Abstract
Pre-hospital rapid sequence intubation was introduced within paramedic scope of practice
in South Africa seven years ago. Since then, little data has been published on this high-risk intervention as
practiced operationally or by students learning rapid sequence intubation in the pre-hospital environment.
The objective of this study was to describe a series of pre-hospital rapid sequence intubation cases,
including those that South African University paramedic students had participated in.
Methods: A University clinical learning database was searched for all endotracheal intubation cases
involving the use of neuromuscular blockers between 1 January 2011 and 31 December 2015. Data from
selected cases were extracted and analysed descriptively.
Results: Data indicated that most patients were young adult trauma victims with a dominant injury
mechanism of vehicle-related accidents. The majority of cases utilised ketamine and suxamethonium,
with a low rate of additional paralytic medication administration. 63% and 72% of patients received
post-intubation sedation and analgesia, respectively. The overall intubation success rate from complete
records was 99.6%, with a first pass success rate of 87.9%. Students were successful in 92.4% of attempts
with a first-pass success rate of 85.2%. Five percent of patients experienced cardiac arrest between rapid
sequence intubation and hospital arrival.
Discussion: Students demonstrated a good intubation success and first pass-success rate. However, newly
qualified paramedics require strict protocols, clinical governance, and support to gain experience and
perform pre-hospital rapid sequence intubation at an acceptable level in operational practice. More
research is needed to understand the low rate of post-intubation paralysis, along with non-uniform
administration of post-intubation sedation and analgesia, and the 5% prevalence of cardiac arrest.