title: Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice.
abstract: BACKGROUND
  In the West Midlands region of the UK, delivery of pre-hospital care has been remodelled through introduction of a 24 h Medical Emergency Response Incident Team (MERIT). Teams including physicians and critical care paramedics (CCP) are deployed to incidents on land-based and helicopter-based platforms. Clinical practice, including delivery of rapid sequence induction of anaesthesia (RSI), is underpinned by standard operating procedures (SOP). This study describes the first 12 months experience of prehospital RSI in the MERIT scheme in the West Midlands.
  
  
  METHODS
  Retrospective review of the MERIT clinical database for the 12 months following the launch of the scheme. Data was collected relating to the number of RSIs performed; indication for RSI; number of intubation attempts; grade of view on laryngoscopy and the base speciality/grade of the operator performing intubation.
  
  
  RESULTS
  MERIT teams were activated 1619 times, attending scene in 1029 cases. RSI was performed 142 times (13.80% of scene attendances). There was one recorded case of failure to intubate requiring insertion of a supraglottic airway device (0.70%). In over a third of RSI cases, CCPs performed laryngoscopy and intubation (n=53, 37.32%). Proficiency of obtaining Grade I view at laryngoscopy was similar for physicians (74.70%) and CCPs (77.36%). Intubation was successful at the first attempt in over 90% of cases.
  
  
  CONCLUSIONS
  This study demonstrates that operation within a system that provides high levels of exposure, underpinned by comprehensive and robust training and governance frameworks, promotes levels of performance in successful prehospital RSI regardless of base speciality or profession.
authors.affiliation: Academic Department of Anaesthesia, Critical Care, Pain & Resuscitation, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: McQueen
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Brierley Hill, West Midlands, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Crombie
authors.affiliation: West Midlands CARE Team, Bristol Road Ambulance Station, Birmingham, West Midlands, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hulme
authors.affiliation: Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Brierley Hill, West Midlands, UK.
authors.forename: Stef
authors.initials: S
authors.lastname: Cormack
authors.affiliation: West Midlands Deanery, St Chad's Court, Birmingham, West Midlands, UK.
authors.forename: Nageena
authors.initials: N
authors.lastname: Hussain
authors.affiliation: West Midlands Deanery, St Chad's Court, Birmingham, West Midlands, UK.
authors.forename: Frank
authors.initials: F
authors.lastname: Ludwig
authors.affiliation: West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, West Midlands, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Wheaton
mesh_terms: D000488:Allied Health Personnel; D000552:Ambulances; D000758:Anesthesia / Q000379:methods*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004739:England; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D010348:Patient Care Team / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Trauma, research; major trauma management; paramedics, extended roles; prehospital care; rsi