Anesthesia & Clinical Research
Open Access

Abstract

Role Allocation and Team Dynamics during Pre-Hospital Rapid Sequence Induction of Anaesthesia by a Physician-Critical Care Paramedic Team in the United Kingdom: A 12 Months Review of Practice

Nick Crombie, Arun George and Carl McQueen

Background: Critical care paramedics working alongside physicians in the West Midlands MERIT scheme
Medical Emergency Response Incident Team (MERIT) have been shown to demonstrate high levels of proficiency in
laryngoscopy during Rapid Sequence Induction of anaesthesia (RSI). The MERIT SOP does not stipulate the team
member who should be allocated the role of laryngoscopy during RSI. The aim of this study is to analyse and
identify factors that influence role allocation in pre-hospital RSI performed by MERIT scheme personnel in the West
Midlands.
Methods: We conducted a retrospective review from 12 months of our mission database for patients who had
undergone pre-hospital RSI performed by MERIT. Data collected included the indication for RSI, the number of
intubation attempts (including documented failures to intubate), documentation of predicted difficulty in intubation
and the degree of airway soiling prior to RSI. The clinical role of the operator performing laryngoscopy was recorded
for each attempt.
Results: 113 cases or pre-hospital RSI were identified. Critical care paramedics successfully intubated 49/58
(84.48%) cases in which they were allocated the first attempt at laryngoscopy. Success at first attempt lower for
physicians (76.92%) but greater proportions of such cases involved patients at the extremes of age and heavy
airway soiling with a wider range of indications.
Conclusions: As part of a multidisciplinary team working alongside physicians, Critical Care Paramedics
successfully intubate the majority of patients at the first attempt in carefully selected groups. Further research to
investigate other factors at scene that influence role allocation and team dynamics in pre-hospital RSI is required.