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Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice
  1. Carl McQueen1,
  2. Nicholas Crombie2,
  3. Jonathan Hulme3,
  4. Stef Cormack2,
  5. Nageena Hussain4,
  6. Frank Ludwig4,
  7. Steve Wheaton5
  1. 1Academic Department of Anaesthesia, Critical Care, Pain & Resuscitation, Birmingham Heartlands Hospital, Birmingham, West Midlands, UK
  2. 2Midlands Air Ambulance, Unit 16 Enterprise Trading Estate, Brierley Hill, West Midlands, UK
  3. 3West Midlands CARE Team, Bristol Road Ambulance Station, Birmingham, West Midlands, UK
  4. 4West Midlands Deanery, St Chad's Court, Birmingham, West Midlands, UK
  5. 5West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, West Midlands, UK
  1. Correspondence to Dr Carl McQueen, Academic Department of Anaesthesia, Critical Care, Pain & Resuscitation, 1st Floor MIDRU Building, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, West Midlands B9 5SS, UK; carl_mcqueen{at}hotmail.com

Abstract

Introduction 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.

  • paramedics, extended roles
  • prehospital care
  • Trauma, research
  • rsi
  • major trauma management

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