| Effect of intensive physician oversight on a prehospital rapid-sequence intubation program. | |
| | |
MedLine Citation:
|
PMID: 20397866 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To examine the effects of adding close concurrent and retrospective physician oversight, consistent with National Association of EMS Physicians (NAEMSP) recommendations, to an existing regional prehospital rapid-sequence intubation (RSI) program. METHODS: This study involved a retrospective cohort of patients receiving RSI between January 1, 2004, and July 31, 2008. On January 1, 2007, an updated program including additional concurrent and retrospective physician oversight, increased RSI-specific continuing medical education, and cadaver laboratory training was implemented. Study patients were divided into a preintervention group (group 1) and a postintervention group (group 2) based on date of medical care. Data regarding baseline characteristics, airway management, medication usage, and performance factors were compared between the groups. A retrospective review by two emergency medical services (EMS) physicians assessed whether the RSI was "clearly indicated" based on a predetermined set of criteria. RESULTS: There were 109 RSIs performed in group 1 and 54 in group 2. Absolute increases in the use of both basic life support (BLS) (5%, p = 0.2) and advanced life support (ALS) (41%, p = 0.001) airway techniques were observed. Increases in postintubation administration of midazolam (30%, p = 0.001) and morphine (24%, p = 0.001) and a decrease for vecuronium (-28%, p = 0.001) were observed. There was no statistically significant difference in the intubation success rates (92% vs. 94%) and the frequencies of recognized esophageal endotracheal tube (ETT) placement (5% vs. 6%). The number of unrecognized esophageal ETT placements remained zero. Physician chart review demonstrated an absolute increase in "clearly indicated" RSIs (17%, p = 0.01). CONCLUSIONS: Close concurrent and retrospective physician oversight consistent with recommendations from the NAEMSP is associated with improved cognitive skills in paramedics, including appropriate patient selection for RSI. Further research is warranted to validate this model and optimize where resources are best used to enhance patient safety and improve clinical management for this controversial paramedic skill. |
| | |
Authors:
|
Jeremy T Cushman; Aaron Zachary Hettinger; Aaron Farney; Manish N Shah |
Related Documents
:
|
1602426 - Effects of two treatment techniques on delay and vigilance tasks with attention deficit... 15273006 - Confronting prejudice (literally): reactions to confrontations of racial and gender bias. 16864836 - Sodium valproate vs phenytoin in status epilepticus: a pilot study. 16451886 - Challenges facing pbl tutors: 12 tips for successful group facilitation. 2406376 - Test characteristics of self-reported hypertension among the hispanic population: findi... 6694426 - Alcoholism in physicians. |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors Volume: 14 ISSN: 1545-0066 ISO Abbreviation: Prehosp Emerg Care Publication Date: 2010 Jul-Sep |
Date Detail:
|
Created Date: 2010-05-28 Completed Date: 2010-09-13 Revised Date: 2011-08-01 |
Medline Journal Info:
|
Nlm Unique ID: 9703530 Medline TA: Prehosp Emerg Care Country: England |
Other Details:
|
Languages: eng Pagination: 310-6 Citation Subset: IM |
Affiliation:
|
Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. jeremy cushman@urmc.rochester.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Clinical Competence
/
standards Emergency Medical Services* Emergency Medical Technicians / education*, organization & administration Humans Intubation, Intratracheal / methods*, standards* Medical Audit Middle Aged Physicians* Program Evaluation Retrospective Studies Time Factors |
| Grant Support | |
ID/Acronym/Agency:
|
K23 AG028942-02/AG/NIA NIH HHS; K23 AG028942-03/AG/NIA NIH HHS; K23 AG028942-04/AG/NIA NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Reaching Emergency Medical Services Providers: Is One Survey Mode Better than Another?
Next Document: Out-of-Hospital Chest Escharotomy: A Case Series and Procedure Review.