Emergency Medicine

Out-of-hospital rescuers receive little practice in performing endotracheal intubation

Emergency medical services (EMS) advanced life support rescuers, such as paramedics, prehospital nurses, and EMS physicians need regular clinical practice to perform endotracheal intubation (ETI) in a safe and effective manner. ETI requires great skill to perform in order to reduce the likelihood of adverse events such as airway injury, inadvertent oxygen deficiency, slowed heart rate, and death. Out-of-hospital ETI, an important and difficult means of resuscitating patients, is a rare event for most rescuers, according to a study supported in part by the Agency for Healthcare Research and Quality (HS13628). Thus, responder personnel have little opportunity to reinforce ETI training, notes Henry E. Wang, M.D., M.P.H., of the University of Pittsburgh School of Medicine.

Researchers analyzed a database of all EMS patient care reports in Pennsylvania to examine the frequency of ETI performance by that State's out-of-hospital rescuers in 2003. In 1,544,791 patient care reports, 11,484 ETIs were reported by 5,245 out-of-hospital rescuers. The median ETI frequency was one per rescuer. Of 5,245 rescuers, 67 percent performed 2 or fewer ETIs and 39 percent did not perform any ETIs. The median number of opportunities for performing ETI was three. ETI frequency was associated with patient volume and was higher for air medical and urban rescuers than for ground ambulance-based and rural rescuers, respectively. ETI frequency was not associated with response or transport times.

See "Procedural experience with out-of-hospital endotracheal intubation," by Dr. Wang, Douglas F. Kupas, M.D., David Hostler, Ph.D., and others in the August 2005 Critical Care Medicine 33(8), pp. 1718-1721.

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