Experiences of emergency care practitioners on pre-hospital rapid sequence intubation in South Africa

Abstract

Background: Pre-hospital Rapid Sequence Intubation (RSI) is a complex, high-stakes and time-sensitive procedure performed in unpredictable resource-constrained environments. Successful execution of pre-hospital RSI demands coordinated teamwork, thorough preparation and clear communication.
Aim: This qualitative study explored the experiences of Emergency Care Practitioners (ECPs) during pre-hospital RSI.
Setting: The study was conducted across three South African provinces: Gauteng, KwaZulu-Natal and the Western Cape.
Methods: The study adopted a descriptive qualitative design, using focus group discussions (FGDs) to understand ECPs’ experiences during prehospital RSI. Six FGDs were conducted online via Microsoft Teams. All discussions were audio-recorded, transcribed and analysed using qualitative data analysis software, NVivo 13 (2020 R1).
Results: A total of 39 ECPs voluntarily participated in six FGDs, representing both public and private sectors. The following themes emerged; system-driven administrative demands and procedural complexity, resource and workforce constraints affecting RSI performance and communication-related challenges and information gaps affecting clinical decision-making.
Conclusion: The ECPs voice concerns about challenges that require Emergency Medical Services (EMS) management to implement supportive measures, including improved access to resources and equipment during pre-hospital RSI. Additionally, they argue that practitioner proficiency promotes the effective execution of pre-hospital RSI.
Contribution: The findings of this study and the insights gained can guide EMS leadership and policymakers in formulating targeted strategies that will ensure the availability of essential resources and strengthen operational support to enhance the safety and quality of care delivered to critically ill or injured patients requiring RSI.