title: Prehospital anaesthesia by a physician and paramedic critical care team in Southwest England.
abstract: OBJECTIVE
  Prehospital anaesthesia using rapid sequence induction (RSI) is carried out internationally and in the UK despite equivocal evidence of clinical benefit. It is a core skill of the prehospital critical care service established by the Great Western Ambulance Service NHS Trust (GWAS) in 2008. This retrospective analysis of the service's first 150 prehospital RSIs describes intubation success rates and complications, thereby contributing towards the ongoing debate on its role and safety.
  
  
  METHODS
  Within the GWAS critical care team, RSI is only carried out in the presence of a qualified physician and critical care paramedic (CCP). The role of the intubating practitioner is interchangeable between physician and CCP. Data were collected retrospectively from RSI audit forms and electronic patient monitor printouts.
  
  
  RESULTS
  GWAS physician and CCP teams undertook 150 prehospital RSIs between June 2008 and August 2011. The intubation success rate was 82, 91 and 97% for the first, second and third attempts, respectively. Successful intubation on the first attempt was achieved in 58 (85%) and 64 (78%) patients for physicians and CCPs, respectively. RSI complications included hypoxaemia (10.2%), hypotension (9.7%) and bradycardia (1.3%).
  
  
  CONCLUSIONS
  Prehospital RSI can be carried out safely, with intubation success rates and complications comparable with RSI in the emergency department. The variation in the intubation success rates between individual practitioners highlights the importance of ongoing performance monitoring, coupled with high standards of clinical governance and training.
authors.affiliation: aAcademic Department of Emergency Care, Emergency Department, University Hospitals Bristol NHS Foundation Trust bDepartment of Health and Clinical Research, Faculty of Health and Life Sciences, University of the West of England, Bristol, UK.
authors.forename: Johannes
authors.initials: J
authors.lastname: von Vopelius-Feldt
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Benger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000458:organization & administration; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003422:Critical Care / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004739:England; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D010820:Physicians / Q000458:organization & administration; D012189:Retrospective Studies; D055815:Young Adult