Prehospital rapid sequence intubation in an emergency medical services system with two advanced life support providers.
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.
Merlin
Mark A
MA
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, New Jersey 08901, USA. merlinma@umdnj.edu
Safdar
Huma
H
Calabrese
Susan
S
Lewinsky
Alex
A
Manfre
Joseph
J
Van Pelt
Stephen
S
Marques-Baptista
Andreia
A
D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000379:methods; D013390:Succinylcholine / Q000008:administration & dosage*; D016896:Treatment Outcome
D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine