Abstract
BackgroundWe examined the effect of advanced preparation and organisation of equipment and drugs for Pre-hospital Emergency Anaesthesia (PHEA) and tracheal intubation on procedural time, error rates, and cognitive load.MethodsThis study was a randomised, controlled experiment with a crossover design. Clinical teams (physician and paramedic) from the Emergency Medical Retrieval Service and the Scottish Air Ambulance Division were randomised to perform a standardised pre-hospital clinical simulation using either unprepared (standard practice) or pre-prepared (experimental method) PHEA equipment and drugs. Following a two-week washout period, each team performed the corresponding simulation. The primary outcome was intervention time. Secondary outcomes were safety-related incidents and errors, and degree of cognitive load.ResultsIn total 23 experiments were completed, 12 using experimental method and 11 using standard practice. Time required to perform PHEA using the experimental method was significantly shorter than with standard practice (11,45 versus 20:59) minutes: seconds; p = < 0.001). The experimental method also significantly reduced procedural errors (0 versus 9, p = 0.007) and the cognitive load experienced by the intubator assistant (41.9 versus 68.7 mm, p = 0.006).ConclusionsPre-preparation of PHEA equipment and drugs resulted in safer performance of PHEA and has the potential to reduce on-scene time by up to a third.
Highlights
We examined the effect of advanced preparation and organisation of equipment and drugs for Pre-hospital Emergency Anaesthesia (PHEA) and tracheal intubation on procedural time, error rates, and cognitive load
Intervention time was defined as starting at the decision to perform PHEA and ending when correct Tracheal tube (ETT) position was confirmed with the facilitator turning on the End-tidal capnography (EtCO2) simulation software, in response to visualising chest inflation
We assessed the degree of individual cognitive load (ICL), defined as the amount of cognitive work/energy required by the participant to complete the procedure, including the level of judgements/decisions needing to be made
Summary
We examined the effect of advanced preparation and organisation of equipment and drugs for Pre-hospital Emergency Anaesthesia (PHEA) and tracheal intubation on procedural time, error rates, and cognitive load. The primary purpose of an ambulance service is to provide rapid access to emergency care. This involves prompt, effective pre-hospital care and rapid transport to hospital. Most PHEA complications are predictable, and risk can be significantly reduced with appropriate preparation [2]. It is this preparation step that accounts for the majority of procedural time. NHS Consultant Physician Experience 9 (2 to 16) n/a (years)
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