Abstract
BackgroundRapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The research study aimed to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice.MethodsAn online descriptive cross-sectional survey was conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies.ResultsA total of 87 participants agreed to partake. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n = 27, 35.5%) and the Western Cape (n = 25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. The majority of participants (n = 69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available; however, our results found that introducer stylets and/or bougies and end-tidal carbon dioxide devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks.ConclusionThe practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, relies on comprehensive implementation and adherence to all the components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, some areas may benefit from further research to improve current practice.
Highlights
Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally
Training For the theoretical (43.4%), simulated practical (40.8%), pharmacology (35.5%), mechanical ventilation (46.1%) and special circumstances (36.8%) components, most participants reported the quality of education and training received to be good (Fig. 1)
Assistants to perform RSI Consistent with Emergency Medicine Society of South Africa (EMSSA) guidelines recommending at least one RSI assistant, our findings suggest that most Emergency Care Practitioner (ECP) have at least one; two is preferable [45]
Summary
Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally, by physician or non-physician providers [1, 2]. RSI is regarded the gold standard for advanced airway management in critically ill and/or injured patients, mainly due to the optimal conditions created to facilitate endotracheal intubation (ETI) and by restricting the physiological effects of the procedure [2, 3]. Newer literature suggests that highly trained non-physician providers and increased experience may improve ETT pass success rates and reduce adverse events [12]. The important role of a well-established clinical governance system, to deliver safe, quality patient care before, during and after ETI, ensuring optimal oxygenation, ventilation, normocapnia and normovolemia as well as preventing aspiration and other adverse effects associated with increased mortality and morbidity, should be underscored [13,14,15]
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