Rapid sequence induction of anaesthesia in UK emergency departments: a national census

Introduction Rapid sequence induction of anaesthesia and tracheal intubation (RSI) is an integral part of modern emergency care. Previously, emergency department (ED) RSI has been provided by anaesthetists, but UK emergency physicians are increasingly developing this skill. We undertook a 2-week census of ED RSI to establish a baseline of current practice. Methods All 115 UK College of Emergency Medicine airway leads were contacted and asked to return anonymised data on every drug-assisted intubation occurring in their ED during a 2-week period in September 2008. The number of RSIs and also the total number of ED attendances during the same period were requested. Results Complete data were returned from 64 EDs (56%). The total number of patients undergoing RSI was 218, with an incidence of 0.12%, or approximately one in every 800 ED attendances. Anaesthetic staff undertook 80% of ED RSIs, predominantly senior anaesthetic trainees of specialist trainee year 3 (ST3) or above. During normal office hours 74% of these anaesthetic trainees were supervised during the procedure, with a significant fall in supervision rates to 15% outside normal office hours (p < 0.00001 on chi(2) testing). Discussion The 0.12% incidence of ED RSI is consistent with previous studies, as is the finding that only 20% are performed by emergency physicians. The relative infrequency of ED RSI and increasing pool of staff has important implications for training and skills maintenance. Despite the acknowledged difficulty of this technique, nearly half of all ED RSIs are done by unsupervised trainees.