Prehospital oral endotracheal intubation by rural basic emergency medical technicians

J. S. Bradley, G. L. Billows, Michael Olinger, S. P. Boha, W. H. Cordell, D. R. Nelson

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

Study objective: To determine whether basic emergency medical technicians (EMT-B) can perform prehospital oral endotracheal intubation with success rates comparable to those of paramedics. Methods: This was a nonrandomized, controlled trial using historical controls. Seven basic life support emergency medical services systems in six counties and their corresponding emergency departments in rural Indiana participated. Eighty- seven full-time EMTs with no prior or concurrent paramedic training volunteered for intubation training. Apneic prehospital patients aged 16 years or older without an active gag reflex or massive facial trauma were eligible for intubation and study enrollment. The EMTs completed a 9-hour didactic and airway manikin training course in direct laryngoscopic endotracheal intubation. The course was adapted from the national paramedic curriculum. Results: Thirty-four (39%) of the EMT-Bs attempted to intubate 57 eligible patients. In 49.1% of these patients, successful endotracheal tube placement was confirmed by the receiving physician (95% confidence interval, 36.4% to 61.9%); in contrast, the prehospital intubation success rates from three previous studies of manikin-trained paramedics ranged from 76.9% to 90.6% (P<.001). Complications included five (9%)inadvertent extubations, two endotracheal tube cuff ruptures, two prolonged intubation attempts, and one mainstem bronchus intubation. There were no unrecognized esophageal intubations. Two of the seven EMS agencies did not report any intubation data. Conclusion: Rural EMTs with didactic and airway manikin training failed to achieve prehospital intubation success rates comparable to those of paramedic controls. Possible explanations include training deficiencies, poor skill transference from manikin to human intubation, infrequent intubation experiences, and inconsistent supervision.

Original languageEnglish
Pages (from-to)26-32
Number of pages7
JournalAnnals of Emergency Medicine
Volume32
Issue number1
DOIs
StatePublished - 1998

Fingerprint

Emergency Medical Technicians
Intratracheal Intubation
Intubation
Allied Health Personnel
Manikins
Airway Extubation
Emergency Medical Services
Bronchi
Curriculum
Reflex
Hospital Emergency Service
Rupture

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prehospital oral endotracheal intubation by rural basic emergency medical technicians. / Bradley, J. S.; Billows, G. L.; Olinger, Michael; Boha, S. P.; Cordell, W. H.; Nelson, D. R.

In: Annals of Emergency Medicine, Vol. 32, No. 1, 1998, p. 26-32.

Research output: Contribution to journalArticle

Bradley, J. S. ; Billows, G. L. ; Olinger, Michael ; Boha, S. P. ; Cordell, W. H. ; Nelson, D. R. / Prehospital oral endotracheal intubation by rural basic emergency medical technicians. In: Annals of Emergency Medicine. 1998 ; Vol. 32, No. 1. pp. 26-32.
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