Neil Spencer, Anthony Bleetman, Danny Hopkins
Journal of Paramedic Practice, Vol. 1, Iss. 1, 01 Oct 2008, pp 17 - 20

Rapid sequence induction (RSI) is one of the key additional skills that an appropriately-trained doctor can bring to the prehospital environment. Controversy remains over the most appropriate person to perform RSI.
To review the scope of RSI activity on one helicopter emergency medical service (HEMS) unit and assess paramedic involvement and leadership in delivering prehospital RSI.
Prospective review of clinical database for air ambulance service
Crews performed 72 RSIs over a 13-month period. Paramedics intubated 47 patients (65%). None of the intubations performed by paramedics required any intervention by the doctor. Of the RSIs 55 (76%) were performed on trauma patients and 17 (24%) for patients with medical emergencies; 31 (43%) were carried out in the presence of emergency physicians, 30 (42%) with anaesthetists present and 11 (15%) with a surgical specialist registrar. One doctor (consultant emergency physician) was present at RSIs on two patients at one scene; the paramedic intubated one of the patients. Six adverse events were reported. There were no reported serious technical complications of the RSI procedure such as incorrect tube placement or oxygen desaturation.
Our experience supports the growing recognition that appropriately-trained non-anaesthetists can perform RSI as safely as anaesthetists in both the hospital and prehospital environments. Our study also suggests that with appropriate training and supervision, paramedics carry no greater risks in RSI than their anaesthetic and non-anaesthetic medical colleagues.

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