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SET Protocol

Question# 751

Is SET protocol still the expectation from the RPPEO, why or why not? Should we still have the receiving hospital sign off on tube placement once TOC in the event of a Coroner's inquest? This was part of the protocol along with a c-collar and ETCO2/auscultation with every pt. movement in order to ensure ETT was still in place. I went to look for this on the website as other paramedics are inquiring and was unable to find an answer anywhere. This is something many other services are still using and not just in our region. Thank you.


SET protocol has not been studied to date and although this would make for a great study, it would be an enormous one to undertake. Furthermore, there is currently insufficient evidence and no scientific data that supports either benefit or harm to enforce this practice or make it mandatory.

That said, securing the endotracheal tube by reducing movement of the head with a c-collar would assist with reducing the risk of dislodgment. This would be considered best practice, similar to securing an IV with tape so that it also does not become accidentally displaced during patient movement.

SET protocol is currently still being taught at the College level and it is still a requirement for entry to practice with the RPPEO. Therefore, paramedics working in our region should be familiar with SET protocol and implementing it into their practice.

As for documentation, having the physician or RT sign your ePCR to confirm proper endotracheal tube placement is always an option however, it is critical to confirm tube placement yourself upon transfer of care by documenting ETCO2 with good capnography, along with auscultation of the lung fields if possible, as well as visualization of the number at the teeth. Including this pertinent information in your ePCR at handover will work in your favour should there be any concerns from anyone.



07 November 2023

ALSPCS Version




Please reference the MOST RECENT ALS PCS for updates and changes to these directives.