Mainland European countries have a long history of sending physicians out with emergency medical services to provide prehospital critical care.
It is interesting to note an almost universal standard in the conduct of prehospital emergency anaesthesia by prehospital critical care services. Take a look at many services in the UK, Australasia, and Scandinavia, and you’ll see many more similarities than differences in the way they prepare roles and equipment, position the patient, brief the team, and manage a failed laryngoscopy drill. This is not coincidence. There is likely an element of convergent evolution – an optimal way of doing something is reached by different routes in different places – but a more likely factor is the shared experience and cross-pollination of ideas between services facilitated by specialists and trainees who have worked across the different systems in different countries.
This collective experience of many thousands of prehospital RSIs by hundreds of clinicians over tens of years in several countries is available to anyone to tap into through the free availability of YouTube videos and downloadable standard operating procedures. This wonderful sharing of information allows us to witness Scandinavians applaud Brits for demonstrating the safety of prehospital RSI using a standardised system.
Another common theme is the RSI checklist.
RSI checklists have been around in physician-based HEMS systems for over a decade, and since the powerful NAP4 national airway audit in the UK published three years ago, they have been a key recommendation for emergency airway management in hospital too. Anyone not convinced of the role of checklists might want to read Atul Gawande’s The Checklist Manifesto: How To Get Things Right, about which you can hear more here. Examples of emergency intubation checklists are freely available from the UK, the US, and Australia.
Here we can see an example from Budapest, where the team demonstrates a recognisable approach to prehospital RSI. Enjoy hearing the RSI checklist in Hungarian at around 7 minutes and 50 seconds: