Clinical characteristics of paramedics' performance of endotracheal intubation.

Paramedics intubated 358 of 383 (93.5%) patients over a nine-month period. There were 85 survivors. The intubators used the curved-blade laryngoscope in 304 patients (79.5%). Two of 25 (8.0%) patients who were not successfully intubated lived; 83 of 358 (23.2%) successfully intubated patients survived. Clinically significant complications occurred in 32 patients (8.9%) who were successfully intubated. Paramedics encountered adverse conditions in 126 patients (32.9%). Presenting cardiac rhythm was recorded. There were no significant differences in intubation success rate between survivors and nonsurvivors or as a function of cardiac rhythm. This retrospective study further documents the ability of paramedics to successfully perform endotracheal intubation. The high success rate supports training with live subjects. Further studies of cause and impact of complications, correlation of success with increased survival, and alternative techniques are essential for effective EMS system medical control.

[1]  A. Gordon,et al.  The oesophageal obturator airway: a new device in emergency cardiopulmonary resuscitation. , 1980, British medical journal.

[2]  J. Darin,et al.  Traumatic cardiac arrest: scope of paramedic services. , 1985, Annals of emergency medicine.

[3]  R. Kaplan,et al.  Success rates of blind orotracheal intubation using a transillumination technique with a lighted stylet. , 1986, Annals of emergency medicine.

[4]  J. Pointer.  The advanced life support base hospital audit for medical control in an emergency medical services system. , 1987, Annals of emergency medicine.

[5]  M. S. Bogetz,et al.  Pre-hospital tracheal intubation versus esophageal gastric tube airway use: a prospective study. , 1985, The American journal of emergency medicine.

[6]  P. Paris,et al.  Field endotracheal intubation by paramedical personnel. Success rates and complications. , 1984, Chest.

[7]  P. Pepe,et al.  Prehospital endotracheal intubation: rationale for training emergency medical personnel. , 1985, Annals of emergency medicine.

[8]  S. Shea,et al.  Prehospital endotracheal tube airway or esophageal gastric tube airway: a critical comparison. , 1985, Annals of emergency medicine.

[9]  J. Schofferman,et al.  The esophageal obturator airway. A clinical evaluation. , 1976, Chest.

[10]  L. Jacobs,et al.  Endotracheal intubation in the prehospital phase of emergency medical care. , 1983, JAMA.

[11]  M. Copass,et al.  Prehospital cardiopulmonary resuscitation of the critically injured patient. , 1984, American journal of surgery.

[12]  J. Pointer.  The emergency physician and medical control in advanced life support. , 1985, The Journal of emergency medicine.

[13]  J P Smith,et al.  The urban paramedic's scope of practice. , 1985, JAMA.

[14]  Inadequate oxygenation and ventilation using the esophageal gastric tube airway in the prehospital setting. , 1983, JAMA.

[15]  M. Posluszny,et al.  Paramedic orotracheal intubation: a feasibility study. , 1984, The American journal of emergency medicine.

[16]  Comparison of paramedic intubation training techniques. , 1985, The American journal of emergency medicine.

[17]  P. Paris,et al.  Effect of varied training techniques on field endotracheal intubation success rates. , 1984, Annals of emergency medicine.

[18]  M. Tenenbein.  Outcome of pediatric resuscitation. , 1984, Annals of emergency medicine.

[19]  K. Iserson.  Blind nasotracheal intubation: a model for instruction. , 1984, Annals of emergency medicine.

[20]  C. Baker,et al.  The esophageal obturator airway: obturator or obtundator? , 1985, The Journal of trauma.