I have to agree with Francis and the others who support the use of RSI in both the pre-hospital setting and the ED. The studies from the states and local audit confirm that it is a safe procedure when performed by non-anaesthetists. The debate over training is a little more complex, and I think a course such as Ron Walls airway course in the states, and a period of intensive experience in the OT ( ? how long ), and ongoing experience in the ED is what is required. Paramedics and basics doc's can and should be trained in this technique. The often quoted problem is the varying skill levels amoung providers - if that is a real problem then set minimum standards for training and ongoing skill development, rigidly enforce them - but dont deny the patient what may save their life or at least their higher functions in a prehospital environment.
Now can we achieve the same level of skill as the Anaesthetic SpR 4 or a consultant, no probably not. But can we acheive a better standard of care for the emergency patient with an airway problem, than the anaesthetic SHO or junior SpR can provide, or prevent what is lost by the 15 minute wait for the senior to arrive, then yes absolutely. So either the Anaesthetic department provide us with an experienced registrar or a consultant immediately avaiable 24 hrs / 7 days, or we will do it ourselves - its that simple - and can anybody see that happening ? This is what we do, manage airways in really sick patients, often with minimal history and after a pie and alot of lagar, we do it frequently and we do it in a timely fashion and we are doing it safely. The evidence is rapidly mounting up against those who think ED specialists and trainees are incompetant and are a danger to patients by performing RSI. The trick is knowing what your doing, being familiar with your drugs and having a plan for if it goes wrong.
off my soap box now
Craig
Dr Craig Ellis
Registrar in Emergency Medicine
Wellington Hospital
Wellingon, New Zealand
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