Abstract
BackgroundPrehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. The aim of this study was to provide data regarding airway management-training and expertise from the regional physician-staffed emergency medical service (EMS).MethodsThe EMS in this part of The Central Region of Denmark is a two tiered system. The second tier comprises physician staffed Mobile Emergency Care Units. The medical directors of the programs supplied system data. A questionnaire addressing airway management experience, training and knowledge was sent to the EMS-physicians.ResultsThere are no specific guidelines, standard operating procedures or standardised program for obtaining and maintaining skills regarding prehospital advanced airway management in the schemes covered by this study. 53/67 physicians responded; 98,1% were specialists in anesthesiology, with an average of 17,6 years of experience in anesthesiology, and 7,2 years experience as EMS-physicians. 84,9% reported having attended life support course(s), 64,2% an advanced airway management course. 24,5% fulfilled the curriculum suggested for Danish EMS physicians. 47,2% had encountered a difficult or impossible PHETI, most commonly in a patient in cardiac arrest or a trauma patient. Only 20,8% of the physicians were completely familiar with what back-up devices were available for airway management.ConclusionsIn this, the first Danish study of prehospital advanced airway management, we found a high degree of experience, education and training among the EMS-physicians, but their equipment awareness was limited. Check-outs, guidelines, standard operating procedures and other quality control measures may be needed.
Highlights
Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel
We focused on emergency medical service (EMS)-physician training, experience and equipment awareness, as these aspects of Prehospital advanced airway management (PHAAM) have been addressed only by a few other papers [31,32,33], and because knowledge of the present state regarding these aspects may be vital for the improvement of patient safety and for future quality improvement initiatives
Data from the medical directors showed that the Mobile Emergency Care Units (MECU) in this part of the region all have full rapid sequence induction (RSI) -capabilities and carry the same equipment for airway management: Bag -Valve-Mask (BVM) with oxygen reservoir, tracheal tubes and standard laryngoscopes with Miller blades, Airtraq laryngoscope, standard intubating bougie, Gum Elastic Bougies, standard laryngeal masks (LMA), intubating laryngeal masks (ILMA) and equipment for establishing a surgical airway
Summary
Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. Sollid et al [25] found that there were significant differences between the self-reported experience with difficult PHETI among full-time and part-time HEMS anaesthesiologist working in three different HEMSschemes in western Norway. Both Sollid [25] and Hüter [26] found room for improvement in HEMS-doctors experience and training in the use of back-up airway devices. This template will make it possible to compare PHAAM - data from different EMS’s
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