[Seriously injured patients intubated at the accident site. A three-year survey from the mobile emergency care unit in Aarhus]

Abstract

Background: The success rate of out-of-hospital endotracheal intubations performed by paramedics has been questioned. It seems to be difficult to achieve and keep a routine. The aim was to describe the severity of injuries and the number of such intubations in trauma patients treated by the Mobile Emergency Care Unit (MECU) staffed with an anaesthetist.

Materials and methods: The case records of all trauma patients on whom the MECU, Arhus, performed endotracheal intubation at the accident site from 1 May 1997 to 30 April 2000 were studied. Lesions were classified according to the abbreviated injury scale (AIS), and the injury severity scores (ISS) were calculated. Severe injury was defined as an ISS > 15.

Results: Over the three-year period the MECU attended 2546 trauma patients, 95 (3.7%) of whom were intubated at the site. In one case, endotracheal intubation was not possible and cricothyrotomy had to be performed. Of the patients intubated at the site 65 had an ISS > 15. This, according to previous studies, corresponded to about 20% of all severely injured patients arriving at our hospital. Sixty patients had severe lesions in the head region. In sixty-eight cases (72%) endotracheal intubation was preceded by anaesthesia.

Discussion: Out-of-hospital endotracheal intubation of trauma patients was not a frequent intervention, as compared to all emergency calls, but it was relatively frequent in the severely injured brought to our hospital. If endotracheal intubation is to be one of the available interventions in the prehospital setting, this study confirms that it should preferably be done by physicians experienced in intubation and anaesthesia.