Pre-hospital rapid sequence induction: factual inaccuracies.

To the Editor: The article on pre-hospital rapid sequence induction (RSI) in the September issue of the SAMJ [1] makes a valuable contribution to our understanding of RSI in this environment in South Africa (SA). However, there are some factual inaccuracies in the article regarding the educational background of those performing the procedure, which I would like to clarify. In SA, emergency care personnel are registered with the Health Professions Council of South Africa (HPCSA) in different categories depending on the qualification that they hold. Although the term 'paramedic' is used in a very general way in the international literature, in SA it has a specific meaning in relation to a specific category of registration. Currently, RSI does not exist in the scope of practice of emergency care personnel registered in the category of 'paramedic' , but only in the registration category of emergency care practitioner (ECP). This distinction is of some importance when considering the educational background of those practicing RSI, as ECPs hold a four-year degree in emergency medical care (EMC). On page 633, and again on page 636, the authors describe RSI training as being a 'two day university course' and that they consider this to be insufficient. [1] I agree that two days of training on RSI is insufficient. However, this is not an accurate description of current RSI education at all institutions offering the EMC degree programme. The 'two day university course' was offered once in 2009 by one institution for those who already held an EMC degree, as a way of incorporating RSI (which was newly-approved at the time) into their clinical practice. The important point is that it was a 'once-off ' arrangement intended to update those who qualified with an EMC degree before RSI was approved for ECP scope of practice; it has not been the approach followed for undergraduate students since 2010. At the University of Johannesburg (UJ), RSI has been incorporated into an educational strategy on airway management which spans four years. Our approach in designing and implementing RSI education since 2010 has involved advice, input and involvement from specialists in both anaesthesiology and emergency medicine. Assessments include a mix of theory, objective structured clinical evaluations, simulations and assessments carried out in the emergency centre and pre-hospital environments. While we would like all of our students to have clinical experience in RSI before qualifying as independent practitioners, there is a …