Standardized Rapid Sequence Intubation (RSI) Improves Effectiveness and Safety in Mixed Physician and Paramedic Hungarian EMS.
Life (Basel, Switzerland) · 2025-11-07 · Observational study
Abstract
(1) Background: Ground Emergency Medical Services in Hungary are provided by the National Ambulance Service. Paramedics, physicians, and specialists in this service are competent in performing endotracheal intubation (ETI) on patients. The aim of this study is to evaluate the impact of the standardized Rapid Sequence Intubation (RSI) procedure on safety and effectiveness. (2) Methods: A retrospective observational study was conducted concerning the RSI procedure. Patient documentation from a 2-year implementation period was analyzed using a dedicated Case Report Form (CRF), where both RSI and non-RSI methods were used. Our primary endpoint was Definitive Airway Sans Hypoxia and Hypotension on First Attempt (DASH-1A). Our secondary endpoints included success on the first attempt; overall success; and hypoxia, hypotension, and cardiac arrest complications. (3) Results: In total, 6399 intubation cases were studied; non-RSI was used in 3236, and RSI was applied in 3163 cases. DASH-1A was attained in a significantly higher number of cases with RSI than non-RSI (55.0 vs. 68.5%, p < 0.0001). The DASH-1A results of the RSI group were significantly better in the paramedic (54.0 vs. 68.5%, p < 0.0001) and the physician (55.0 vs. 66.7%, p = 0.0017) subgroups. In the specialist subgroup, the difference was not statistically significant (64.5 vs. 69.7%, p = 0.1514). (4) Conclusions: Standardized RSI significantly increased effectiveness and safety in the paramedic and physician subgroups.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Endotracheal intubation · Rapid sequence intubation · Prehospital physicians · Paramedics & EMTs
Related articles
- Nonphysician Out-of-Hospital Rapid Sequence Intubation Success and Adverse Events: A Systematic Review and Meta-Analysis. (Ann Emerg Med, 2017)
- Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. (Crit Care, 2012)
- 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)
- [Rapid sequence intubation (RSI) in a patient with severe head injury on the island--a case report and review of the literature]. (Acta Med Croatica, 2006)
- The future of paramedic intubation: who should be responsible? (Journal of Paramedic Practice, 2010)