Field Trial of Endotracheal Intubation by Basic EMTs☆,☆☆,★,★★
Section snippets
INTRODUCTION
Early airway management is critical to the recovery of patients with life-threatening illnesses and injuries. Previous research has suggested that out-of-hospital endotracheal intubation improves survival after devastating conditions such as cardiac arrest and penetrating truncal trauma.1
In most areas of the United States, out-of-hospital endotracheal intubation is performed by paramedics and nurses. However, in many EMS systems, patients in respiratory or cardiac arrest are treated initially,
MATERIALS AND METHODS
We conducted a prospective clinical trial in the EMS system of the city of Cincinnati. The EMS program is based in the fire department and uses 35 fire companies staffed by EMT-Bs for first response. Four paramedic-staffed fire companies are used for first response in outlying areas. ALS and transport are provided by four second-tier paramedic-staffed ambulances. Patients with less serious illnesses or injuries are transported by six ambulances staffed by EMT-Bs.
We identified four fire stations
RESULTS
Sixty-six EMT-Bs completed the training program and passed the final examinations. Fourteen (18%) completed the examinations successfully on a second try. Ten additional EMT-Bs (13%) did not successfully complete the program. One did not pass the final written examination, and nine did not successfully complete the practical examination. Patient enrollment began on May 10, 1994, and was completed on February 28, 1997. More than 219 cardiac-arrest patients were cared for by EMT-Bs from the
DISCUSSION
Our findings demonstrate that most EMT-Bs could learn to intubate manikins after a very short training course. Unfortunately, this success in the classroom did not translate to a high success rate among patients in the field. Experienced emergency physicians are able to successfully intubate about 99% of patients.7 Most studies of paramedic field intubation show success rates better than 90%8, 9, 10, 11, 12.Therefore the success rate in this study of 51% is a cause for great concern.
In
Acknowledgements
We thank the many diligent EMT-B/firefighters in the Cincinnati Fire Division who attended the training sessions, worked hard to pass the examinations, and were willing to try a new procedure in the most difficult of circumstances. We also thank the paramedics who assisted in the training sessions and provided guidance in the field. We particularly thank Lt. Robert Baioni and Assistant Chief Gary Auffart. Without their hard work, this study would not have been completed. Finally we appreciate
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Cited by (166)
European Resuscitation Council Guidelines 2021: Adult advanced life support
2021, ResuscitationHow much experience do rescuers require to achieve successful tracheal intubation during cardiopulmonary resuscitation?
2018, ResuscitationCitation Excerpt :About 25% of all interruptions of chest compression are related to the performance of ETI [5]. An observational study reported that the ETI failure rate can be as high as 50% when ETIs are performed in the pre-hospital setting, where staff experience a lower volume of ETIs [29,30]. Therefore, to minimize the risk of hypoxia or chest compression interruption during the procedure, ETI should be performed only by expert rescuers with high ETI success rates [1,2].
Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations
2017, Journal of Emergency Medicine
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From the Department of Emergency Medicine, University of Cincinnati.
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Funded by a grant from the Emergency Medicine Foundation and by the University of Cincinnati Department of Emergency Medicine. Laerdal Incorporated donated the manikins.
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Reprint no. 47/1/87678
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Address for reprints: Michael R Sayre, MD Department of Emergency Medicine University of Cincinnati PO Box 670769 Cincinnati, OH 45267-0769 513-558-4995 Fax 513-558-5791 E-mail [email protected]