title: Tracheal intubation practice and maintaining skill competency: survey of pediatric emergency department medical directors.
abstract: OBJECTIVE
  One of the most critical resuscitation skills in pediatric emergency medicine is establishing and maintaining a patent airway. This often requires tracheal intubation (TI). The purpose of this survey study was to determine the practice of TI in pediatric emergency departments (PEDs) and the methods used by PED medical directors to maintain TI competency among PED physicians.
  
  
  METHODS
  This is an observational survey study. Medical directors of PEDs were surveyed through e-mail (http://web-online-surveys.com). There were 20 survey questions: 4 yes/no and 16 multiple choice.
  
  
  RESULTS
  Of the 108 PED medical directors who were surveyed, 61 (57%) completed the questionnaire. The mean number of TI per PED for 1 year was 63.7; SD, 79.3; median, 37; range, 3 to 400. The mean percentage of TI that were rapid sequence intubations was 76%; SD, 19.8%; median, 83%; range, 30% to 100%. The physician types most commonly performing TI on nontrauma versus trauma patients were as follows: pediatric emergency medicine, 50 (82%) versus 43 (70%); emergency medicine, 4 (7%) versus 4 (7%); and anesthesiology, 1 (2%) versus 4 (7%). The physician types most commonly consulted for difficult airway patients were: anesthesiology, 40 (66%); and pediatric critical care, 14 (23%). Alternative or rescue airway equipment/procedures available to PED were as follows: laryngeal mask airway (LMA), 50 (90%); needle cricothyroidotomy, 47 (77%); fiberoptic scope, 34 (56%); and tracheal tube introducer, 22 (36%). There were 38 (62%) PED medical directors who judged the number of TI opportunities to be inadequate to maintain TI competency among their physicians. The following activities reported as required for remedial training or to maintain TI competency were: pediatric advanced life support/advanced pediatric life support courses, 42 (69%); simulation training, 29 (48%); perform TI under the supervision of an anesthesiologist, 23 (38%); advance airway course, 21 (34%); and/or none, 1 (2%).
  
  
  CONCLUSIONS
  Most PED TI for both nontrauma and trauma patients were performed by PED physicians. Most of these were rapid sequence intubations. The number of TI per PED had a large range. Most PED medical directors judged this number to be inadequate to maintain TI competency. Didactic activities to maintain TI skills were most common, but many other activities were used.
authors.affiliation: Pediatric Department, Medical University of South Carolina, SC 29425, USA. losek@musc.edu
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Losek
authors.forename: Lauren R
authors.initials: LR
authors.lastname: Olson
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Dobson
authors.forename: Peter W
authors.initials: PW
authors.lastname: Glaeser
mesh_terms: D002983:Clinical Competence; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000706:statistics & numerical data*; D008511:Medicine; D010372:Pediatrics; D008486:Physician Executives; D013038:Specialization; D011795:Surveys and Questionnaires