Implementing new advanced airway management standards in the Hungarian physician staffed Helicopter Emergency Medical Service.

Akos Soti,Peter Temesvari,Attila Eross,Laszlo Hetzman,Andras Petroczy

doi:10.1186/s13049-014-0081-z

Abstract

In 2011 the Hungarian Air Ambulance Nonprofit Limited Company introduced a new Rapid Sequence Intubation standard operating procedure using a template from London’s Air Ambulance. This replaced a previous ad-hoc and unsafe prehospital advanced airway management practice. It was hoped that this would increase clinical standards including internationally comparable results. All Rapid Sequence Intubations performed by the units of the Hungarian Air Ambulance under the new procedure between June 2011 and November 2013 were reviewed in a retrospective database analysis. During this period the air ambulance units completed 4880 missions with 433 intubations performed according to the new procedure. The rate of intubations that were successful on first attempt was 95.4% (413), while intubation was successful overall in 99.1% (429) of the cases; there was no failed airway. 90 complications were noted with 73 (16.9%) patients. Average on scene time was 49 minutes (ranging between: 15–110 minutes). This data shows that it is possible to effectively change a system that was in place for decades by implementing a new robust system that is based on a good template.

Highlights

The Hungarian Air Ambulance Nonprofit Ltd. is the only Helicopter Emergency Medical Service (HEMS) provider in Hungary operating from 7 air bases with 100% physician manned helicopters in daylight hours
Prehospital endotracheal intubation has been routine in the last few decades in Hungary, but until recently, no effort was made to standardize indications or procedures for drug assisted intubation
Prehospital endotracheal intubation only improves outcome if performed in a governance system focused on patient safety [3]

Summary

Introduction

The Hungarian Air Ambulance Nonprofit Ltd. is the only Helicopter Emergency Medical Service (HEMS) provider in Hungary operating from 7 air bases with 100% physician manned helicopters in daylight hours. Prehospital endotracheal intubation has been routine in the last few decades in Hungary, but until recently, no effort was made to standardize indications or procedures for drug assisted intubation. Muscle relaxant drugs were never used (not even by anaesthetists) in prehospital care. This practice has never been thoroughly audited nor any data published on it. In 2010 the results of a local audit strengthened the suspicion that the previously described practice didn’t meet internationally published standards. In 2011 a decision was made to change the ad hoc and unsafe practice and to implement a new RSI Standard Operating Procedure (SOP) for the HEMS units. The aim was to achieve high clinical standards and internationally comparable results

Methods

Results

Conclusion