Date of Award

Spring 2016

Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Services Research

Committee Director

Kimberly Adams Tufts

Committee Member

Andrea Parodi

Committee Member

N. Clay Mann


Background: Pre-hospital endotracheal intubation (ETI) is one of the most critical skills performed by paramedics and is considered the “gold standard” of airway management. Pre-hospital ETI success rates are variable, ranging from 33% to 100% across EMS systems in the U.S. Previous investigative efforts have identified factors associated with pre-hospital ETI success, but the generalizability of findings is limited. Few researchers have controlled for the concurrent effects of multiple factors when examining pre-hospital ETI success. Methods: In this retrospective exploratory study, we used national data from the National Emergency Medical Services Information System (NEMSIS) and data from a four state regional representation of the U.S. emergency medical services (EMS) system for 2013 to generate National and Comprehensive State models. Hierarchical logistic regression was used to evaluate what variables predicted pre-hospital ETI success. Results: Type of service requested, U.S. census region, EMS total call time, Center for Medicare and Medicaid Services service level, provider certification level, race, chief complaint organ system, and cardiac arrest were structure factors significantly associated with pre-hospital ETI success (p < .001). Number of pre-hospital ETI attempts and response mode to scene were process factors significantly associated with pre-hospital ETI success (p < .001). Conclusion: Future researchers should examine systems with the best patient outcomes and use Utstein-style templates to frame data collection for airway management. These approaches will help clarify the use of advanced airway management and help to develop evidence-based guidelines for EMS provider.