Emergency medical technicians outperform anaesthetists! ▸

Participants were asked to perform bag-valve-mask ventilation for three minutes on a mannikin using a facemask and a two litre self inflating bag. Tidal volumes were measured and recorded by computer. The effectiveness of bag-valve-mask (defined as the proportion of ventilation attempts that achieved a tidal volume of >434 ml) was significantly greater for emergency medical technicians than for anaesthetists (p<0.001). Six of the 27 anaesthetists, but none of the 29 emergency medical technicians, were unable to produce even one “effective” tidal volume of at least 434 ml. The paper concludes that emergency medical technicians are able to perform adequate bag-valve-mask ventilation.

▴ Walsh K, Loveday K, O’Rathaille M. A comparison of the effectiveness of pre-hospital bag-valve-mask ventilation performed by Irish emergency medical technicians and anaesthetists working in a tertiary referral teaching hospital. Ir Med J2003;96:77–9.OpenUrlPubMed

Prehospital intubation for trauma? ▸

Prehospital care practitioners will read this controversial paper from the United States with interest. The authors prospectively collected data on 191 patients who presented with a Glasgow Coma Scale of less than 9 and a “head” Abbreviated Injury Scale score of more than two. They compared outcomes according to whether or not patients received prehospital intubation (usually by paramedics who were trained to use some anaesthetic drugs). The results indicated significantly increased morbidity and mortality associated with prehospital intubation. The authors do acknowledge some limitations in their study design—their call for a randomised controlled trial seems eminently sensible.

▴ Bochicchio GV, Ilahi O, Joshi M, et al. Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury. J Trauma2003;54: … OpenUrlCrossRefPubMedWeb of Science