Can Education and Enhanced Medical Director Oversight Improve Definitive Airway Control in the Prehospital Environment?

Abstract

Background Endotracheal intubation (ETI) is the most definitive technique for airway management. However, supraglottic airway (SGA) may be used when ETI is not feasible. The purpose of this study was to determine the effect of updated field sedation protocols, simulation teaching, robust Quality Assurance/Continuing Quality Improvement (QA/CQI) program, and enhanced emergency medical services (EMSs) medical director oversight on ETI and SGA usage at a Level 1 trauma center. Methods After the transition of EMS directors in May 2016, field sedation protocols were updated, a new QA/CQI was instituted, and multiple teaching and simulation sessions were conducted. A retrospective review of EMS data was conducted on all prehospital airway interventions performed by EMS personnel. Intubations occurring from July 2013 to May 2016 served as controls. Intubations from May 2016 to December 2017 served as the comparison group. Data collected included intubation type/indication, age, and successful or unsuccessful. Results There were 967 ETI and SGA performed on 84% and 15% of patients, respectively. Success rates were 75% for ETI and 82% for SGA. ETI increased from 83% in the control group to 88% in the study group, and SGA decreased from 16% in the control group to 11% in the study group ( P = .029). The success rate for ETI increased by 2% in the study group ( P = .539). Discussion This study showed that definitive airway control could be positively impacted by incorporating education and medical director oversight into EMS training. ETI increased and SGA decreased after implementation.

Emergency Medical Services Provider Acceptance of and Attitudes About Pediatric SimBox Simulations

“…As a future direction, and as described in previous studies, 19,20 a follow-up investigation can be conducted; such an investigation may be helpful in determining the optimal frequency for EMS SimBox participation. Recent work has shown an association between EMS education and increased success with adult endotracheal intubation 21 . Another limitation is that the methods of our work do not assess correlation of participant agreement with actual patient outcomes.…”

“…Recent work has shown an association between EMS education and increased success with adult endotracheal intubation. 21 Another limitation is that the methods of our work do not assess correlation of participant agreement with actual patient outcomes. The ongoing larger study of pediatric emergency care coordination in EMS agencies will look to correlate agency-level quality of care and patient outcomes with performance in simulations.…”