Paramedic rapid sequence induction (RSI) in a South African emergency medical service: A retrospective observational study

Loading...
Thumbnail Image
File version

Version of Record (VoR)

Author(s)
Gunning, M
Perkins, Z
Crilly, J
von Rahden, R
Griffith University Author(s)
Primary Supervisor
Other Supervisors
Editor(s)
Date
2013
Size
File type(s)
Location
Abstract

Background. 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.

Journal Title

SAMJ South African Medical Journal

Conference Title
Book Title
Edition
Volume

103

Issue

9

Thesis Type
Degree Program
School
DOI
Patent number
Funder(s)
Grant identifier(s)
Rights Statement
Rights Statement

© 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.

Item Access Status
Note
Access the data
Related item(s)
Subject

Biomedical and clinical sciences

Acute care

Persistent link to this record
Citation
Collections