Performance characteristics and complications of an Inter-Changeable Operator Model for intubation in an Australian...

The Inter-Changeable Operator Model (ICOM) enables paramedics and flight nurses to perform intubations interchangeably with team physicians in prehospital critical care. However, literature on ICOM characteristics and performance is limited.

We conducted a retrospective, observational study of an ICOM operating within an Australian Helicopter Emergency Medical Service over a nine-year period. First pass success, major complication rates and clinically important time intervals were compared between first intubator groups.

A total of 413 patients met the inclusion criteria, with paramedics performing the majority of first intubation attempts (379/413, 91.8%). Physicians primarily conducted second intubation attempts and managed high-risk patients. In unadjusted analysis, the risk of major complication in the paramedic/supervised registrar group was not lower than the most senior physician intubator group (relative risk [RR] 0.59, 95% confidence interval [CI]: 0.26-1.32; P = 0.198) and after adjustment the risk was also not lower (RR 0.60, 95% CI: 0.24-1.54; P = 0.289). First pass failure occurred in 12 (3.1%) and 1 (4.8%) patients intubated by paramedic/supervised registrar and most senior physician groups, respectively (P = 0.498). The median (95% CI) adjusted difference in contact to intubation time between paramedic/supervised registrar first intubator and most senior physician groups was -2 min (-7 to 3; P = 0.392). Total adjusted scene time was also not significantly different between groups (median difference 2 min, 95% CI: -3 to 7; P = 0.500).

Paramedics conducting most intubations within an ICOM are both safe and efficient. Larger studies are required to examine differences between physician subgroups.