title: The use of TRISS methodology to validate prehospital intubation by urban EMS providers.
abstract: The purpose of this study was to determine the impact of field orotracheal intubation (OI) by urban emergency medical technician-paramedics (EMT-Ps) on outcome compared with trauma score and injury severity score (TRISS) expectations. The records of all trauma patients intubated by EMT-Ps or hospital personnel were abstracted for OI attempts/ successes, use of neuromuscular blockade (NMB), scene time, discharge neurological status, and hospital survival compared with TRISS. EMT-Ps attempted 43% of all intubations; 81% were successful versus 98% by hospital staff (P < .05). NMB was used by 76% of hospital intubations versus none by EMS (P < .05). Scene time was 10.3 +/- 3.2 minutes versus 11.6 +/- 2.1 for patients intubated by emergency medical services (EMS) and hospital staff (P < .05). Sixty percent of patients intubated by EMS versus 68% by hospital staff had good/moderate discharge neurological status. Survival for patients intubated by EMS versus hospital staff was 11% and 40%, respectively, compared with 2% and 45% expected by TRISS. Field OI by urban EMT-Ps has a favorable impact on survival with good neurological outcome (P < .05).
authors.affiliation: Washington Hospital Center, Washington, DC, USA.
authors.forename: H
authors.initials: H
authors.lastname: Frankel
authors.forename: G
authors.initials: G
authors.lastname: Rozycki
authors.forename: H
authors.initials: H
authors.lastname: Champion
authors.forename: J D
authors.initials: JD
authors.lastname: Harviel
authors.forename: R
authors.initials: R
authors.lastname: Bass
mesh_terms: D000328:Adult; D000776:Anesthesiology; D004219:District of Columbia; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008505:Medical Staff, Hospital; D009460:Neurologic Examination; D019148:Neuromuscular Blockade; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014187:Transportation of Patients; D014193:Trauma Centers; D015599:Trauma Severity Indices; D019037:Urban Health Services