Abstract
BACKGROUND: Despite the improvement in prehospital care in the last decade in India through dedicated ambulance services, airway management is often performed by undertrained or untrained personnel and remains teetering to the edge of collapse. This study aimed at assessing the airway status in critically ill patients at their arrival to the Emergency Department (ED). METHODS: This prospective study included all triage priority I patients presenting to the ED during August 2017 and September 2017. Details of their airway status at arrival to the ED was noted. The severity at presentation and outcome of patients brought in ambulances and private vehicles were determined using descriptive analytic statistics and bivariate logistic regression analysis. RESULTS: The study included 450 patients, with a male predominance (65.3%). Only a third (31%) of patients were brought in ambulances with a reminder through various means of transport. Compared to patients brought by private vehicles, patients brought to the ED by ambulances had a higher odds of being hypoxic at ED arrival [OR: 1.63 (95% CI: 1.08-2.46); P value: 0.01] and requiring invasive ventilation on arrival to the ED [OR: 2.36 (95% CI: 1.46-3.80) P value: < 0.001]. Overall, 55.7% (248/450) required hospital admission while 21% (95/450) were discharged stable from the ED after resuscitation and stabilization by the ED team. The overall mortality rate was 11.1% (50/450), with 13.5% (19/144) of those brought by ambulances and 10% (31/309) of those brought by private vehicles succumbing to their illness in the hospital. CONCLUSION: Private vehicles still remain the predominant mode of prehospital transport though ambulances are used to transport sicker patients. More than half the critically ill patients remained hypoxic on arrival to the ED. Our study clearly highlights the glaring deficiency in airway status at ED arrival and stresses the urgent need to improve prehospital care.