IntroductionThe placement and securing of an airway via rapid sequence induction (RSI) prehospital is essential in maintaining a patent airway in the traumatic and medical unstable patient. Paramedics are frequently confronted with having to provide an advanced airway during the resuscitation phase of treatment to prevent death from airway failure or failure of adequate oxygenation prior to the delivery of the patient to hospital. This discussion paper looks at the fundamentals of RSI in securing the airway of patients in the resuscitative stage in prehospital environment.
ResuscitationThe term “resuscitation” can simply be defined as the reviving of a person who has lost consciousness. Resuscitation is much more than just performing cardiopulmonary resuscitation (CPR). Throughout the decades, methods of resuscitation have advanced to the current sophisticated and effective levels of cardiopulmonary resuscitation (CPR) from bystanders who witness the collapse; to paramedic intervention, fluid or blood administration, passive cooling, through to the establishment of advanced airway control. Levitan (2015) suggests that intubation and CPR are only parts of resuscitation of the critically ill.HistoryFalcone, Herron, Dean & Werman (1996) suggest that emergency prehospital intubation is an emergency procedure that can make the difference in life and death situations.
The use of rapid sequence intubation is to provide a secure emergent airway, utilising an advanced airway management which involves the sequential application of oxygenaton, sedation and a short acting paralytic, followed by the placement of an endotracheal tube. El-Orbany & Connolly (2010) suggested that the term RSI was in fact inaccurate and the term rapid sequence induction and intubation (RSII) was a more accurate and descriptive term. It was Stept and Safar that first introduced the technique in 1970. Since it was introduced, RSI has seen many developmental changes and has transitioned from the operating room into emergency departments and out into the prehospital environment. RSI is intended to optimally prepare patients for laryngoscopy and intubation through facilitating conditions for successful first pass intubation.
The use of out-of-hospital rapid sequence intubation is used by a number of ambulance and emergency medical services around the world including Australia, Europe, South Africa, England and the United States (Fouche, Stei, Simpson,Carlson, & Do, 2017). Despite ongoing studies and research, the implementing of paralytic agents and RSI in the prehospital field remains controversial (Alves, 2015).The management of the airway can be arguably one of the most important and challenging skills that paramedics are required to master, as failure to provide an adequate airway can quickly lead to failure to oxygenate, hypoxia, secondary brain injury, disability or death.