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Comparison of intubation skills between interfacility transport team members
1Department of Respiratory Care, Loma Linda University Children's Hospital, California 92354, USA. Kadams@ahs.llumc.edu
Objective:
To compare intubation skill level and success rate between interfacility transport team members.
Design:
Prospective collection of data.
Setting:
University affiliated children's hospital interfacility transport team.
Patients:
One hundred thirty-two pediatric patients (age range 4 days to 11 years) intubated prior to transport by a specialized team.
Interventions:
None.
Methods:
Prospective data was gathered from June 1992 November 1996. In 3616 transports reviewed, 132 intubations were performed by the team at the referring facility. Patient ages ranged from 4 days to 11 years with a mean age of 23 months. We compared resident physicians and respiratory care practitioners (RCPs) to a standard threshold of 1 attempt per successful intubation. An attempt was defined as passage of the endotracheal tube into the oropharynx in an effort to pass it through the vocal cords. Patients were sedated and paralyzed for the procedures. The physicians were 2nd and 3rd year pediatric or emergency medicine residents. They received intubation training in Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Program (NRP), and during rotations through neonatal and pediatric intensive care units. RCPs had an average of 3.5 years of experience overall on the transport team. They received training primarily on mannequins and written tests while in school. They were certified in PALS and NRP and required to participate in annual skill laboratories, which consisted of mannequin intubations and a written examination.
Results:
The results showed the RCPs to have greater overall success as well as greater success of intubation on first attempt compared to the resident physicians.
Conclusion:
In our experience, RCPs on the interfacility transport team were very successful in performing endotracheal intubations and were more successful than resident physicians. RCPs are established members of not only the transport team, but also the intensive care units and, therefore, should be considered qualified to routinely perform endotracheal intubations in those settings as well.