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dc.contributor.authorGunning, M
dc.contributor.authorPerkins, Z
dc.contributor.authorCrilly, J
dc.contributor.authorvon Rahden, R
dc.date.accessioned2018-01-17T22:32:46Z
dc.date.available2018-01-17T22:32:46Z
dc.date.issued2013
dc.date.modified2014-04-11T05:09:52Z
dc.identifier.issn0256-9574
dc.identifier.urihttp://hdl.handle.net/10072/58261
dc.description.abstractBackground. Early access to critical care interventions may improve outcomes for severely ill and injured patients. South Africa (SA) faces the unique challenges of prolonged pre-hospital times and limited access to physicians. In 2008, the Health Professions Council of SA introduced paramedic rapid sequence induction (RSI), the gold standard critical care intervention for emergency airway management; however, the risk to benefit ratio in this context is unclear. Objective. We conducted a pilot study to identify if paramedic RSI in the SA pre-hospital care setting is effective and safe.Methods. We undertook a retrospective observational study of paramedic RSI performed by an emergency medical service, between 12 December 2009 and 12 December 2011.Results. Eighty-six RSIs were performed during the study period. No failed intubations were reported. Heart rate was significantly reduced from a median baseline value of 112 to 90 bpm, and oxygen saturations improved from 92% to 99% at handover following RSI. Nineteen patients (22%), however, had an adverse event (AE). Female patients (odds ratio (OR) 18.3; 95% confidence interval (CI) 3.46 - 99.38; p=0.001) and patients subsequently transported by helicopter (OR 7.24; 95% CI 1.44 - 36.32; p=0.016) remained independently associated with AEs after adjusting for confounders. Conclusions. RSI performed by specially trained paramedics is effective in terms of self-reported success. However, the 1 in 5 AE rate highlights safety concerns. The importance of a robust clinical governance programme to identify problems, refine practice and improve the quality of care is underscored.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.languageEnglish
dc.language.isoeng
dc.publisherHealth and Medical Publishing Group
dc.publisher.placeSouth Africa
dc.publisher.urihttp://www.scielo.org.za/scielo.php?pid=S0256-95742013000900021&script=sci_arttext&tlng=en
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrom632
dc.relation.ispartofpageto637
dc.relation.ispartofissue9
dc.relation.ispartofjournalSAMJ South African Medical Journal
dc.relation.ispartofvolume103
dc.rights.retentionY
dc.subject.fieldofresearchClinical Nursing: Secondary (Acute Care)
dc.subject.fieldofresearchMedical and Health Sciences
dc.subject.fieldofresearchcode111003
dc.subject.fieldofresearchcode11
dc.titleParamedic rapid sequence induction (RSI) in a South African emergency medical service: A retrospective observational study
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
dcterms.licensehttps://creativecommons.org/licenses/by-nc/4.0/deed.en
dc.description.versionVersion of Record (VoR)
gro.rights.copyright© 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
gro.date.issued2013
gro.hasfulltextFull Text
gro.griffith.authorCrilly, Julia


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