Alan Garner1
1Nepean Hospital
Although strongly resembling prehospital HEMS systems in Europe, the CareFlight Rapid Response Helicopter Service is unique in Australasia as it provides a dedicated prehospital physician-led response service for a largely urban area in Sydney, Australia. Response and service characteristics of the service are therefore different to other retrieval services in Australia. This presentation presents data on aspects of prehospital intubation by the service.
Location of intubation
It has been recommended that prehospital rapid sequence intubation (PH-RSI) be performed in locations that provide 360-degree access to the patient but there is a lack of supporting evidence.
We found that intubating selected patients inside an ambulance was not associated with increased complications, but significantly reduced scene times compared with intubation outside the vehicle on a stretcher. Patients intubated on the ground were more likely to have complications, but this was probably due to differences in underlying patient characteristics. Selected patients can be safely intubated in the back of ambulances with resulting reductions in scene time.
Effect of changes on case identification systems on Pre-hospital Intubation Performance Indicators
Intubation within 45 minutes of injury has been proposed as a performance standard in prehospital care with a previous Australian retrieval service study indicating distance as the major compliance impediment. We compared performance against this standard between two case identification systems; direct screening by HEMS crew, or paramedics in a central control room.
As with the previous Australian study we found that distance to the scene was strongly associated with benchmark compliance. However, the case identification systems also significantly affected the proportion of complying patients with dispatch delays being the major reason for non-compliance within 50km of the operations base.
The intubation interchangeable operator model in an Australian HEMS
Paramedics who are trained in prehospital intubation can serve as intubators interchangeably with the team physician, the ‘Inter-Changeable Operator Model’ (ICOM) in some prehospital critical care teams but there is little literature describing ICOM characteristics and performance.
At CRRH, paramedics conducted the first intubation attempt in more than ninety percent of cases, whilst physicians conducted most second attempts, as well as selected patients with predictors of difficulty. First pass success and major complication rates were similar between intubator groups. Time from patient contact and total scene times were also similar. Paramedics conducting most intubations within an ICOM is both safe and efficient.