title: Prehospital rapid sequence induction following trauma in the era of regional networks for major trauma.
abstract: OBJECTIVE
  Rapid sequence induction (RSI) provides prompt airway control during emergency evacuation of trauma patients. Physicians may be tasked to travel with paramedic ambulance crews to the scene of injury when RSI is more likely to be required. This study investigates whether there are any differences in the practice of prehospital RSI during emergency retrievals for trauma since the establishment of the regional Major Trauma Network (MTN) in March 2012.
  
  
  METHODS
  A retrospective observational study examined prehospital records for all trauma patients from September 2010 to January 2015 at a Major Trauma Centre in Birmingham, UK. Prehospital physician availability increased from 12 to 24 h after March 2012, and tasking became centralized. Data included demographics, mechanism of injury, crew personnel, and details of RSI. The periods before and after the establishment of the regional MTN were compared.
  
  
  RESULTS
  There were 5244 patients: 1432 (27.3%) before and 3812 (72.7%) after March 2012. Of the patients, 67.2% were male. The most common injuries were road traffic collisions (45.0%). Physicians were more likely to be present after (2345 missions, 61.5%) than before (529 missions, 36.9%) March 2012 (P<0.01). RSI was performed 434 (8.3%) times and was more likely during the latter than the former period [359 (9.4%) vs. 75 (5.2%), P<0.01]. Successful tracheal intubation was achieved in 99% of occasions.
  
  
  CONCLUSIONS
  The establishment of regional MTNs enables centrally tasked, 24-h physician availability for emergency trauma patients. There has been an increase in physician presence on emergency missions and increased frequency of RSI for at-risk trauma patients at times when there may previously have been an unmet requirement.
authors.affiliation: aNational Institute for Health Research, Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital bAcademic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham cMidlands Air Ambulance, Stourbridge, West Midlands, UK.
authors.forename: David N
authors.initials: DN
authors.lastname: Naumann
authors.forename: Aisling
authors.initials: A
authors.lastname: McLaughlin
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Midwinter
authors.forename: Nicholas
authors.initials: N
authors.lastname: Crombie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058109:Airway Management / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000078329:Workforce; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult