“…While there is no national training programme or curriculum for UK-CCPs, most UK-CCPs have additional competencies beyond that of UK paramedics, such as procedural sedation, joint or fracture reduction, and invasive interventions such as thoracostomy (authors’ unpublished data, 2012). By contrast with some of their colleagues in Australia14 or North America,15 UK-CCPs are currently not able to undertake RSI independently 12. Within the authors’ institution (South Western Ambulance Service), UK-CCPs are dispatched to severely ill or injured patients only, either by helicopter or car, and regular participation in clinical governance measures is mandatory 17…”

“…Concerns regarding the risk of detrimental effects have led to the conclusion that only physicians should undertake certain interventions, such as rapid sequence induction (RSI) of anaesthesia and tracheal intubation 4 11 12. Others would argue that it is not the professional group of the prehospital provider that determines capability but clinical competency, and therefore, well trained and experienced paramedics should be able to provide an equivalent level of prehospital critical care to physicians 13 14. Paramedics subspecialising in the delivery of prehospital critical care have become established in North America, mainly as flight paramedics on helicopters, providing interhospital transfers and/or primary scene responses 15.…”

“…Paramedics subspecialising in the delivery of prehospital critical care have become established in North America, mainly as flight paramedics on helicopters, providing interhospital transfers and/or primary scene responses 15. In parts of Australia, mobile intensive care ambulance (MICA) paramedics are dispatched to patients with suspected major trauma, either by car or helicopter 14. Similar models exist in South Africa and New Zealand, and efforts to improve prehospital critical care in the UK have resulted in an increasing number of critical care paramedics (UK-CCPs) over recent years 16.…”

Paramedic rapid sequence intubation in patients with non-traumatic coma

“…In Victoria, Australia, paramedic RSI was introduced in 1999 for airway management of comatose patients prior to transport by the helicopter emergency medical service (EMS) 8. Between 2005 and 2008, paramedic RSI was introduced to road-based paramedic practice in the context of a randomised controlled trial in patients with TBI in which paramedic RSI at the scene was compared with transport and subsequent intubation by a physician in the emergency department 2.…”

Prehospital airway management

“…There is an evidence-based consensus that endotracheal intubation is a useful technique for practitioners with a high case load and adjunctive anaesthetic agents—for example, some rotary wing services 9. However, there is no evidence to support intubation as a baseline skill for all prehospital providers, particularly those with a low case exposure.…”