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Emergency Medicine

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Limiting out-of-hospital endotracheal intubation to experienced rescuers would limit the practice

Out-of-hospital rescuers and emergency medical service (EMS) personnel receive limited training and clinical experience in out-of-hospital endotracheal intubation, a highly skilled and complex procedure used to restore breathing in critically ill and injured patients. Use of this procedure should be limited to rescuers or agencies meeting defined minimum levels of clinical experience, suggests a new study. However, the authors caution that this approach would substantially decrease the number of out-of-hospital intubations performed across a Statewide EMS system.

Henry E. Wang, M.D., M.S., of the University of Pittsburgh School of Medicine, and colleagues analyzed 2003 Pennsylvania Statewide EMS data on endotracheal intubations done by a valid rescuer, EMS agency, and minor civil division. During the study period, there were 11,771 endotracheal intubations (7,854 cardiac arrest, 3,917 non-arrest, 1,325 trauma, and 561 pediatric). Limiting the procedure to rescuers with at least 3, 5, 10, and 15 intubations per year would result in relative intubation reductions of 12, 32, 79, and 93 percent, respectively.

Limiting intubations to EMS agencies with at least 20, 30, 50, 100, and 150 intubations per year would result in relative reductions of 15, 27, 41, 65, and 73 percent, respectively. Thus, adoption of the lowest minimum experience standards (3 or fewer intubations per rescuer or 20 or fewer per agency) would at least limit intubations by the least experienced providers without affecting major reductions in the overall number of procedures.

The study was supported by the Agency for Healthcare Research and Quality (HS13628).

See "How would minimum experience standards affect the distribution of out-of-hospital endotracheal intubations?" by Dr. Wang, Benjamin N. Abo, B.S., N.R.E.M.T.-P., Judith R. Lave, Ph.D., and Donald M. Yealy, M.D., in the September 2007 Annals of Emergency Medicine 50(3), pp. 246-252.

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