Prehospital Rapid Sequence Intubation in a Blunt Trauma Patient: A Case for High-Fidelity Simulation in Prehospital Medicine

Rapid sequence intubation (RSI) is a procedure that has moved from the operating room to the emergency department and now to the prehospital setting. It is a procedure that has significant risk but is used infrequently, and therefore, providers have a tendency to lose proficiency. These facts make simulation training and evaluation of utmost importance. As our experience and skill as a specialty continue to improve, high-fidelity simulation scenarios can easily incorporate these techniques to improve patient outcomes. This simulation case consists of four files that can be utilized by faculty implementing this evaluation/learning activity. This case can be presented with a single faculty member providing case information and role-playing various aspects of the case. It may be enhanced with additional actors or standardized patients. This scenario has been presented to 45 paramedics over 9 different days to evaluate their ability to maintain competence in RSI. Our experience to date has been that experienced paramedics are able to successfully negotiate this case without significant difficulty. As we have stressed the importance of the use of continuous waveform capnography and preprocedure resuscitation, the paramedics have been more successful in the management of these types of patients. This scenario provides an opportunity for paramedic evaluation and training in RSI. Please see the end of the Educational Summary Report for author-supplied information and links to peer-reviewed digital content associated with this publication. Introduction Patients with blunt traumatic injury are commonly encountered by prehospital providers. Being the first to care for these patients can be stressful. Given that many patients with traumatic injuries are critically ill and require time-sensitive assessment, treatment, and transportation, educational resources are needed to help train providers to make appropriate initial clinical decisions. Rapid sequence intubation (RSI) is a procedure that has moved from the operating room to the emergency department and now to the prehospital setting. It is a procedure that has significant risk but is used infrequently, and therefore, providers have a tendency to lose proficiency. These facts make simulation training and evaluation of utmost importance. As our experience and skill as a specialty continue to improve, high-fidelity simulation scenarios can easily incorporate these techniques to improve patient outcomes. This resource provides the instructions and materials for a high-fidelity simulation case or oral board exam appropriate for paramedic students, emergency medical technicians/paramedics, and critical care transport providers including paramedics and nurses. Blunt trauma patients with significant injuries such as the scenario presented here provide an opportunity for providers to assess and manage potentially unstable airways. RSI is a prehospital clinical skill used by many emergency medical services (EMS) agencies and requires careful consideration of multiple factors to safely manage airway emergencies. Methods This simulation case consists of four files that can be utilized by faculty implementing this evaluation/learning activity. Appendix A includes all of the information needed to plan and implement this case. Laerdal SimMan, CAE Healthcare METIman, or other appropriate high-fidelity patient simulator can be used. Alternatively, with a few modifications, this case could also be completed using low-fidelity patient mannequins or even used in an oral board presentation format. This case can be presented with a single faculty member providing case information and role-playing various Stopyra J, Beaver B, Fitch MT, Nelson RD. Prehospital rapid sequence intubation in a blunt trauma patient: a case for high-fidelity simulation in prehospital medicine. MedEdPORTAL Publications. 2016;12:10358. http://dx.doi. org/10.15766/mep_2374-8265.10358 Published: March 10, 2016