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Field trial of endotracheal intubation by basic EMTs
M R Sayre1, J C Sakles, A F Mistler
1Department of Emergency Medicine, University of Cincinnati, USA. michael.sayre@uc.edu
Annals of Emergency Medicine
|February 24, 1998
Summary
Emergency Medical Technicians-Basic (EMT-Bs) trained in a short course achieved a low success rate for endotracheal intubation in the field. This finding questions the effectiveness of the current EMT-B intubation training curriculum.
Area of Science:
- Emergency Medical Services
- Pre-hospital Care
- Airway Management
Background:
- The 1994 basic-EMT (EMT-B) curriculum included endotracheal intubation training.
- Assessing the field success and complication rates of EMT-B endotracheal intubations 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.
- EMT-Bs received 10 hours of intubation training, including manikin practice.
- Eligible patients were apneic and over 15 years old; success rates were calculated with 95% confidence intervals.
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 most other patients.
Conclusions:
- Short-course trained EMT-Bs achieved approximately 50% success in field endotracheal intubations.
- The low success rate raises concerns about the adequacy of the 1994 EMT-B national curriculum's intubation training.
- Further evaluation of pre-hospital airway management training protocols is warranted.