References
Airway management in UK ambulance services: results of the National Ambulance Service Airway Management Audit
Abstract
Aim:
To establish the range of airway devices provided to ambulance staff employed by the UK NHS ambulance services, which level of practitioner is allowed to use which device or intervention, and what the main factors were in the purchasing decisions taken.
Methods:
Medical directors from all 14 UK NHS ambulance services were invited to participate in an anonymous, web-based survey of emergency airway management equipment provided within their service and which grades of practitioner were authorised to use the equipment they provided. Additionally, they were asked for the main reasons for the purchase of the selected equipment.
Results:
All 14 ambulance services completed the survey questionnaire. A range of clinical grades is now employed by UK ambulance services although there is inconsistency in both title and skill set. All services provide a range of airway equipment, but there is no common inventory across UK ambulance Trusts. Nearly all staff were authorised to use some of the basic equipment, but wider variations appear with more complex or sophisticated techniques. In particular there appears to be significant gaps in advanced equipment and those authorised to use it in respect of children.
Conclusions:
The range of airway equipment and those authorised by ambulance services to undertake airway management interventions appears to be evolving. It is of concern that there remains an apparent lack of standardisation of the range of airway equipment provided by UK NHS ambulance services.
Effective airway management is an essential component in the management of the critically ill or injured. Substandard airway management is a contributory factor in patient hypoxia, a recognised cause of preventable deaths from trauma (Anderson et al, 1988; Sanddal et al, 2011). It is likely that hypoxia is also implicated in preventable deaths from illness. In the United Kingdom (UK), airway management in the out-of-hospital emergency environment is normally the responsibility of ambulance service personnel. UK ambulance services employ a number of different practitioners, such as emergency medical technicians (EMT), paramedics, critical care paramedics (CCP) and doctors, although the range of practitioners is subject to variation across the UK. Each level of practitioner has a different skillset in relation to airway management, and airway management would normally be the responsibility of the practitioner with the greatest clinical skill level available at any given time. By frequency, that role is generally adopted by the ambulance paramedic, although there has been increased involvement by pre-hospital physicians with a more advanced airway skillset.
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