Emergency Medical Technician Training Research Articles

Hyperventilation During Manual Ventilation Can Be Reduced Using a Novel Ventilator but Not With Education Interventions.

Traumatic brain injury (TBI) is the leading cause of combat casualties in modern war with an estimated 20% of casualties experiencing head injury. Since the release of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury in 1995, recommendations for management of TBI have included the avoidance of routine hyperventilation. However, both published and anecdotal data suggest that many patients with TBI are inappropriately ventilated during transport, thereby increasing the risk of morbidity and mortality from secondary brain injury. Enlisted Air Force personnel with prior emergency medical technician training completing a 3-week trauma course were evaluated on their ability to provide manual ventilation. Participants provided manual ventilation using either an in-situ endotracheal tube (ETT) or standard face mask on a standardized simulated patient manikin with TBI on the first and last days of the course. Manual ventilation was provided via a standard manual ventilator and a novel manual ventilator designed to limit tidal volume (VT) and respiratory rate (RR). Participants were given didactic and hands-on training on the third day of the course. Half of the participants were given simulator feedback during the hands-on training. All students provided 2 minutes of manual ventilation with each respirator. Data were collected on the breath-to-breath RR, VT, and peak airway pressures generated by the participant for each trial and were averaged for each trial. A minute ventilation (MV) was then derived from the calculated RR and VT. One hundred fifty-six personnel in the trauma course were evaluated in this study. Significant differences were found in the participant's performance with manual ventilation with the novel compared to the traditional ventilator. Before training, MV with the novel ventilator was less than with the traditional ventilator by 2.1 ± 0.4 L/min (P = .0003) and 1.6 ± 0.5 L/min (P = .0489) via ETT and face mask, respectively. This effect persisted after training with a difference between the devices of 1.8 ± 0.4 L/min (P = .0069) via ETT. Both traditional education interventions (didactics with hands-on training) and simulator-based feedback did not make a significant difference in participant's performance in delivering MV. The use of a novel ventilator that limits RR and VT may be useful in preventing hyperventilation in TBI patients. Didactic education and simulator-based feedback training may not have significant impact on improving ventilation practices in prehospital providers.

Comparison of three methods of cardiopulmonary resuscitation training in terms of improving the skills of emergency medical technicians; a pretest–posttest study

Objective: There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs.
 Methods: This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions.
 Results: At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05).
 Conclusion: We found that virtual training was more effective than classic and peer training for CPR training of EMTs.

Emergency Medical Technician Training in Medical School on Preparation for Required National Board Exams and Clerkship Rotations: Results from a Student Survey.

PurposeThe University of South Carolina School of Medicine Greenville has incorporated Emergency Medical Technician (EMT) training into the first semester curriculum with students becoming state-certified EMTs and completing one ambulance shift per month throughout their pre-clerkship years. Although there have been programs that have reported EMT experiences in the pre-clinical years of medical education, student perceptions of how the EMT experiences help prepare them for board exams and clerkships is limited. Therefore, the aim of this study was to measure student perceptions regarding the impact of an EMT course and training in the pre-clerkship curriculum in medical school on helping prepare them for national board exams (ie USMLE® Step 1, 2 Clinical Knowledge (CK), 2 Clinical Skills (CS)) and clerkship rotations.MethodsSecond-, third-, and fourth-year medical students at the University of South Carolina School of Medicine Greenville completed an anonymous voluntary survey with response rates of 66.3%, 55.2%, and 56.9%, respectively. The study was reviewed and exempted by the University of South Carolina Institutional Review Board.ResultsSeventeen percent, 14%, and 41% of students agreed/strongly agreed an EMT course helped prepare them for the USMLE Step 1, Step 2 CK, and Step 2 CS exam, respectively. Sixty-four percent of students agreed/strongly agreed that an EMT course and experience helped prepare them for clerkship rotations.ConclusionThe findings in this study support EMT training and experience as an EMT as one method to help prepare students for clerkship rotations.

A Student Survey: Influence of Emergency Medical Technician Training on Student's Application, Matriculation, and Transition into Medical School.

PurposeMedical education seeks to develop active methods of learning in addition to skills for patient interaction. With this in mind, the University of South Carolina (UofSC) School of Medicine Greenville developed a curriculum with an integrated emergency medical technician (EMT) certification course designed to provide a meaningful clinical experience for students; however, no data exists on whether this type of course influences a student’s decision to apply to or attend a medical school and how such a course affects the transition to the medical school environment. The purpose of this study was to determine if an EMT course, as part of the medical school curriculum, influences students’ decision to apply and attend a particular medical school and if this course influences students’ transition to medical school while providing awareness of patients’ lives and circumstances.MethodsA voluntary anonymous survey was distributed in Spring 2019 to first-, second-, third-, and fourth- year medical students at the UofSC School of Medicine Greenville. Response rates were 68.5%, 66.3%, 55.2%, and 56.9%, respectively.ResultsForty-three percent of students agreed/strongly agreed that the EMT course at UofSC School of Medicine Greenville factored into their decision to apply while 52% of students agreed/strongly agreed that it factored into their decision to attend. Students agreed/strongly agreed (82%) that the program helped with medical school transition. Ninety-one percent of students reported that EMT experiences increased awareness of patients’ lives and circumstances.ConclusionStudents felt an EMT certification course at the beginning of the first year helped with the transition to medical school and increased awareness of patients’ lives and circumstances.

How Does Occupational Licensing Affect Entry into the Medical Field? An Examination of Emts

The COVID‐19 pandemic has led to temporary suspensions of many occupational licensing laws, especially for health care professionals, in an effort to manage surges in health care demand. The crisis highlights more general concerns about occupational licensing laws, yet convincing empirical evidence on the degree to which such laws have inhibited entry into health care professions is scarce because most studies must rely on cross‐sectional variation to identify such effects. In this study, we indirectly examine how occupational licensing affects the choice to become an Emergency Medical Technician (EMT) by exploiting the demand‐side shock from the Affordable Care Act (ACA). Although demand‐side shocks should increase the likelihood of becoming an EMT relative to other similar non‐medical professions, this effect should be moderated in states with higher barriers to entry. Using a large number of individuals from the American Community Survey (ACS) who work as either EMTs or in a similar non‐medical field (protective services), we find suggestive evidence that while the demand‐side shock from the ACA increased the likelihood of being an EMT, this effect was substantially moderated by more stringent occupational licensing laws. Although the effect for the full sample is marginally significant, the estimated effects are substantially larger for individuals under age 40, who are presumably more flexible in choosing a career path. Evaluated at the average number of days to complete EMT training and the pre‐treatment uninsured rate, the implied effects for young individuals in the most careful specification suggests virtually complete offset; the ACA demand‐side shock would increase entry by 18 percentage points, while occupational licensing restrictions reduce entry by a similar magnitude.

Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept.

BackgroundEmergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public–private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.MethodsFrom 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide).Lessons LearnedDuring the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials.ConclusionThese key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

The state of emergency medical technician education in Ghana.

ObjectiveThe National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students.MethodsA standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings.ResultsStudents and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25).ConclusionThe faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.

Medical Student Perceptions of Emergency Medical Technician Training During the First Year of Medical School.

PurposeMedical schools look for ways to provide clinical experiences and skill development in connection with knowledge. One method used is to provide emergency medical technician (EMT) training to medical students; however, limited data are available concerning EMT training in medical education. Therefore, the aim of this study was to review student feedback about the EMT curriculum through multiple iterations of the curriculum.MethodsStudents completed a voluntary school administered survey upon completion of their first year of medical school. Student responses to statements related to the EMT course and program were analyzed for classes matriculating in academic years 2012–2017. A one-way ANOVA with post hoc Tukey Honestly Significant Difference (HSD) was performed across all years for each survey statement.ResultsMean response scores to statements related to the EMT course were higher when the EMT course was a standalone course and lower when integrated with biomedical science coursework. Students “strongly agreed” or “agreed” with most statements related to experiences and clinical skill development provided by the EMT program. Response rates ranged between 46–52 (88–100%) for 2012, 40–46 (74–85%) for 2013, 72–79 (88–96%) for 2014, 73–86 (71–83%) for 2015, 47–65 (46–63%) for 2016, 62–82 (59–78%) for 2017.ConclusionOur data show that first year medical students liked the course design best when the EMT course was a standalone course at the start of the M.D. program while students liked experiences and clinical skill development provided by the EMT program regardless of course design.

Barriers perceived by volunteer EMTs in Participating in Continuous Professional Development in Ireland.

<p>Introduction</p><p>Following the relaunch in 2016 of mandatory Continuous Professional Competency (CPC) for Emergency Medical Technicians (EMT) by Pre-Hospital Emergency Care Council (PHECC) Ireland, the aim of this research was to explore volunteer EMTs perceived attitudes, barriers and confidence in relation to participating in CPC.</p><p>Methods</p><p>A questionnaire for EMTs was distributed to the four main pre-hospital volunteer organisations and via the PHECC CPC coordinator social media account (Facebook) to gather information on attitudes towards CPC, perceived barriers to participating in CPC, and finally comfort level in completing the didactic aspects of CPC.</p><p>Results</p><p>In total 341 eligible responses accounting for 15% of EMT registrants were analysed. 65% believed CPC was necessary for professional development, with 61% reporting it an important part of their practice. 57% believed CPC should be linked with maintaining PHECC registration, showing a decline of 38% against recent Irish research. The unique profile of respondents as volunteers highlights barriers commonly cited in the literature as having a more significant impact on CPC participation, most noteworthy over 80% cited time and access to relevant material/courses as impacting on participation. A 40/60 split between 2nd and 3rd level educational qualifications among respondents highlighted a marked difference in perceived confidence for completing didactic CPC elements among graduates with 2nd level reporting confidence at a third that of the level of 3rd level graduates. Compounding this finding, 52% of respondents reported receiving little or no training in CPC. Additionally, respondents cited restricted or no access to online journal or materials due to poor links via PHECC Registered Training Institutions or representative bodies to academic library access impacting on their ability to complete the didactic element of CPC.</p><p>Recommendations</p><p>It is recommended that the PHECC 2014 EMT Education and Training Standard be updated to include standardised CPC education for newly qualified EMTs. To fulfil case studies, reflective practice and literature reviews, volunteer EMTs require access to online journals and treatment information beyond the pre-hospital arena, all of which require immediate and viable solutions for successful completion of CPC by EMTs.</p>

Naloxone access for Emergency Medical Technicians: An evaluation of a training program in rural communities

IntroductionOpioid-related overdose death rates in rural communities in the United States are much higher than their urban counterparts. However, basic life support (BLS) personnel, who are more common in rural areas, have much lower rates of naloxone administration than other levels of emergency medical services (EMS). Training and equipping basic level Emergency Medical Technician (EMTs) to administer naloxone for an opioid overdose could yield positive outcomes. MethodsFollowing a legislative change that allowed EMTs to administer naloxone in one rural state, we evaluated an EMT training program by examining EMTs' opioid overdose knowledge and attitudes before and after the training. ResultsOne-hundred-seventeen rural EMTs participated the training. They demonstrated statistically significant improvements on almost all of the knowledge questions after the training (p's = 0.0469 to <0.0001). The opioid overdose competency and concern scales showed statistically significant improvement (p < 0.0001) and reduction (p < 0.0001), respectively. Furthermore, statistically significant changes in knowledge and opinions of state law regarding naloxone administration were observed. Significantly more EMTs supported the idea of expanding naloxone to people at risk for overdose (p = 0.0026) after the training. ConclusionsAt a time when states are passing legislation to expand first responders' access to naloxone, this study provides evidence about authorizing EMTs to administer naloxone.

Emergency Medical Technician Training During Medical School: Benefits for the Hidden Curriculum

Medical schools are encouraged to introduce students to clinical experiences early, to integrate biomedical and clinical sciences, and to expose students to interprofessional health providers and teams. One important goal is for students to gain a better understanding of the patients they will care for in the future and how their social and behavioral characteristics may affect care delivery. To promote early clinical exposure and biomedical integration, in 2012 the University of South Carolina School of Medicine Greenville incorporated emergency medical technician (EMT) training into the curriculum. This report describes the program; outlines changes (made after year 1) to improve biomedical integration; and provides a brief analysis and categorization of comments from student reflections to determine whether particular themes, especially related to the hidden curriculum, appeared. Medical students wrote frequently about EMT-related experiences: 29% of reflections in the charter year (1.2 per student) and 38% of reflections in the second year (1.5 per student) focused on EMT-related experiences. Reflections related to patient care, professionalism, systems-based practice, and communication/interpersonal skills. The frequency of themes in student reflections may provide insight into a medical program's hidden curriculum. This information may serve to inform curricula that focus on biosocial elements such as professionalism and communication with the goal of enhancing future physicians' tolerance, empathy, and patient-centeredness. The authors plan to conduct further qualitative analysis of student reflections to iteratively revise curricula to address gaps both in learning and in the differences between the explicit curriculum and actual experiences.

Performance of Norwegian civilian EMTs and army medics in penetrating trauma: a controlled simulation-based assessment.

BackgroundPenetrating trauma kills rapidly. Thorough and efficient examination and aggressive hemorrhage control is important to save lives. The aim of this study was to assess the skills of civilian Emergency Medical Technicians (EMTs) in bleeding examination and control compared to Army Medics. Our hypothesis was that civilian pre‐hospital systems perform at a lower level compared to an expert group, and did not have sufficient focus on education and training in examination and treatment of penetrating injuries.Material and methodsWe included 60 volunteer Certified EMTs and Army Medics. First, the participants examined a wounded patient. Second, the participants were presented a patient with a penetrating injury on a pork side fixated to the thigh with an artificial arterial bleeding.ResultsThe EMTs took significantly shorter time examining, median 1 min 5 s vs. 3 min 58 s (P < 0.001). 5/30 (17%) of EMTs and 28/30 (93%) of army medics did an approved gauze wound packing of the penetrating injury (P < 0.001). EMTs took (median) 18 s and army medics 8 s to hemostasis regardless of approved packing or not (P < 0.001). Time spent on the packing was (median) 1 min 50 s vs. 5 min 47 s respectively (P < 0.001). Increasing time spent on the procedure showed significantly better chance of a successful procedure.ConclusionThe EMTs had lower accuracy in examination but used significantly shorter time than the Army Medics. The treatment part of the study showed poor EMT performance compared to the Army Medics. This study indicates that more wound packing training needs to be incorporated into initial and ongoing civilian EMT training.

Emergency Medical Technician Training for Medical Students: A Two-Year Experience

Background: New medical school educational curriculum encourages early clinical experiences along with clinical and biomedical integration. The University of South Carolina School of Medicine Greenville, one of the new expansion schools, was established in 2011 with the first class matriculating in 2012. To promote clinical skills early in the curriculum, emergency medical technician (EMT) training was included and begins in the first semester. Along with the early clinical exposure, the program introduces interprofessional health and teams and provides the opportunity for students to personally see and appreciate the wide variety of environments from which their future patients emanate. Objective: This report describes the EMT program and changes that were made after the first class that were designed to integrate EMT training with the biomedical sciences and to assess the value of these integrative changes using objective criteria. Methods: A two-year retrospective study was conducted that involved the first two classes of medical students. Baseline student data and pass rates from the psychomotor skill and written components of the State examination were used to determine if students performed better in the integrated, prolonged course. Results: There were 53 students in the first class and 54 in the second. Of the 51 students in the first class and 53 students in the second class completing the state psychomotor and written examination, 20 (39%) in the first class and 17 (32%) in the second passed on the initial psychomotor skill attempt; however, more students passed in the first three attempts in the second class than the first class, 51 (96%) versus 45 (88%) , respectively. All students passed by 5 attempts. For the written examination, 50 (98%) students in the first class and 51 (96%) in the second class passed on the first attempt. All students passed by the third attempt. Pass rates on both components of the State examination were not significantly different between classes. Conclusion: Medical students who received their EMT training in a 6-week, non-integrated format performed similarly on the EMT State certification examination to those who received their training in a prolonged, integrated structure.

What is needed to increase the professional competencies of the military emergency medical technicians of the Republic of Korea Air Force?

What is needed to increase the professional competencies of the military emergency medical technicians of the Republic of Korea Air Force?

The Development of Sustainable Emergency Care in Ghana: Physician, Nursing and Prehospital Care Training Initiatives

BackgroundGhana's first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. ObjectiveWe describe the history and status of novel postgraduate emergency physician, nurse, and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. DiscussionSignificant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist-level emergency physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national Emergency Medical Service. ConclusionThis work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled health care workers in Ghana and may serve as a model for similar developing nations.

Medical students as EMTs: skill building, confidence and professional formation

ObjectiveThe first course of the medical curriculum at the Hofstra North Shore-LIJ School of Medicine, From the Person to the Professional: Challenges, Privileges and Responsibilities, provides an innovative early clinical immersion. The course content specific to the Emergency Medical Technician (EMT) curriculum was developed using the New York State Emergency Medical Technician curriculum. Students gain early legitimate clinical experience and practice clinical skills as team members in the pre-hospital environment. We hypothesized this novel curriculum would increase students’ confidence in their ability to perform patient care skills and enhance students’ comfort with team-building skills early in their training.MethodsQuantitative and qualitative data were collected from first-year medical students (n=97) through a survey developed to assess students’ confidence in patient care and team-building skills. The survey was completed prior to medical school, during the final week of the course, and at the end of their first year. A paired-samples t-test was conducted to compare self-ratings on 12 patient care and 12 team-building skills before and after the course, and a theme analysis was conducted to examine open-ended responses.ResultsFollowing the course, student confidence in patient care skills showed a significant increase from baseline (p<0.05) for all identified skills. Student confidence in team-building skills showed a significant increase (p<0.05) in 4 of the 12 identified skills. By the end of the first year, 84% of the first-year students reported the EMT curriculum had ‘some impact’ to ‘great impact’ on their patient care skills, while 72% reported the EMT curriculum had ‘some impact’ to ‘great impact’ on their team-building skills.ConclusionsThe incorporation of EMT training early in a medical school curriculum provides students with meaningful clinical experiences that increase their self-reported level of confidence in the performance of patient care skills early in their medical education.

Prehospital Medical Care and the National Ski Patrol: How Does Outdoor Emergency Care Compare to Traditional EMS Training?

The purpose of this study was to identify the differences between the educational curricula, skill sets, and funds of knowledge required for certification as an Outdoor Emergency Care Technician (OEC-T), Emergency Medical Technician (EMT), and Emergency Medical Responder (EMR). We directly and in detail compared topics and skills presented in the OEC-T curriculum with those presented in the EMT and EMR education and training curricula. The information and skills taught in the OEC-T curriculum are in general more extensive than those taught in EMR training but are not equivalent to EMT. The OEC-T program has more depth in environmental medical issues, such as altitude illness, hyperthermia and hypothermia. Completion of the EMR program is 112 hours shorter and constitutes 30% of the duration of the EMT program. Completion of the OEC-T program (for certification only and not including additional "on-hill" patroller training) is 80 hours shorter and is half the duration of the EMT program. The OEC-T curriculum includes a skill set and fund of knowledge that exceeds those of the EMR program, but does not include all the knowledge needed for an EMT program. The OEC-T program prepares out-of-hospital providers to care for patients in the wilderness, with special emphasis on snowsports pathology. The EMT program places a greater emphasis on medical disease and emergency medication administration. These differences should be considered when determining staffing requirements for agencies caring for patients with snowsports pathology.

362 Emergency Medical Technicians in Accra, Ghana: A Basic Trauma Knowledge Assessment

To date there has been no baseline knowledge assessment amongst the emergency medical technicians of the Ghana Ambulance Service. The Ghana Ambulance Service emergency medical technician training academy has graduated 4 classes, of over 200 emergency medical technicians, in either 3-, 6-, 9- or 12-month courses. The emergency medical technicians receive biannual supplementary refresher courses. Our objective is to perform a baseline trauma knowledge assessment of the Ghana Ambulance Service emergency medical technicians who currently work in the capital city of Accra.

Paramedics in prehospital emergency medical systems across Europe

Emergency medical services (EMS) vary across Europe, with two predominant models: the Anglo-American model which uses mainly paramedics in a prehospital setting, where ‘the patient goes to the doctor’; and the Franco-German model which uses mainly physicians in a prehospital setting, where ‘the doctor goes to the patient’. No perfect model exists, and each country has an EMS model based upon the needs of the community and the available economic resources. This overview shows that the EMS in Europe are modern, efficient and structured in the same way. The dispatch centre, the means and the response times are similar; the biggest differences concern the personnel who staff ambulances and their training, although they all have to perform the same emergency procedures and manage similar types of patient. The role of emergency medical technicians (EMT) is vital in all prehospital EMS systems. However, the training of EMT with equal skills is very different, with great variations as a function of each country. European harmonization appears to be necessary, even if it seems difficult.

Clinical and hemodynamic comparison of 15:2 and 30:2 compression-to-ventilation ratios for cardiopulmonary resuscitation*

To compare cardiopulmonary resuscitation (CPR) with a compression to ventilation (C:V) ratio of 15:2 vs. 30:2, with and without use of an impedance threshold device (ITD). Prospective randomized animal and manikin study. Animal laboratory and emergency medical technician training facilities. Twenty female pigs and 20 Basic Life Support (BLS)-certified rescuers. Acid-base status, cerebral, and cardiovascular hemodynamics were evaluated in 18 pigs in cardiac arrest randomized to a C:V ratio of 15:2 or 30:2. After 6 mins of cardiac arrest and 6 mins of CPR, an ITD was added. Compared to 15:2, 30:2 significantly increased diastolic blood pressure (20 +/- 1 to 26 +/- 1; p < .01); coronary perfusion pressure (18 +/- 1 to 25 +/- 2; p = .04); cerebral perfusion pressure (16 +/- 3 to 18 +/- 3; p = .07); common carotid blood flow (48 +/- 5 to 82 +/- 5 mL/min; p < .001); end-tidal CO2 (7.7 +/- 0.9 to 15.7 +/- 2.4; p < .0001); and mixed venous oxygen saturation (26 +/- 5 to 36 +/- 5, p < .05). Hemodynamics improved further with the ITD. Oxygenation and arterial pH were similar. Only one of nine pigs had return of spontaneous circulation with 15:2, vs. six of nine with 30:2 (p < 0.03). HUMANS: Fatigue and quality of CPR performance were evaluated in 20 BLS-certified rescuers randomized to perform CPR for 5 mins at 15:2 or 30:2 on a recording CPR manikin. There were no significant differences in the quality of CPR performance or measurement of fatigue. Significantly more compressions per minute were delivered with 30:2 in both the animal and human studies. These data strongly support the contention that a ratio of 30:2 is superior to 15:2 during manual CPR and that the ITD further enhances circulation with both C:V ratios.