Procedural experience with out-of-hospital endotracheal intubation

OBJECTIVE: Out-of-hospital rescuers likely need regular clinical experience to perform endotracheal intubation (ETI) in a safe and effective manner. We sought to determine the frequency of ETI performed by individual out-of-hospital rescuers. DESIGN: Analysis of an administrative database of all emergency medical services (EMS) patient care reports in Pennsylvania. SETTING: Commonwealth of Pennsylvania from January 1 to December 31, 2003. SUBJECTS: EMS advanced life support rescuers (paramedics, prehospital nurses, and EMS physicians) who reported at least one patient contact during the study period. INTERVENTIONS: None. MEASUREMENTS: We calculated individual rescuer ETI frequency and opportunity. We evaluated relationships between ETI frequency and the number of patient contacts. We also examined the relationship with practice setting (air medical vs. ground rescuers and urban vs. rural rescuers). MAIN RESULTS: In 1,544,791 patient care reports, 11,484 ETIs were reported by 5,245 out-of-hospital rescuers. The median ETI frequency was one (interquartile range, 0-3; range, 0-23). Of 5,245 rescuers, >67% (3,551) performed two or fewer ETIs, and >39% (2,054) rescuers did not perform any ETIs. The median number of ETI opportunities was three (interquartile range, 0-6; range, 0-76). ETI frequency was associated with patient volume (Spearman's rho = 0.67) and was higher for air medical (p = .006) and urban (p < .0001) rescuers. ETI frequency was not associated with response (Spearman's rho = -0.01) or transport (Spearman's rho = -0.06) times. CONCLUSIONS: Out-of-hospital ETI, an important and difficult resuscitation intervention, is an uncommon event for most rescuers.