Preliminary experience with a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation☆
Introduction
Endotracheal intubation (ETI) has been performed on critically-ill out-of-hospital patients for over 20 years [1], [2], [3]. However, recent studies have suggested the need to re-examine how this procedure is performed in the field setting [4], [5]. There are many published studies of out-of-hospital intubation, but these studies are inadequate in the light of current demands for evidence-based approaches to prehospital medical practice [6], [7], [8], [9]. Previous studies of field ETI used retrospective, single-site designs with inconsistent terminology and inadequate scope or detail [1], [2], [10], [11], [12]. Prior studies have also provided only limited insights regarding issues of interest in current prehospital airway management; for example, complications encountered during ETI and the effect of prehospital ETI upon patient survival.
In this preliminary study we sought to evaluate the feasibility of obtaining prospective, multi-centered data examining current out-of-hospital airway management practices. We had two specific goals: (1) to evaluate the use of a standard data reporting tool to capture pertinent details regarding the course of ETI attempted by multiple EMS services operating in differing patient population settings under varying clinical protocols, and (2) to provide preliminary estimates of factors of current interest in out-of-hospital airway management.
Section snippets
Methods
We used a prospective, multi-centered observational design involving 45 advanced life support (ALS) EMS services from across the Commonwealth of Pennsylvania. Participating services included units in urban, suburban, rural, and air medical settings. All services used independent personnel, medical direction and clinical protocols; at the time of this study, statewide medical protocols had not yet been enacted. Service staffing practices included both all career and career/volunteer
Results
The 45 EMS services participating in the study included 8 urban, 15 suburban, 20 rural, and 2 air medical services. Data forms were made available to all ALS units in 44 services. (In one ground service, data forms were inadvertently distributed to only selected rescuers rather than being placed on all ambulances.) The study services served a total population of approximately 1 870 000 over a geographical area of 12 000 mile2, and included a total of 1350 ALS personnel with over 150 000
Discussion
Broadly-applicable inferences regarding out-of-hospital ETI can be difficult to make because of variations in patient and population settings, protocols, staffing configurations, and documentation practices. Previous evaluations of out-of-hospital ETI have generally been limited to retrospective, single EMS service reviews [1], [2], [10], [11], [12]. Prospective collection of multi-centered data is desirable because it bridges variations across different practice settings and provides
Acknowledgements
This study was supported by a grant from The Pittsburgh Emergency Medicine Foundation, Pittsburgh, Pennsylvania. The authors acknowledge Donald Holsten, NREMT-P, James Traub, NREMT-P, and Mark Pinchalk, BS, EMT-P, for their special assistance with study center recruitment and coordination. We acknowledge Elizabeth Peitzman for her assistance in data entry and analysis. We acknowledge the assistance of the Commonwealth of Pennsylvania, Department of Health EMS Office, Margaret Trimble, B.S.N.,
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This paper was presented at The National Association of EMS Physicians Annual Meeting, Tucson, Arizona, January 2002.