Paramedic Rapid Sequence Intubation (RSI) in a South African Emergency Medical Service (EMS) is effective, but is it safe?

Background Early access to critical care interventions may improve outcomes for severely ill and injured patients. A Cochrane review [1] in 2009 reported that evidence supporting prehospital emergency intubation is lacking, but this does not equate to lack of benefit and prehospital RSI remains controversial. South Africa faces unique challenges due to prolonged prehospital times and limited access to physicians. In response to these challenges, the Health Professions Council of South Africa introduced paramedic RSI in 2008. This has been shown to be superior to intubation without paralysis, but a recent meta-analysis concluded that in the absence of prehospital physicians, alternatives to RSI should be strongly considered due to patient safety concerns[2]. This study aimed to identify if RSI performed by paramedics, in the South African prehospital care context is effective and safe.