In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study
Abstract Background Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and ofte...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-04-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13049-017-0386-9 |
| _version_ | 1811277995412815872 |
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| author | Helmut Trimmel Christoph Beywinkler Sonja Hornung Janett Kreutziger Wolfgang G. Voelckel |
| author_facet | Helmut Trimmel Christoph Beywinkler Sonja Hornung Janett Kreutziger Wolfgang G. Voelckel |
| author_sort | Helmut Trimmel |
| collection | DOAJ |
| description | Abstract Background Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. Methods In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. Results From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5–42.5) vs. 19.0 (15.0–27.0) during initial training; 62.0 (41.8–86.5) vs. 33.5 (18.0–54.5) during the first, and 64.0 (34.5–93.8) vs. 27 (12.5–56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0–14.8) TIs vs. 0.0 (0.0–0.0) SGA cases during the first, and 9.0 (7.0–13.8) TIs vs. 0.0 (0.0–0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Discussion Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency. Conclusions In-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities. |
| first_indexed | 2024-04-13T00:26:49Z |
| format | Article |
| id | doaj.art-850044287d794626b05335dcd8ac67bd |
| institution | Directory Open Access Journal |
| issn | 1757-7241 |
| language | English |
| last_indexed | 2024-04-13T00:26:49Z |
| publishDate | 2017-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj.art-850044287d794626b05335dcd8ac67bd2022-12-22T03:10:35ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412017-04-012511710.1186/s13049-017-0386-9In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control studyHelmut Trimmel0Christoph Beywinkler1Sonja Hornung2Janett Kreutziger3Wolfgang G. Voelckel4From the Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener NeustadtFrom the Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener NeustadtFrom the Department of Anesthesiology, Emergency and Critical Care Medicine and Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener NeustadtDepartment of Anesthesiology and Critical Care Medicine, Medical UniversityNorwegian Air AmbulanceAbstract Background Pre-hospital airway management is a major challenge for emergency medical service (EMS) personnel. Despite convincing evidence that the rescuer’s qualifications determine efficacy of tracheal intubation, in-hospital airway management training is not mandatory in Austria, and often neglected. Thus we sought to prove that airway management competence of EMS physicians can be established and maintained by a tailored training program. Methods In this descriptive quality control study we retrospectively evaluated all in- and pre-hospital airway cases managed by EMS physicians who underwent a structured in-hospital training program in anesthesia at General Hospital Wiener Neustadt. Data was obtained from electronic anesthesia and EMS documentation systems. Results From 2006 to 2016, 32 EMS physicians with 3-year post-graduate education, but without any prior experience in anesthesia were trained. Airway management proficiency was imparted in three steps: initial training, followed by an ongoing practice schedule in the operating room (OR). Median and interquartile range of number of in-hospital tracheal intubations (TIs) vs. use of supra-glottic airway devices (SGA) were 33.5 (27.5–42.5) vs. 19.0 (15.0–27.0) during initial training; 62.0 (41.8–86.5) vs. 33.5 (18.0–54.5) during the first, and 64.0 (34.5–93.8) vs. 27 (12.5–56.0) during the second year. Pre-hospitaly, every physician performed 9.0 (5.0–14.8) TIs vs. 0.0 (0.0–0.0) SGA cases during the first, and 9.0 (7.0–13.8) TIs vs. 0.0 (0.0–0.3) SGA during the second year. Use of an SGA was mandatory when TI failed after the second attempt, thus accounting for a total of 33 cases. In 8 cases, both TI and SGA failed, but bag mask ventilation was successfully performed. No critical events related to airway management were noted and overall success rate for TI with a max of 2 attempts was 95.3%. Discussion Number of TIs per EMS physician is low in the pre-hospital setting. A training concept that assures an additional 60+ TIs per year appears to minimize failure rates. Thus, a fixed amount of working days in anesthesia seems crucial to maintain proficiency. Conclusions In-hospital training programs are mandatory for non-anesthetist EMS physicians to gain competence in airway management and emergency anesthesia.Our results might be helpful when discussing the need for regulation and financing with the authorities.http://link.springer.com/article/10.1186/s13049-017-0386-9Airway managementTrainingEmergency physicianEmergency anesthesiaTracheal intubationDifficult airway algorithm |
| spellingShingle | Helmut Trimmel Christoph Beywinkler Sonja Hornung Janett Kreutziger Wolfgang G. Voelckel In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Airway management Training Emergency physician Emergency anesthesia Tracheal intubation Difficult airway algorithm |
| title | In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study |
| title_full | In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study |
| title_fullStr | In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study |
| title_full_unstemmed | In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study |
| title_short | In-hospital airway management training for non-anesthesiologist EMS physicians: a descriptive quality control study |
| title_sort | in hospital airway management training for non anesthesiologist ems physicians a descriptive quality control study |
| topic | Airway management Training Emergency physician Emergency anesthesia Tracheal intubation Difficult airway algorithm |
| url | http://link.springer.com/article/10.1186/s13049-017-0386-9 |
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