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Prehospital Rapid Sequence Intubation in an Emergency Medical Services System with Two Advanced Life Support Providers

Published online by Cambridge University Press:  28 June 2012

Mark A. Merlin ,
Huma Safdar ,
Susan Calabrese ,
Alex Lewinsky ,
Joseph Manfre ,
Stephen Van Pelt  and
Andreia Marques-Baptista
Mark A. Merlin*
Affiliation:
Assistant Professor Emergency Medicine and Pediatrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; EMS/Critical Care Transport Medical Director, Robert Wood Johnson University Hospital; New Jersey EMS Fellowship Director, New Brunswick, New Jersey, USA
Huma Safdar
Affiliation:
Resident in Emergency Medicine, New York, New York, USA
Susan Calabrese
Affiliation:
EMS Education Coordinator, Paramedic, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
Alex Lewinsky
Affiliation:
Paramedic, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
Joseph Manfre
Affiliation:
Paramedic, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
Stephen Van Pelt
Affiliation:
Department of Medical Education, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
Andreia Marques-Baptista
Affiliation:
NJ EMS/Disaster Medicine Fellow, Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
*
1 Robert Wood Johnson Place Medical Education Building Room 104, New Brunswick New Jersey 08901, USA E-mail: merlinma@umdnj.edu
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Abstract

Objective:

A rapid sequence intubation (RSI) method was introduced to a university-based emergency medical services (EMS) system. This is a report of the initial experience with the first 50 patients in a unique, two-tiered, two-advanced life support (ALS) providers system.

Methods:

The data were evaluated prospectively after an extensive RSI training period, consisting of didactic information and skills performance. Fifty consecutive patient records that documented the procedure were abstracted. Data abstracted included end-tidal CO2, heart rate, blood pressure, and pulse oximetry at various time intervals. Intubation success rates and number of attempts were documented. The consistency of proper documentation also was noted on patient care records.

Results:

No differences were noted in heart rate prior to RSI and one and five minutes after the RSI procedure was begun. No differences in blood pressure at one and five minutes were noted. Statistically significant improvements were found in pulse oximetry comparing prior to RSI and one minute after (p < 0.001; 95% CI = 3.15–11.41) as well as prior to RSI and five minutes after RSI was started (p < 0.0002; 95% CI = 4.60–13.33). No differences were observed in end-tidal CO2 at one and five minutes. Overall intubation success rate was 96%, with 82% on first attempt and 92% on two or less attempts. Documentation for individual vitals was consistently <75%.

Conclusions:

Patients had no significant worsening of vital signs during the RSI procedure and mild improvement in pulse oximetry. Intubation success rates were consistent with national averages. Proper documentation was lacking in more than one quarter of the charts. These data add to a body of literature that raises further concerns regarding prehospital RSI.

Keywords

airwayemergency medical servicesintubationprehospitalsuccinylcholine
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 25 , Issue 4 , August 2010 , pp. 341 - 345
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2010

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