Difficult airway simulator intubation success rates using Commission on Accreditation of Medical Transport systems training standards

OBJECTIVES

This study was undertaken to evaluate difficult airway simulator intubation success rates using Commission on Accreditation of Medical Transport Systems (CAMTS) initial and maintenance intubation training standards on transport-RN novice intubators over a 1-year period.

METHODS

Twelve transport nurses were blinded to and randomly assigned five or six of 64 different difficult airway simulator scenarios. Intubation success rates were measured 1 month before training, 1 month after training, and 1 year later, following CAMTS initial and maintenance intubation standards. Outcome measurements included first attempt intubation rate, overall intubation success rate, number of attempts to intubation, time per attempt, time to intubation, and time between attempts. During the study, participants received no additional training or opportunities to intubate.

RESULTS

First-attempt intubation rates significantly improved (P 5 .022) from 19% 1 month before training to 36% 1 month after training, but did not significantly change (P > .999) 1 year later following CAMTS maintenance standards (34%). Mean cumulative success rates did not significantly improve after four attempts or after 3.5 minutes. The overall mean time per attempt and time between attempts declined with subsequent intubation attempts.

CONCLUSIONS

Using initial and maintenance CAMTS standards, simulator difficult airway intubation success rates are low in novice intubators. Our results suggest that one intubation/quarter may be enough to maintain difficult airway intubation success rates. Training significantly improves intubation rates. Little advantage occurs in intubation rates after four attempts or 3.5 minutes.

Emergency medical services education and licensure--a road map for the future

Fragmentation exists nationwide in regards to Emergency Medical Services (EMS). This fragmentation is evident throughout the EMS system in the way we educate, train, certify, and recertify the pre-hospital professional. In Louisiana EMS, there are two facets of our education system: the training/education institution and the instructors who facilitate the education. However, there is no mandated credentialing of the institution doing the teaching. Currently, the State of Louisiana utilizes both the National Registry of Emergency Medical Technicians computer-based written examination as well as their practical examination. Louisiana has four provider levels of EMS professionals: First Responder (FR), Emergency Medical Technician-Basic (EMT-B), EMT-Intermediate/85 (EMT-I/85), and EMT-Paramedic. Creating consistency in the levels of EMS will enhance both education and patient care ensuring that all citizens of the state will receive the most appropriate and up to date pre-hospital care. Louisiana will also be adopting the National Registry's Accreditation Policy, which will require all advanced level education (Paramedic) to be conducted by CoAEMSP (Committee on Accreditation of Educational Programs for the EMS Profession) institutions. Louisiana's challenge will exist with the adoption of the Scope of Practice Model levels and the movement of our current certification system to a licensure system. The goal is to create an EMS system in Louisiana that is substantiated by a national curriculum, national accreditation, a national scope of practice and the passage of a national examination.

Paramedic Student Adherence to the National Standard Curriculum Recommendations

OBJECTIVES

The National Standard Curriculum-Paramedic (NSC-P) is the accepted curriculum for paramedic programs across the country. The purpose of this study was to examine the completion of the NSC-P clinical internship recommendations by paramedic students.

METHODS

Paramedic student internship experience data from 2001 to 2005 was retrospectively reviewed from FISDAPtrade mark. Student records that met the following inclusion criteria were analyzed: 1) student provided consent for research, 2) data verified by a preceptor, and 3) student successfully graduated from their paramedic program. The data were descriptively evaluated to determine the number of students who completed 100% of the NSC-P recommendations, to determine what percentage of students were completing each category, and to determine the average number of tasks completed by students for each recommendation.

RESULTS

Of the 1,817 student records that met the inclusion criteria, 140 (7.7%) completed 100% of the NSC-P recommended goals in each category. Students met or exceeded the recommended number of tasks most often for 15 medication administrations (92%), 25 successful IV accesses (88%), 30 geriatric assessments (63.7%), 5 live endotracheal intubations (63.5%), and 50 adult assessments (63.2%). A majority of PS are completing less than 50% of the NCS-P recommendations for 20 ventilations on an un-intubated patient, 20 psychiatric patient assessments, 8 pediatric respiratory distress assessments, and 10 obstetric patient assessments.

CONCLUSION

A vast majority of paramedic students are not completing all of the NSC-P recommendations. The reasons for this shortcoming are likely multifaceted and require further research.

PREHOSPITAL PAIN MANAGEMENT

OBJECTIVE

To assess the knowledge of emergency medical technicians-paramedics (EMT-Ps) and compare their practice perceptions with actual pain management interventions in adults and pediatric patients (adolescents and children) with chest pain (CP), extremity injuries, or burns.

METHODS

This study included a cross-sectional survey of EMT-Ps and review of the emergency medical services (EMS) system patient care database. EMT-Ps were surveyed for: 1) knowledge of pain treatment protocol; 2) estimated number of CP, extremity injury, or burn encounters and the frequency of morphine administration; and 3) barriers to providing morphine. Data on patients transported with any above conditions and those who received morphine were abstracted from the EMS patient care database. Data were analyzed using descriptive statistics, and 95% confidence intervals (CIs) were calculated.

RESULTS

Of 202 EMT-Ps, 155 (77%) completed the survey. Eighty-two percent reported knowledge of pain treatment protocol for both adults and pediatric patients. For adults, EMT-Ps estimated they administered morphine to 37% with CP (95% CI 35, 40), 24% with extremity injuries (95% CI 17, 30), and 89% with burns (95% CI 52, 99). In children and adolescents, inability to assess pain (93%) was the most common reason for withholding morphine. According to the EMS database, 5% of adults with CP (95% CI 4, 5), 12% extremity injuries (95% CI 8, 15), and 14% burns (95% CI 8, 20) received morphine. In children and adolescents, 3% with extremity injuries (95% CI 1, 5) and 9% with burns (95% CI 0, 26) received morphine. Pain score was documented in 67.0% of adult patients, compared with only 4.0% in pediatric patients (Delta = 63.0%, 95% CI: 60, 65).

CONCLUSIONS

Significant disparity exists between EMT-Ps' perceptions of acute pain assessment and the frequency of providing analgesia and their actual practice. Children and adolescents had less documentation of pain assessment and received less analgesic interventions compared with adults. Inability to assess pain may be an important barrier to the provision of analgesia.

Program Accreditation Effect on Paramedic Credentialing Examination Success Rate

OBJECTIVES

Program accreditation is used to ensure the delivery of quality education and training for allied health providers. However, accreditation is not mandated for paramedic education programs. This study examined if there is a relationship between completion of an accredited paramedic education program and achieving a passing score on the National Registry Paramedic Certification Examination.

METHODS

We used data from the National Registry Paramedic Certification Examination for calendar year 2002. Successful completion (passing) of the examination was defined as correctly answering a minimum of 126 out of 180 (70%) of the questions and meeting or exceeding the individual subtest passing scores. Accredited paramedic training programs were certified by the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions (CoAEMSP) on or before January 1, 2002. Candidates reported demographic characteristics including age, gender, self-reported race and ethnicity, education, and employer type. We examined the relationship between passing the examination and attendance at an accredited paramedic training program.

RESULTS

A total of 12,773 students completed the examination. Students who attended an accredited program were more likely to pass the examination (OR = 1.65, 95% CI: 1.51-1.81). Attendance at an accredited training program was independently associated with passing the examination (OR = 1.58, 95% CI = 1.43-1.74) even after accounting for confounding demographic factors.

CONCLUSION

Students who attended an accredited paramedic program were more likely to achieve a passing score on a national paramedic credentialing examination. Additional studies are needed to identify the aspects of program accreditation that lead to improved examination success.