Prehospital oral endotracheal intubation by rural basic emergency medical technicians.
To determine whether basic emergency medical technicians (EMT-B) can perform prehospital oral endotracheal intubation with success rates comparable to those of paramedics.
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.
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. (...)
Mots-clés Pascal : Intubation, Trachée, Voie orale, SAMU, Secours première urgence, Secouriste, Période préhospitalière, Zone rurale, Evaluation professionnelle, Etude comparative, Evaluation performance, Agent santé, Adulte, Homme, Réanimation, Personnel paramédical
Mots-clés Pascal anglais : Intubation, Trachea, Oral administration, Emergency medical care unit, First emergency care, Rescuer, Prehospital period, Rural area, Professional evaluation, Comparative study, Performance evaluation, Health worker, Adult, Human, Resuscitation
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0336217
Code Inist : 002B30A05. Création : 27/11/1998.