Analysis of intubations: Before and after establishment of a rapid sequence intubation protocol for air medical use

Abstract

After finding the success rate of intubations in our air medical program to be less than optimal (with a success rate of only 73%), a protocol for increased doses of sedatives and neuromuscular blocking (NMB) agents was developed for field use by flight nurses and paramedics. A retrospective chart review was performed for 100 intubations before and 100 intubations after establishment of this protocol. Success rate of intubation increased from 73% to 96%, which was statistically significant (p < 0.01). No difference existed between the two groups with regard to age, gender, Glasgow Coma Scale scores, nature of injury, route of intubation, number of attempts or percent intubated. Two patients (2%) became bradycardic using the new protocol. Our results suggest that protocols including sedatives and NMB agents can be used safely and effectively by an appropriately trained air medical team of nurses and paramedics and may improve patient care.