RSI/DAI protocol deadline approaching

By LETCH DAY
Director of Operations, Kentucky Board of EMS

FRANKFORT — On January 12, 2006, the Kentucky Board of EMS agreed to adopt and follow the National Scope of Practice, Version 4.0. Rapid Sequence intubation is not recognized as a standard of care in the pre-hospital environment and was not adopted as a paramedic skill recognized within the National Scope of Practice Model.

Furthermore, recent and accumulating medical evidence citing the unanticipated negative impact of this skill on patient outcome have raised significant and, as yet, unresolved questions regarding the role and safety of this skill in the pre-hospital environment.

The National Association of Emergency Physicians and the American College of Surgeons have published position statements on drug-assisted intubation in the pre-hospital environment. KBEMS has determined that the skills and knowledge required to implement a Drug Assisted Intubation (DAI) and Rapid Sequence Intubation (RSI) significant and should be consistent, at a minimum, with the recommended published guidelines of these institutions and has developed a state waiver protocol for RSI and a state protocol for DAI that is consistent with these guidelines.

Therefore, if your medical protocols include Rapid Sequence Intubation and/or Drug Assisted Intubation you shall cease and desist these procedures as of August 1, 2007. During this ‘sunset’ period, you may continue to utilize these procedures. However, you must make reasonable efforts to conclude the use of said procedures through education and training for all paramedics to assist in this amendment to your entity’s standing medical protocols.

Each service that desires to continue to use Rapid Sequence Intubation after August 1, 2007 may apply to use the approved state waiver protocol which is available via the website for the Kentucky Board of EMS at https://kbems.kctcs.edu/kbems. This application must include all the information for each required field and must be accompanied with the Statement of Understanding completed by your service’s medical advisor.

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