Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services

Background Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process. Methods The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records. Results During the study period (2012–2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25–42] vs. 29 [IQR 21–39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7–77.8%) to 97.6% (95% CI 96.7–98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0–73.9%) to 93.4% (95% CI 92.3–94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6–88.9%) to 98.5% (95% CI 97.7–99.0%), respectively. Deterioration in compliance indicators was not observed. Conclusions We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.