Field Trial of Endotracheal Intubation by Basic EMTs

Area of Science:

• Emergency Medicine
• Medical Education

Background:

• The 1994 Emergency Medical Technician-Basic (EMT-B) curriculum included endotracheal intubation training.
• Assessing the field success and complication rates of endotracheal intubations performed by EMT-Bs is crucial.

Purpose of the Study:

• To evaluate the success and complication rates of endotracheal intubations performed by EMT-Bs in an out-of-hospital setting.
• To assess the efficacy of the 1994 EMT-B national curriculum's intubation training module.

Main Methods:

• A prospective clinical trial was conducted over 28 months in an urban EMS system.
• Four EMT-B engine companies received 10 hours of intubation training, including manikin practice.
• Eligible patients were apneic and over 15 years old; 95% confidence intervals were calculated for success rates.

Main Results:

• Sixty-six EMT-Bs were authorized to perform field intubations.
• EMTs attempted 103 endotracheal intubations with a success rate of 53% (95% CI, 42% to 61%).
• Three unrecognized esophageal intubations occurred; paramedics intubated all other patients not successfully intubated by EMT-Bs.

Conclusions:

• Short-course trained EMT-Bs achieved approximately 50% success in field endotracheal intubations.
• The low success rate challenges the adequacy of the 1994 EMT-B national curriculum's intubation training.
• Further evaluation of EMT-B intubation training and protocols is warranted.