The Impact of Mandatory Minimums on Intubation

Street Science

 

 
 
 

Keith Wesley, MD, FACEP | | Monday, November 5, 2007


Review of: Henry E, Wang HE, Abo BN, et al: "How Would Minimum Experience Standards Affect the Distribution of Out-of-Hospital Endotracheal Intubations?" Annals of Emergency Medicine. 50:246-252, 2007

The Science

In this study, researchers reviewed the Pennsylvania state pre-hospital database for 2003 and tabulated the number of endotracheal intubations. They then examined the intubations to determine who performed them and how many were performed per EMT, as well as within the EMS agency. The question was: What would happen to intubation rates if they were limited only to individuals and agencies with different minimum intubations per year?

There were 11,998 successful intubations, of which they could attribute 11,771 to a particular individual, agency or geographic location. They included 7,854 cardiac arrest, 3,917 non-arrest, 1,325 trauma and 561 pediatric intubations. Air medical units performed 849 intubations. In the rural areas of Pennsylvania (minor civil divisions) 31.6 percent had no intubations performed.

3,442 rescuers performed the 11,771 intubations (range of 1_23 intubations per rescuer; median three). 370 EMS agencies performed intubations (range of 1_1,407 intubations per agency; median 17).

The researchers concluded that if endotracheal intubation were limited to rescuers performing a minimum of three, five, 10 and 15 per year, the relative overall reduction in intubations performed would be 12, 32, 79 and 93 percent, respectively. If intubation was limited to agencies with a minimum number of 20, 30, 50, 100 and 150 intubations, the overall reductions would be 15, 27, 41, 65 and 73 percent, respectively.

The Street

Endotracheal intubaton continues to be a controversial topic. How many tubes a year should you pass to be competent? This study is the first to look at a statistical model to determine the impact of setting mandatory minimums.

What is most interesting about this study is that the reductions in intubations would predominantly affect cardiac arrest. With the recent AHA changes and our growing understanding of the proper role of airway control and ventilation, the role of endotracheal intubation is questionable, and the overall reduction in intubation may not have a negative effect.

Unfortunately, this study only tracked successful intubations. There are no outcome data, so we don t know the clinical impact of any reduction in intubations..

While I believe that there should be some minimum number of intubations per year to be considered competent, I don t know what that number is. However, before a service decides to set that number, it is vital that they perform, statewide, the same level of scrutiny to their intubation rates as this study.

It would be very interesting to look more closely at the non-arrest and trauma intubations, determine where they occurred, and follow their clinical outcome. I suspect as we move forward, such studies will further refine the role of out-of-hospital intubation.


Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Industry News, Airway and Respiratory, Research

 
What's Your Take? Comment Now ...

Featured Careers & Jobs in EMS

 

 

 

 

 

 

 

 

 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

The Evolution of Civilian High Threat Medical Guidelines

How mass killing events have proven a need for new guidelines.
More >

Multimedia Thumb

Ottawa Shooting, EMS Audio

Edited audio from the Parliament Hill incident.
Watch It >


Multimedia Thumb

Illinois Ambulance Service on Chopping Block

Peoria Heights EMS depends on property tax vote.
Watch It >


Multimedia Thumb

Kentucky Firefighters, Medics Drill for Ebola

Lexington firefighters and medics prepare for possible patients.
Watch It >


Multimedia Thumb

Mid-South EMTs Prepare for Ebola

Mid-South EMTs are certified for service.
Watch It >


Multimedia Thumb

Ottawa Shooting Incident

Solider is shot by gunman at national memorial in Ottawa.
More >


Multimedia Thumb

Life Link III Trauma Tactics Conference in Minnesota

Conference was designed to enhance the skills of providers of all levels, covering rescue and prehospital situations, to transport and in-hospital treatment.
More >


Multimedia Thumb

EMS Tailgating

Rigs converted for football.
More >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


More Product Videos >