Feasibility of Basic Emergency Medical Technicians to Perform Selected Advanced Life Support Interventions

Abstract

Objective. Emergency medical technician-basic (EMT-B) providers often provide the initial care to victims of out-of-hospital cardiac arrest. While automated external defibrillators enable EMT-B providers to deliver rescue shocks, patients in cardiac arrest may require additional interventions that EMT-B providers may not presently deliver. We sought to evaluate the feasibility of training EMT-B providers to provide additional cardiac resuscitation procedures using the laryngeal mask airway (LMA) andintraosseous (IO) access. Methods. In this prospective observational study, we trained 18 EMT-B providers to use the LMA andIO drill (EZ-IO) in a three-hour educational session. Working in two-person teams, the rescuers performed a simulated ventricular fibrillation resuscitation. We evaluated placement success as well as elapsed time to placement of the LMA andEZ-IO. Results. EMT-B providers successfully placed the LMA in 14 of 18 scenarios (78%; 95% confidence interval, 52% to 94%), with a mean of two attempts for placement. Subjects successfully placed the EZ-IO in 17 of 18 scenarios (94%; 95% confidence interval, 73% to 100%), all on the first attempt. The median time to LMA placement following the third shock was 109 seconds (interquartile range, 58–158) andthe median time to EZ-IO placement was 72 seconds (interquartile range, 50–93) after LMA placement. Conclusions. EMT-B providers demonstrated moderate success in performing advanced-level cardiac resuscitation interventions. These observations suggest potential for expanding the role of basic-level rescuers in cardiopulmonary resuscitation. Key words: cardiopulmonary resuscitation; emergency medical services; simulation; out-of-hospital cardiac arrest; intraosseous; laryngeal mask airway.