Prehospital airway management in Finnish emergency medical service by non-physicians

• Main Author: Länkimäki, S. (Sami)
• Other Authors: Alahuhta, S. (Seppo), Kurola, J. (Jouni)
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: Oulun yliopisto 2020
• Subjects: airway management; emergency medical service; endotracheal intubation; prehospital care; supraglottic airway device; ensihoito; hengitysteiden hallinta; intubaatio; vaihtoehtoinen hengitystie; Northern Finland
• Online Access: http://urn.fi/urn:isbn:9789526227481

Abstract Prehospital advanced airway management is one of the most demanding procedures in the out-of-hospital scene. Prehospital advanced airway management is indicated based on patient assessment and suspected underlying illness or trauma. Prehospital emergency airway management can be performed using various methods. Endotracheal intubation (ETI) has been described as the ‘gold standard’ in emergency airway management to ensure sufficient ventilation and oxygenation. In previous years, critical questions have been raised regarding the use of ETI by providers not sufficiently experienced in performing this procedure. In the Finnish emergency medical service (EMS) system, ETI is rare and therefore often difficult for non-physician care providers. Previous studies have shown SADs to be easy to insert and to provide effective ventilation in manikins, anaesthetized patients and OHCA cases. The aim of this thesis was to study different airway devices used by non-physicians in prehospital care. After manikin training, first responders inserted a disposable laryngeal tube (LT-D) in OHCA patients with reasonable success and insertion time (I). A questionnaire completed by EMS providers in Northern Finland revealed a low frequency of prehospital advanced airway management procedures and the need for improvement in maintaining airway management skills (II). A laryngeal mask airway (LMA) Supreme (LMA-S) was used by trained advanced life support paramedics in unconscious patients with a high success rate, but ventilation-related problems due to air leakage were noticed (III). ETI provided by an experienced and well-trained small group of helicopter emergency medical service (HEMS) paramedics had a high success rate after a second attempt (IV). In conclusion, the devices studied were used in patients with OHCA or altered consciousness with reasonable success. The best option for pre-hospital airway management may be an individualized process where the intervention chosen depends on the EMS provider’s skills, the patient ...