Rapid sequence induction: a survey of practices in three French prehospital mobile emergency units

Rapid sequence intubation outside hospital is fraught with difficulties: an intervention in a supposed hostile environment, the lack of precise information about the medical history of the patient, the diversity in the skills of doctors. In France, a Commission of Experts drew up a set of guidelines in 2000. Objectives This prospective study was conducted in three mobile emergency and intensive care units. Methods The patients were over 15 years of age and were not in cardiac arrest. The study was to compare practices in the three units with the guidelines drawn up by the Commission of Experts so as to define the main parameters for quality assurance. All of the patients involved were considered to have full stomachs and required rapid sequence induction. Results This procedure comply the guidelines only in 45% of cases; in the other cases succinylcholine should have been administered (mobile emergency and intensive care unit A) and the Sellick manoeuvre should have been used (mobile emergency and intensive care unit A and B). Notwithstanding, these two centres treated more traumatized patients than mobile emergency and intensive care unit C, and use of the Sellick manoeuvre in such circumstances is questionable. Conclusions More training and greater diffusion of the protocols are required, especially with regard to doctors who intervene intermittently.