[Out-of-hospital tracheal intubation practice by advanced level ambulance crews and reeducation program for skill retention: survey of emergency life saving technicians].

BACKGROUND: Five years have passed since out-of-hospital tracheal intubation training for advanced level ambulance crews (emergency life saving technicians: ELSTs) was started in Japan. Herein, we reviewed results of the initial training and reeducation program. METHODS: Using a questionnaire sent by post, we surveyed out-of-hospital tracheal intubations performed by 19 ELSTs trained at Hiroshima University Hospital. RESULTS AND CONCLUSIONS: Sixty-three tracheal intubations were attempted between 2004 and 2009, of which 56 (89%) were successful and 7 (11%) unsuccessful, with ventilation maintained using another means such as a laryngeal mask airway or bag-valve-mask in the latter cases. Esophageal intubation occurred in 6 cases, but were immediately recognized and dealt with appropriately. Only 1 failed intubation patient, in whom esophageal intubation was changed to bag-valve-mask ventilation, survived until discharge. The average number of yearly intubation attempts (1.2) was small, thus nearly all ELSTs replied that they desired a reeducation program to maintain their intubation skills. Furthermore, some expressed a preference to receive reeducation under conditions close to actual emergency settings. That latter finding reflects the difficulty of out-of-hospital tracheal intubation performed in adverse conditions, such as in inappropriate patient or rescuer positions, and secretion or bleeding in the oral cavity.