Optimal training for emergency needle thoracostomy placement by prehospital personnel: didactic teaching versus a cadaver-based training program.

Abstract

Tension pneumothorax can rapidly progress to cardiac arrest and death if not promptly recognized and appropriately treated. We sought to evaluate the effectiveness of traditional didactic slide-based lectures (SBLs) as compared with fresh tissue cadaver-based training (CBT) for placement of needle thoracostomy (NT). Forty randomly selected US Navy corpsmen were recruited to participate from incoming classes of the Navy Trauma Training Center at the LAC + USC Medical Center and were then randomized to one of two NT teaching methods. The following outcomes were compared between the two study arms: (1) time required to perform the procedure, (2) correct placement of the needle, and (3) magnitude of deviation from the correct position. During the study period, a total of 40 corpsmen were enrolled, 20 randomized to SBL and 20 to CBT arms. When outcomes were analyzed, time required to NT placement was not different between the two arms. Examination of the location of needle placement revealed marked differences between the two study groups. Only a minority of the SBL group (35%) placed the NT correctly in the second intercostal space. In comparison, the majority of corpsmen assigned to the CBT group demonstrated accurate placement in the second intercostal space (75%). In a CBT module, US Navy corpsmen were better trained to place NT accurately than their traditional didactic SBL counterparts. Further studies are indicated to identify the optimal components of effective simulation training for NT and other emergent interventions.