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Endotracheal intubation is an advanced and complex skill that requires training and experience and is subject to significant skill degradation when it is not performed regularly. Failed intubation and misplaced tubes have been linked to significant morbidity and mortality, leading some jurisdictions to require a minimum number of procedures per year in order for providers to be permitted to perform intubation.
Using data on 11,771 intubations from a large prehospital database in Pennsylvania, these authors determined the effects of imposing a minimum intubation requirement on the number of prehospital intubations performed. If performance of intubation were limited to providers with a minimum of 3, 5, 10, and 15 intubations per year, the number of intubations performed would be reduced by 12%, 32%, 79%, and 98%, respectively. If performance were limited to emergency medical services agencies with a minimum of 20, 30, 50, 100, and 150 intubations per year, then the number of intubations would be reduced by 15%, 27%, 41%, 65%, and 73%, respectively.
Wang HE et al. How would minimum experience standards affect the distribution of out-of-hospital endotracheal intubations? Ann Emerg Med 2007 Sep; 50:246.
Comment
Patients need oxygenation, not an endotracheal tube. Adequate bag-valve mask ventilation clearly is superior to failed or misplaced intubation, and requiring a minimum annual number of intubations is a reasonable starting point to ensure quality. EMS agencies and medical directors need to reevaluate the benefit/risk formula for prehospital intubation.