Prehospital rapid-sequence intubation: a pilot training program.
OBJECTIVE
To develop a training program enabling paramedics to use sedation and paralytic medications to facilitate endotracheal intubation in patients who otherwise could not be successfully intubated.


METHODS
Paramedics underwent a training program consisting of six hours of didactic education, two four-hour mannequin labs, one four-hour animal intubation lab, and operating room experience. Rapid-sequence intubation (RSI) runs were reviewed for appropriateness in patient selection and medication use. Non-RSI runs were reviewed to determine whether appropriate patients were being missed. Intubation success rates continue to be followed. Long-term quality assurance includes monthly run reviews, periodic quizzes, and unannounced on-site practical tests.


RESULTS
101 patients have been intubated using RSI, including medical, trauma, pediatric, and adult cases. Of all patients receiving RSI drugs, 100 of 101 were successfully intubated. There were no undetected esophageal intubations. Paramedics were able to demonstrate proper patient selection and appropriately administer RSI medications. The use of sheep labs was a critical component of this training because it permitted multiple intubations in a live model possessing an airway quite similar to that of the human. The gum elastic bougie was felt to be critical in the intubation of three patients.


CONCLUSIONS
This RSI training model can serve as a template for other agencies seeking to implement RSI. Limitations of this model include the availability of live animal labs and the expense of conducting the training. Intense medical director involvement has been key to the success of this prehospital RSI program.
Kaye
Kory
K
Region Hospital EMS, St Paul, Minnesota, USA. kory.l.kaye@healthpartners.com
Frascone
Ralph J
RJ
Held
Timothy
T
D000402:Airway Obstruction / Q000150:complications / Q000628:therapy*; D000818:Animals; D002983:Clinical Competence; D000075202:Contraindications; D004496:Education, Continuing / Q000379:methods*; D004634:Emergency Medical Technicians / Q000193:education*; D005045:Etomidate / Q000627:therapeutic use*; D015600:Glasgow Coma Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007442:Intubation, Intratracheal / Q000379:methods*; D008348:Manikins; D008910:Minnesota; D009467:Neuromuscular Depolarizing Agents / Q000627:therapeutic use*; D009873:Operating Rooms; D010865:Pilot Projects; D016730:Program Development; D013390:Succinylcholine / Q000627:therapeutic use*; D013663:Teaching / Q000379:methods; D013874:Thiopental / Q000627:therapeutic use*; D017749:Total Quality Management; D014474:Unconsciousness / Q000150:complications; D014922:Wisconsin
D006993:Hypnotics and Sedatives; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D013874:Thiopental; D005045:Etomidate