Development of a Consensus-Based Checklist for Physician-Performed Prehospital Endotracheal Intubation in Japan: A...

Prehospital endotracheal intubation (ETI) is a high-risk, multicomponent procedure that requires standardized preparation, team coordination, and rescue planning. In Japan, however, no national protocol exists for physician-performed ETI, and practice remains inconsistent despite recognition of appropriate care. Within the development phase of complex intervention research, this study aimed to develop a consensus-based checklist for physician-performed prehospital ETI in Japan using a Delphi process.

A two-round Delphi survey was conducted among experienced physicians involved in physician-staffed prehospital care in Japan. Candidate items were developed from the literature and organized according to the workflow of prehospital ETI. Participants rated each item using a 4-point Likert scale, and consensus was defined as ≥ 70% agreement. Consensus items were subsequently summarized into a practical checklist.

Forty experts participated in Round 1 (response rate, 69%). All completed Round 2. Consensus increased from 72 of 90 items (80%) in Round 1 to 76 of 80 items (95%) in Round 2 after item refinement. Agreement was high for preparation, monitoring, and confirmation. In contrast, context-dependent items, such as patient relocation and medication choices, showed lower agreement. The final items were integrated into an eight-domain checklist.

This Delphi study developed a proposed consensus-based checklist for physician-performed prehospital ETI in Japan. As a consensus-building step within the development phase of a complex intervention, the checklist identifies core procedural elements while allowing for local operational variation. Future studies should assess feasibility, adherence, and clinical impact in real-world prehospital settings.