Nitrate resistance in platelets from patients with stable angina pectoris

Anesthesiologists on ambulances: where do we stand?

PURPOSE OF REVIEW

This manuscript provides a critical review of the literature regarding the staffing of emergency medical services, with particular emphasis on anesthesiologists.

RECENT FINDINGS

Significant anesthesiology contributions to prehospital care include introduction of new airway management tools and improved physiological monitoring. Contributions to quality of care include patient benefit in terms of life years gained and a specific reduction in mortality from acute myocardial infarction. Intuitive concepts regarding the advantage of anesthesiologists in intubation mishaps and management of the failed airway have yet to be proven. Personnel limitations may be regional, necessitating local evaluation of anesthesiologist availability to staff ambulances. Since a major part of cost-effectiveness research is performed in the US where only paramedics staff ambulances, insufficient data exist regarding the financial implications of such practice. Burnout may be an important factor for deciding whether anesthesiologists should work in the operating room or ambulances or on an alternate basis.

SUMMARY

Further research should be performed to evaluate the clinical and financial implications of staffing ambulances with anesthesiologists or other physicians. Randomized controlled studies using standardized intubation techniques are necessary to examine whether prehospital airway management is improved when delivered by anesthesiologists.

Endotracheal intubation in a rural EMS state: procedure utilization and impact of skills maintenance guidelines

OBJECTIVE

Recent American Heart Association (AHA) guidelines have suggested that advanced life support (ALS) providers should have "regular field experience," defined as six to 12 intubations/year, as a prerequisite to patient endotracheal intubation (EI). The authors sought to assess the impact of this guideline on rural emergency medical services (EMS) practice.

METHODS

Statewide EMS records were reviewed for the calendar years 1997-2001. Data reviewed included the number of providers eligible to perform ALS skills (including EI), number of procedures performed per year by EMS provider, patient age, gender, and prehospital diagnosis. The institutional review board approved the study.

RESULTS

During the study period, a total of 957,836 patient encounters occurred with an average of 1,352 ALS providers annually eligible to perform EI. In the five-year period, there were 5,615 total EI attempts with a range of 37%-42% of eligible providers annually performing EI. A mean of 18 providers per year with a range of 1.8%-0.8% of EI-eligible providers annually attempted EI in more than five patients. One hundred thirty-seven pediatric EI encounters occurred during the five-year period with an annual range of 1.4%-2.7% of eligible providers attempting pediatric EI. During the five-year investigation, EI success rate was reported as 84% by providers with fewer than five annual intubation encounters and 86% by providers with more than five encounters.

CONCLUSION

Rural EMS providers rarely use EI skills, particularly in pediatric patients. If recent AHA intubation guidelines are to be followed in rural EMS settings, a small number of EMS providers will meet minimum EI utilization requirements.