Feasibility of Prehospital Emergency Anesthesia in the Cabin of an AW169 Helicopter Wearing Personal Protective Equipment During Coronavirus Disease 2019.
Air Medical Journal · 2021-01-01 · Method & validation
Abstract
OBJECTIVE: Prehospital emergency anesthesia in the form of rapid sequence intubation (RSI) is a critical intervention delivered by advanced prehospital critical care teams. Our previous simulation study determined the feasibility of in-aircraft RSI. We now examine whether this feasibility is preserved in a simulated setting when clinicians wear personal protective equipment (PPE) for aerosol-generating procedures (AGPs) for in-aircraft, on-the-ground RSI. METHODS: Air Ambulance Kent Surrey Sussex is a helicopter emergency medical service that uses an AW169 cabin simulator. Wearing full AGP PPE (eye protection, FFP3 mask, gown, and gloves), 10 doctor-paramedic teams performed RSI in a standard "can intubate, can ventilate" scenario and a "can't intubate, can't oxygenate" (CICO) scenario. Prespecified timings were reported, and participant feedback was sought by questionnaire. RESULTS: RSI was most commonly performed by direct laryngoscopy and was successfully achieved in all scenarios. The time to completed endotracheal intubation (ETI) was fastest (287 seconds) in the standard scenario and slower (370 seconds, P = .01) in the CICO scenario. The time to ETI was not significantly delayed by wearing PPE in the standard (P = .19) or CICO variant (P = .97). Communication challenges, equipment complications, and PPE difficulties were reported, but ways to mitigate these were also reported. CONCLUSION: In-aircraft RSI (aircraft on the ground) while wearing PPE for AGPs had no significant impact on the time to successful completion of ETI in a simulated setting. Patient safety is paramount in civilian helicopter emergency medical services, but the adoption of in-aircraft RSI could confer significant patient benefit in terms of prehospital time savings, and further research is warranted.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Helicopter & air ambulance · Anaesthetics · COVID-19 pandemic · Paramedics & EMTs · Personal protective equipment · Prehospital physicians · Rapid sequence intubation · Teamwork & human factors
Related articles
- First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics. (Eur J Emerg Med, 2015)
- Rapid sequence induction on an air ambulance service (Journal of Paramedic Practice, 2008)
- Association of mortality and physician experience in prehospital anaesthesia: a registry study on new physicians in Finnish helicopter emergency medical services. (Scand J Trauma Resusc Emerg Med, 2025)
- Pediatric Intubations in a Semiurban Helicopter Emergency Medicine Service: A Retrospective Review. (Air Med J, 2024)
- Structured correction after difficult direct laryngoscopy during prehospital rapid sequence intubation: an eleven-year physician-staffed helicopter emergency medical service registry study. (Int J Emerg Med, 2026)
- The impact of airway assistants on prehospital endotracheal intubations - a subgroup analysis of data from anaesthesiologist-staffed helicopter critical care teams. (Scand J Trauma Resusc Emerg Med, 2025)