Paramedic Competency in Drug-Assisted Intubation: A Cross-Sectional Study

Abstract

Drug-assisted intubation (DAI) is a critical intervention that facilitates prehospital airway management, yet the competency of paramedics in performing DAI remains inadequately characterized. The objectives of this study were to assess the technical skills, decision-making ability, and adherence to established protocols of paramedics who perform DAI, using appropriately developed instruments, and to examine the influence of previous airway management experience and DAI-related training on these competencies. A cross-sectional study design was deployed from October 1, 2022, to December 31, 2022, across a single emergency medical services system in Southern Ontario, Canada. Remote-recorded simulations of six prehospital scenarios requiring DAI were completed by 25 paramedics selected through purposive sampling. Technical assessment, decision-making evaluation, and protocol adherence were measured with structured rubrics. Safety-related adverse events were also documented. Overall competency levels across the three constructs were moderate (technical skills: mean 12.04 ± 2.23, range 7–16; decision making: median 12.00, interquartile range 9.00–13.50; protocol adherence: median 43.00, interquartile range 31.75–48.00), and marked variability in performance among participants was observed. Starting intravenous access before DAI was the most frequent decision-making error; knowledge of contraindications and confirmation methods were the least-frequently demonstrated technical skills. These findings suggest that significant opportunities exist to enhance DAI competency levels among paramedics. Stepwise refresher training, supervision during initial interventions, and development of standardized operating procedures are candidates for improvement initiatives. DAI is a common prehospital airway management procedure associated with high complication rates, and improvements to related competencies therefore warrant attention.