Objectives-To study the current practice of rapid sequence intubations (RSI
s) in four different emergency medicine training programmes in the UK.
Methods-Observational study design involving four regional training program
mes (Wessex, North West, Yorkshire, Avon). Data were collected in real time
using a previously piloted survey tool. Data were collected by specialist
registrars in emergency medicine over a continuous 28 day period. Data coll
ected included: indications for RSI; key timings of RSI procedures; details
of RSI practitioner; complications and outcome of procedure.
Results-Data from 60 RSIs were recorded and collected. The majority of deci
sions to perform RSIs were made by emergency physicians (74% cases). Over 5
0% of the RSIs occurred after 4 pm. Emergency physicians performed 26% of R
SIs although the majority were performed by anaesthetists. Most of the give
n indications for RSIs were based on an assessment of airway protection. Hy
poxia was an uncommon reason for RSI in this study (5%). In two thirds of c
ases the time taken from the decision being made to perform an RSI, to the
achievement of successful intubation, was greater than 20 minutes. No faile
d intubations were recorded, although six other complications (all minor pr
oblems) were recorded. There was no significant difference in the response
times between anaesthetists and emergency physicians.
Conclusions-This study shows that emergency physicians are currently perfor
ming RSIs in emergency departments in the UK. It also suggests improvements
could be made to patient care. In particular, standards of care should be
agreed for the provision of RSI in the emergency department, including the
personnel involved and the appropriate training of individuals. RSI activit
y in emergency departments in the UK should be audited nationally using an
agreed audit tool.