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Rapid sequence intubation
  1. Stephen Bush1,
  2. Alasdair Gray2,
  3. Alistair Mcgowan3,
  4. Neil Nichol4
  1. 1Specialist Registrar in Accident and Emergency(steve.bush{at}CWCOM.net)
  2. 2Consultant in Accident and Emergency
  3. 3Consultant in Accident and Emergency, Accident and Emergency Department, St James's University Hospital, Leeds LS9 7TF
  4. 4Consultant in Accident and Emergency, Ninewells Hospital, Dundee

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    Editor,—All emergency medicine specialists should be competent in rapid sequence intubation (RSI). We thank the authors for their commitment to training this essential skill.1

    The simulator experience with video playback could be an extremely powerful teaching aid for RSI and its potential attendant complications. Currently, only a few accident and emergency (A&E) departments in the United Kingdom have access to this expensive tool.

    RSI is a skill that is used with short notice and requires confidence and competence to perform appropriately. The cognitive and psychomotor skills needed are unlikely to be retained from a single course. RSI should therefore be taught as part of an integrated training programme. This should include prolonged exposure to intubations during an anaesthetic attachment, a short course similar to the National Emergency Airway Management Course from the USA covering core knowledge, and a process of revalidation and quality assurance.

    We feel that the use of simulators would not be practicable for the primary training of the large numbers of UK A&E specialists in RSI. The use of simulators could, however, play a vital part in the regular appraisal and revalidation of individual practitioners once they have completed their training programme. This revalidation of skills and the regular audit of results should form the basis for the essential quality assurance, which this programme would need.

    In summary, if we follow the airline pilot analogy, training occurs in the classroom and in the air, revalidation is the work of the simulator.

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