Emergency intubation: a prospective multicentre descriptive audit in an Australian helicopter emergency medical service

Objective: To describe the safety profile of emergency airway management when performed by a prehospital team consisting of a doctor and a paramedic. Success rates, the incidence of difficult airways and the ability of prehospital doctors to determine a difficult airway are reported. Methods: A prospective audit and descriptive study of three Australian helicopter emergency medical service (HEMS) bases, over a 9-month period. Doctors completed questionnaires regarding the number of endotracheal intubation (ETI) attempts on patients transported intubated and ventilated, Cormack and Lehane view of the cords during laryngoscopy and the anticipated and actual ease of ETI. Results: A total of 114 (11.4%) patients transported by the HEMS was intubated and ventilated. Study questionnaires were completed on 89 of the 114 cases (78.1%), of which 32 (36%) were trauma related. HEMS were involved with 43 (48.3%) of the 89 intubations and performed 12.4% (n = 11) out of hospital. The HEMS ETI success rate was 97.6%. No surgical airways were performed. The actual incidence of difficult airways was higher (n = 4, 9.3%) than the anticipated incidence (n = 1, 2.3%). Six patients (14.0%) were successfully intubated by the doctor after the paramedic failed. Conclusions: Well-trained doctor paramedic teams, utilising standardised operating procedures, can safely perform rapid sequence induction and ETI in the prehospital and emergency environment. However, prehospital doctors are not always able to anticipate a difficult airway. The complication rate was similar to that in hospital emergency departments and to that of other physician-led HEMS.