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- Endotracheal intubation
- emergency medical services
- emergency medical technicians
- clinical competence
- clinical assessment, education
- clinical assessment, competence
This paper is the College of Paramedics (CoP) Council's response to the Airway Working Group's report of June 2008,1 and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC)'s recommendations (based on the report) in a letter of July 2008.2
Comments on Airway Working Group report
A major concern for the CoP is how the conclusions of the Airway Group were reached. For many years the NHS has promoted an evidence-based approach to clinical practice for all professional groups. The JRCALC Airway Group has formed a consensus based on selected literature. Importantly, this was not a formal systematic review and no formal critical appraisal of the papers selected was completed. Furthermore, the papers are only a fraction of the evidence about prehospital intubation. Of 68 references, only 26 relate directly to paramedic intubation: a simple PubMed search (using ‘paramedic’ and ‘intubation’) produces more than 400 papers. As such, the proposals are based on expert opinion rather than robust evidence.
Expert consensus is not always sufficiently robust to support a major change in clinical practice as it is at the bottom of the hierarchies of evidence. However, if the ‘consensus’ of a group of experts is not achieved in accordance with a structured method (such as a Delphi technique), it is not sound enough to appear in most hierarchies of evidence. No such technique was used by the Airway Working Group. These weaknesses were explicitly recognised by its members at the conclusion of their first meeting, and thus there was a unanimous vote by those present to conduct a systematic review of the evidence concerning prehospital intubation to ensure that the group's recommendations were based on robust evidence. The group also recognised that only a very small minority of the evidence reviewed addressed UK paramedic practice (one paper), and that significant differences in the training programmes …
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