| Prehospital advanced airway management by ambulance technicians and paramedics: is clinical practice sufficient to maintain skills? | |
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MedLine Citation:
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PMID: 19934141 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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INTRODUCTION: Ambulance paramedics are now trained routinely in advanced airway skills, including tracheal intubation. Initial training in this skill requires the insertion of 25 tracheal tubes, and further ongoing training is attained through clinical practice and manikin-based practice. In contrast, training standards for hospital-based practitioners are considerably greater, requiring approximately 200 tracheal intubations before practice is unsupervised. With debate growing regarding the efficacy of paramedic intubation, there is a need to assess current paramedic airway practice in order to review whether initial training and maintenance of skills provide an acceptable level of competence with which to practice advanced airway skills. METHODS: All ambulance patient report forms (anonymised) for the period 1 January 2007 to 31 December 2007 were reviewed, and data relating to airway management were collected. Paramedic and technician identification codes were used to determine the number of airway procedures undertaken on an individual basis. RESULTS: Of the 269 paramedics, 128 (47.6%) had undertaken no intubation and 204 (75.8%) had undertaken one or less intubation in the 12-month study period. The median number of intubations per paramedic during the 12-month period was 1.0 (range 0-11). A total of 76 laryngeal mask insertion attempts were recorded by 41 technicians and 30 paramedics. The median number of laryngeal mask insertions per paramedic/technician during the 12-month period was 0 (range 0-2). A survey of ongoing continuing professional development across all ambulance trusts demonstrated no provision for adequate training to compensate for the lack of clinical exposure to advanced airway skills. CONCLUSION: Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews is likely to be inadequate with such infrequent exposure to the skill. |
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Authors:
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C D Deakin; P King; F Thompson |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Emergency medicine journal : EMJ Volume: 26 ISSN: 1472-0213 ISO Abbreviation: Emerg Med J Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-25 Completed Date: 2010-01-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100963089 Medline TA: Emerg Med J Country: England |
Other Details:
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Languages: eng Pagination: 888-91 Citation Subset: IM |
Affiliation:
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South Central Ambulance Service NHS Trust, Hampshire Division, Sparrowgrove, Otterbourne, UK. charlesdeakin@doctors.org.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Ambulances Clinical Competence* Education, Continuing / standards Emergency Medical Services / standards* Emergency Medical Technicians / education, standards* Emergency Medicine / education Employee Performance Appraisal / methods Great Britain Heart Arrest / therapy Humans Intubation, Intratracheal / standards*, statistics & numerical data Laryngeal Masks |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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