From the Research
In Ohio, there is no specific maximum number of paramedics required for rapid sequence intubation (RSI) of a patient, and the procedure is typically performed by at least two paramedics. The procedure involves administering a sedative (such as etomidate, ketamine, or midazolam) followed by a neuromuscular blocking agent (such as succinylcholine or rocuronium) to facilitate endotracheal intubation, as discussed in a recent study 1. Ohio's scope of practice for paramedics allows for RSI, but specific protocols and medication choices are determined by local medical directors.
Having additional personnel can be beneficial for managing complications, assisting with patient positioning, medication administration, and documentation. According to a study published in 2020 2, a multifaceted intervention was implemented using quality improvement methods to increase successful intubation within two attempts, and the results showed that adherence to the standardized process was sustained at 91% for medical patients and a baseline of 55% for trauma patients with a trend toward improvement.
The choice of medications for RSI is critical, and a study published in 2009 3 discussed the algorithm of RSI, which consists of six steps: pre-oxygenation, premedication, myo-relaxation and induction, intubation, primary and secondary confirmation, and post-intubation patient management. Another study published in 2014 4 reviewed the steps of rapid-sequence intubation and discussed premedications, induction agents, neuromuscular blockers, and studies supporting use or avoidance.
In terms of medication choices, etomidate and rocuronium have become increasingly popular for sedation and paralysis, respectively, in pediatric patients undergoing RSI, as discussed in a study published in 2009 5. However, the use of etomidate in patients with septic shock is controversial due to its suppression of adrenal function.
Overall, while there is no specific maximum number of paramedics required for RSI in Ohio, having at least two paramedics present is typical, and additional personnel can be beneficial for managing complications and assisting with the procedure. The choice of medications and protocols for RSI should be determined by local medical directors and based on the latest evidence and guidelines.
Some key points to consider when performing RSI include:
- The procedure typically involves at least two paramedics
- Additional personnel can be beneficial for managing complications and assisting with the procedure
- The choice of medications and protocols should be determined by local medical directors and based on the latest evidence and guidelines
- Etomidate and rocuronium are popular choices for sedation and paralysis in RSI, but their use should be carefully considered in certain patient populations.