Endotracheal Tube Placement by EMT-Basics in a Rural EMS System

Abstract

Objective.To evaluate the effectiveness of an intubation-training module andspecial-waiver project in which Emergency Medical Technicia (EMT)-Basics were trained to perform endotracheal intubations in a rural community.Methods.This was a prospective observational study over a four-year period (July 1998 through May 2002) of all intubation attempts by EMT-Basics in the field. The authors observed intubation data, training methods, andquality-assurance methods of a special-waiver project agreed to by the State Department of Public Health to train andallow EMT-Basics to intubate patients. Data were from documentation unique to the project. Project documentation evaluated the placement andcomplication(s) of endotracheal tube (ETT) placement after arrival to the emergency department. An intubation attempt was defined as direct largyngoscopy. A successful attempt was defined as an appropriately sized ETT placed andsecured in the trachea below the vocal cords andabove the carina. Confirmation of placement in the field included accepted clinical methods andthe use of qualitative colorimetric end-tidal carbon dioxide detectors. The EMT-Basics were trained using a paramedic curriculum, including operating room intubations on live adult patients. All patients were in either cardiopulmonary or respiratory arrest.Results.Thirty-two intubations were performed by EMT-Basics. Thirty attempts were successful andtwo were unsuccessful (94%; 95% confidence interval [CI] 80–98%). Unsuccessful ETT placements were managed with accepted basic life support airway standards. There were no unrecognized esophageal ETT placements (0%; 95% CI 0–11%).Conclusion.This study demonstrated that with an intensive training program using selected highly motivated providers andclose monitoring, a program of EMT-Basic ETT placement in a rural setting can achieve acceptable success rates in patients in cardiac or respiratory arrest.

Keywords:

• emergency medical technicians
• rural
• endotracheal intubation
• cardiac arrest
• respiratory arrest
• training