The Monroe-Livingston Region’s Rapid Sequence Induction Program (RSI Program) provides advanced airway capabilities, specifically rapid sequence induction and intubation, to properly identified critically ill patients requiring such definitive airway management. Individuals and agencies providing RSI do so as an added service under the oversight of the REMAC and the Regional EMS Medical Director. An RSI Paramedic is an individual who is credentialed to provide RSI services to patients in the Monroe-Livingston EMS Region following successfully completing an intensive and comprehensive competency-based program.

Below you will find information specific to the RSI program, including how one becomes an RSI Paramedic, as well as relevant education, policy, and resources.

What you are getting into:

Learn more about the RSI program by watching this short video.

How to be credentialed:

1. Review the credentialing policy.
2. Prepare for the credentialing process.
   1. Speak with your agency medical director about your interest in RSI (you will need their endorsement).
   2. Take the Didactic Training Video Training on Collabornation (Cypherworx - https://collabornation.net/login/urdpm). This series must be taken in Collabornation in order to receive credit to move to the next step of the process (When looking for the course in the course catalog, search "RSI").
   3. The Video Training is also available on YouTube for reference after taking the Collabornation Coursework to allow the candidate to review specific portions of the training without having to register and watch the entire course.
      1. RSI Pathophysiology: https://youtu.be/c8YNp1sseIM
      2. Clinical Judgement for RSI Situations: https://youtu.be/OuLzxo8USSY
      3. RSI Procedures in the MLREMS System: https://youtu.be/NdxtMdy-b_k
      4. RSI Pharmacology: https://youtu.be/_Kzt-SleAWo  
   4. Also highly recommended is the Capnography for BLS Providers course available on Prodigy.  It is a free course, if you don't already have an account, you will need to register.
   5. Whenever possible attend regional RSI Case Conferences to learn more about being an RSI provider and prepare you for the decision-making associated with the role.
      1. These are offered on a quarterly basis in March, June, September and December. Contact mlrems@mlrems.org for more information.
3. Sign up to take the written exam* offered once a year in January by emailing mlrems@mlrems.org for more information.
4. Take the written exam.
   1. The written exam consists of:
      1. Multiple choice questions that test the provider’s knowledge of anatomy, physiology, pharmacology, decision-making and clinical management related to Rapid Sequence Induction.
      2. Two essay questions, one of which involves your approach to a clinical case. The essay’s are evaluated using the following Rubric.
5. Upon successful completion of the written exam, sign up for and attend the required case review in February.
6. Sign up to take the simulation exam by emailing mlrems@mlrems.org for more information.
7. Take the simulation exam
   1. The provider will engage in two high fidelity simulated patient care encounters to evaluate their performance in assessing for, and when indicated, performing RSI. Simulation performance is evaluated by an EMS Physician using the following Rubric.
   2. The provider should bring their own training equipment and monitor to the simulation session – although equipment is provided, it is best to use equipment the provider is already familiar with.
8. You will receive notification of your exam results via email and next steps. All applicants are offered the ability to meet with an EMS Physician to review their performance regardless of test results.

* If you are credentialed outside of the region, you may apply for reciprocity.  To apply for reciprocity, a letter from the applicant as well as a letter of recommendation from either the Agency Clinical Care Coordinator/Manager or equivalent and the Agency Medical Director should be submitted to the Division of Prehospital Medicine.  If reciprocity is granted, the written test requirement for credentialing will be waived, however the simulation test and appropriate fee will still be required.  For more information, refer to the credentialing policy.

How to maintain your RSI credential:

1. Participate in the ongoing quality improvement program
   1. After completing the RSI whether the procedure is successful or not, the RSI Paramedic is responsible for completing the REDCap Quality Improvement Survey: https://redcap.link/RSIProviderFeedback
   2. After transfer of care, a verbal debriefing will be immediately performed either in person or via telephone with an RSI Physician or the respective on-call County EMS Medical Director in cases where the procedure was performed.
2. Continuing education requirements
   1. The Division of Prehospital Medicine offers quarterly RSI Case Reviews for current and interested RSI providers. It is required for current RSI providers to attend at least four case reviews during their four year credentialing period.
   2. Individuals that do not meet the continuing education requirements will be required to re-take the written test.
3. Active practice requirements
   1. While credentialed, the RSI paramedic is expected to have evaluated and deferred or performed at least 10 RSI’s over the four year credentialing period. This is determined by the quality improvement program entries. 
   2. Individuals that do not meet the active RSI practice requirements will be required to re-take the simulation exam

File Name Upload Date RSI Expectations Letter 12/19/2024 4:02:38 AM Current RSI Providers Updated 4-15-2024 4/30/2024 6:07:10 AM RSI Essay Rubric 10/26/2022 10:42:25 AM RSI Simulation Rubric 10/26/2022 10:42:25 AM

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