The use of neuromuscular blocking agents by air medical services

Neuromuscular blocking agents (NMBs) are frequently used to facilitate intubations in the hospital. The 1987 membership of the Association of Air Medical Services (AAMS) was surveyed to determine the frequency of NMB use by flight programs both before and after definitive airway control. Out of 141 programs, 101 returned completed survey forms. Of those responding, 39 of 101 used NMBs before intubation, and 67 programs used NMBs after intubation. The use of NMBs in the base hospital by emergency physicians was a significant predictor of the use by the air medical service. No other factors studied, including flight volume, percentage of trauma-related flights, percentage of flights to an accident scene, or the specialty of the service's medical director, predicted use of the agents after intubation. The presence of a physician on the flight crew was associated with the use of succinylcholine prior to definitive airway control. Reported complications included three deaths attributed to use of NMBs in the preceding two years. We conclude that NMBs are commonly used following intubation, and that NMBs are used before intubation by some flight programs, especially those that have physician crew members.