On 17th September 2020 East of England Ambulance Service NHS Trust (EEAST) announced they were removing endotracheal intubation from paramedic scope of practice. EEAST cited,
“…several adverse incidents relating to Endo-tracheal Intubation that have resulted in Serious Incidents and the risk of harm, the Trust has reviewed all available evidence and made the risk-based decision…”¹
EEAST are not the first trust to do this; London Ambulance Service announced the cessation of routine training in endotracheal intubation for paramedics from 1st June 2010 onwards and Yorkshire Ambulance Service followed suit a few years later. The debate has been raging since 2008 when the Joint Royal Colleges Ambulance Liason Committee published,
“Growing evidence suggests that tracheal intubation is not the optimal method of airway management by paramedics and may be detrimental to patient outcome”.³
Understandably, many paramedics expressed disappointment at being stripped of this potentially life-saving skill. Data shows cardiac arrests, the most common reason for a patient requiring intubation, are relatively rare jobs for the average paramedic. A ten-year study by Ambulance Victoria published in the Resuscitation Journal concluded,
“It would take paramedics an average of 163 days to be exposed to an OHCA (out-of-hospital cardiac arrest) and up to 12.5 years for paediatric OHCAs, which occur relatively rarely.”²
How can paramedics maintain airway management competence?
For ambulance services that still support intubation for all paramedics and those with Critical Care Paramedics who will be called in to intubate when required; how can they maintain competency when the opportunities to do so ‘on the road’ are so infrequent? The answer has to be low-dose high-frequency training, either in hospitals or training centres. All clinicians need to practise their skills little and often to avoid skill fade. The only practical way to achieve this is with airway management training manikins and simulators.
Simulaids offers the widest range of airway management trainers available. As well as the excellent Simulaids® range, we also offer products from Nasco Healthcare, Life/form®, BT Inc and Tru Corp.
The BT Inc Smart Airway Management Simulator is arguably the best tool to solve this particular problem because it offers a self-directed, objective assessment of the skills required to successfully intubate and ventilate a patient. Connecting to an Andriod tablet via Bluetooth, the smart simulator measures:
- the angle of head tilt
- jaw thrust
- pressure on the teeth
- position of the ET Tube (oesophagus or trachea)
- depth of the ET tube
- bag-valve-mask ventilation (volume and time)
All the metrics are brought together with intuitive software which scores the scenario. Results are exported to PDF for storage, email or printing.
The BT Inc Smart Airway Management Simulator is an efficient way of enabling paramedics to practise their skills and measure competency without losing valuable time on the road treating patients.