🚀 go-pugleaf

J.M. Douglas wrote:

> The B.C. Ambulance Service Advanced Life Support (ALS) Paramedics
> currently do not use a paralytic agent for rapid-sequence intubation
> for head trauma patients.  We have concluded from our preliminary
> research that a neuromuscular blockade agent can be used safely and
> effectively in the field by experienced paramedic teams. 

Hi:

Like you, we are not doing rapid sequence induction (RSI). Like you, our staff 
are interested in doing a needs assessment for RSI for our operation.

I would be interested in hearing from you about your investigation into RSI for 
EMA IIIs in BC. I will be in BC at the end of September, so I may give you a 
call if you don't mind.

FYI:

We have a "Facilited intubation" or "pre-intubation sedation" protocol. It 
reads as follows:

"In the instance when the Flight Paramedic determines that sedation is required 
to facilitate intubation, the Flight Paramedic will attempt contact with the 
Base Hospital Physician. If the Patch is impossible or cannot be obtained 
quickly, the Flight Patramedic may administer Midazolam 1-2 mg IV and/or 
Fentanyl prior to intubation and re-attempt the patch."

When intubation is indicated for the patient with a suspected or confirmed brain 
injury, a bolus of Lidocaine 1-1.5 mg/kg may be administered prior to intuation 
to blunt the effect of raised intracranial pressure."

In my experience, the facilitated intubation protocol has worked relatively well 
for many of our patients, with some acceptions where we've had to patch to get 
additional orders for Midazolam and/or Fentanyl. I would also say that we seem 
to have a significant number of patients, who in my humble opinion, would be 
better served by RSI intubation. As I say, we need to do a needs assessment to 
determine if in fact we have a sufficient number of patients who would benefit 
from RSI and if the numbers would be sufficiently high to maintain the skill.

I look forward to hearing from you.

Rob Theriault  EMCA, RCT (Adv., EMA III,
               Critical Care Flight Paramedic
Bandage 1, Dedicated Air Ambulance
Toronto, Ontario, Canada
E-Mail: rob.t@sympatico.ca
---------------------------------------------
Director of Education and Research
Ontario Paramedic Association