Training and competency in rapid sequence intubation: the perspective from a Scottish teaching hospital emergency...

Rapid sequence intubation (RSI) is an established core competency for emergency medicine trainees. The training and experience required to achieve competency is unclear.

To illustrate the RSI training and experience attained as a specialist registrar in a Scottish teaching hospital emergency department (ED) and establish whether it is sufficient to progress to independent practice.

Single centre observational study in the ED of Ninewells Hospital, Dundee. RSI data were collected over a 51-month period (April 2005-July 2009) specifically for: patient population; case-mix; operator; and pre-hospital RSI. Competency was assessed by a postal survey questionnaire.

329 RSIs were performed. Trauma was the most common reason for RSI, in 134 (41%) patients. Emergency physicians were the primary operator in 288 (88%) cases. ED registrars were the predominant operator in 206 (63%) RSI. ED registrars perform approximately 6.5 RSI/year. Pre-hospital RSI occurred in 45 (14%) patients. An ED registrar was the operator in 15 (33%) vs an ED consultant in 30 (66%). 12 (71%) of the 17 questionnaires were completed. All trainees (100%) were confident to perform RSI independently at the end of registrar training. 7 (60%) were confident to practice RSI in the pre-hospital environment.

ED trainees in this department achieve a relatively broad experience and exposure to RSI. Trainees appear to be satisfied with the training they have obtained in order to continue with ED RSI as a new consultant. Additional training is likely to be necessary to confidently perform pre-hospital RSI.