The Wisconsin Physicians Advisory Committee (PAC) met on March 4 to offer its recommendations regarding use of nitrous oxide for pain management, and replacing RSI with Medication Assisted Advanced Airway and expanding options for trained personnel, other than Paramedics, to perform the lifesaving procedure.
Use of nitrous oxide was recommended by PAC for ambulance services at the EMT-Intermediate Technician level and higher. Nitrous oxide is a medication inhaled by mask for patient pain management, and a skill already approved in the National Curriculum. PAC and the EMS office are currently working through a best practices document before any approvals are given to ambulance services. In its final form the document will detail education and training requirements as well as exposure, safety and diversion procedures. Dr. Charles Cady, Wisconsin’s EMS medical director, contacted several state medical directors about their experience using nitrous oxide for pain management.
Rapid Sequence Intubation, or RSI as it is commonly referred, is a medication induced airway management procedure that includes paralytics and currently requires two Paramedics at the patient's side. PAC recommends RSI be replaced with Medication Assisted Advanced Airway, and that the medically induced paralytic procedure be administered by two airway trained technicians, of which one must be a Paramedic. In addition, PAC recommended all new intubating ambulance services have wave form ETCO2 capabilities and all existing intubating services must have it by 2021.
