How Would Minimum Experience Standards Affect the Distribution of Out-of-Hospital Endotracheal Intubations?

Can Emergency Medical Services Personnel Effectively Place and Use the Supraglottic Airway Laryngopharyngeal Tube (SALT) Airway?

“…Experience with ETI clearly illustrates that increased education and practice correlate with improved rates of successful ETI. 17,18 It would seem intuitive that increased education and practice in inserting an ET through the SALT might also increase the success proportions. Additional studies are warranted.…”

Procedures Performed by Emergency Medical Services in the United States

“…2 Mastery of these skills requires sufficient initial training as well as ongoing education, especially if infrequently performed. [3][4][5] The clinical effectiveness of these interventions remains unclear. Although certain prehospital interventions such as intravenous catheter insertion are associated with a reduction in mortality, others have found that specific populations such as trauma patients are 2.63 times more likely to die for every procedure completed in the prehospital setting.…”

Prehospital Airway Management

“…36 Wang and colleagues calculated the learning curves for paramedic students performing ETI and found that at 20 to 25 ETIs in live subjects must be performed to achieve success rates of at least 90%. 2 This finding argues that paramedics with only five ETIs during training may have little skill in performing intubations.…”

“…However, it has been shown that if a minimum number of intubations is used as the criterion to permit ETI in the field, the overall numbers of ETI performed in the field decrease because fewer providers meet the minimum number needed to permit continued performance of the skill. 2 Additionally, supraglottic devices have demonstrated equivalency to ETI in many studies, and many advocate using alternative strategies for ensuring the success rates for intubations, such as simulation and cadaver training. 21,34,35 When time in the operating room is made available to paramedics, it can be a significant training adjunct for clinical practice.…”

“…The frequency with which any provider performs advanced airway management is critical for maintaining skill competency. 2,3 Some systems have reported very low rates of intubation, especially for pediatric patients. [4][5][6] How can competency be maintained when providers intubate three or four times per year?…”