A mixed methods end-user assessment to determine the ideal supraglottic airway device for inclusion into the medic's aid bag

Abstract

BACKGROUND:Many advancements in supraglottic airway technology have occurred since the start of the Global War on Terrorism. While the Tactical Combat Casualty Care guidelines previously recommend the i-gel device, this is based on little data and minimal enduser input. OBJECTIVE:We sought to use a mixed methods approach to investigate the properties of an ideal device for inclusion into the medic's aid bag. METHODS:We performed prospective, serial qualitative studies to uncover and articulate themes relative to airway device usability with 68Wcombat medics. 68W are trained roughly to the level of a civilian advanced emergency medical technician with a heavier focus on trauma care. Physicians with airway expertise demonstrated the use of each device and provided formal training on all the presented devices. We then administered performed focus groups to solicit end-user feedback along with survey data. RESULTS:We enrolled 250 medics during the study. The preponderance of medics were of the rank E4 (28%) and E5 (44%). Only 35% reported ever placing a supraglottic airway in a real human. When reporting on usability, the i-gel had the highest median score, ease of manipulation, grip comfort and ease of insertion while also scoring the best in regard to requiring minimal training. The other compared devices had no clear highest score. Qualitative data saturated around a strong preference for the BaskaMask and/or the i-gel airway device, with the least favorite being the AirQ and the LMA Fastrach airway devises. There was a strong qualitative alignment in how both the BaskaMask and i-gel provided ease of use and simplicity of training. CONCLUSION:There were strong qualitative preferences for two specific airway devices: Baska Mask and i-gel. However, many medics commented on their previous experience with the i-gel compared with the other devices, which may have biased them toward the i-gel. The overall data suggest that medics would prefer a device engineered with features from several devices.

A prospective assessment of the medic autologous blood transfusion skills for field transfusion preparation

“…With regards to the survey data, we found few significant differences across nearly all the survey questions, except for the comfort level in managing a potential transfusion reaction. This is not surprising as with previous studies, we have found little benefit with the quantitative survey data truly identifying key scientific findings 29 . However, the qualitative data indicated that most of the medics stated confidence in their skills regardless of how well they performed the procedure.…”

“…This is not surprising as with previous studies, we have found little benefit with the quantitative survey data truly identifying key scientific findings. 29 However, the qualitative data indicated that most of the medics stated confidence in their skills regardless of how well they performed the procedure. The use of a qualitative method design, while relatively novel for this population, is not a new area of science.…”

“…We previously utilized this method for airway studies, uncovering key findings that were otherwise not discoverable through quantitative methods including surveytype data. 29,30 Additionally, the group setting enhances feedback through a conversation-based approach among the interviewing team member and the end-users. We also found key feedback about the need for quarterly training, which is substantially more than the Army required yearly Table VIII Skills Qualification Testing.…”

“…To ensure open feedback, a non‐uniformed member of the study team performed the interviews (FM, JM, MAM). Our overall qualitative methods have been previously described 29,30 . Notes were taken during the interviews and recordings which were later professionally transcribed.…”

“…Our overall qualitative methods have been previously described. 29,30 Notes were taken during the interviews and recordings which were later professionally transcribed. The notes and transcripts were reviewed along with reoccurring meetings between the interviewers and our study team qualitative methods expert (EAJ) for analysis.…”