Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study

Abstract

ObjectiveTo evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices.Design and settingThis was a cross-sectional simulation-based study where participants installed the MCPR device on a training manikin.ParticipantsWe assessed EMT-Intermediates (EMT-Is) and EMT-Paramedics (EMT-Ps) of the Emergency Medical Services (Ambulance) Division of the Taipei City Fire Department.Primary and secondary outcome measuresThe primary outcome was the gap between self-perceived (subjective) and actual (objective) no-flow time during resuscitation, which we hypothesised as statistically insignificant. The secondary outcome was the association between resuscitation performance and personal attributes like knowledge, attitude and self-confidence.ResultsAmong 210 participants between 21 and 45 years old, only six were female. There were 144 EMT-Is and 66 EMT-Ps. During a simulated resuscitation lasting between four and a half and 5 min, EMTs had longer actual no-flow time compared with self-perceived no-flow time (subjective, 38 s; objective, 57.5 s; p value<0.001). This discrepancy could cause a 6.5% drop of the chest compression fraction in a resuscitation period of 5 min. Among the EMT personal factors, self-confidence was negatively associated with objective MCPR deployment performance (adjusted OR (aOR) 0.66, 95% CI 0.45 to 0.97, p=0.033) and objective teamwork performance (aOR 0.57, 95% CI 0.34 to 0.97, p=0.037) for EMT-Ps, whereas knowledge was positively associated with objective MCPR deployment performance (aOR 2.15, 95% CI 1.31 to 3.52, p=0.002) and objective teamwork performance (aOR 1.77, 95% CI 1.02 to 3.08, p=0.043) for EMT-Is. Moreover, regarding the self-evaluation of no-flow time, both self-satisfaction and self-abasement were associated with objectively poor teamwork performance.ConclusionsEMTs’ subjective and objective performance was inconsistent during the MCPR simulation. Self-confidence and knowledge were personal factors associated with MCPR deployment and teamwork performance. Both self-satisfaction and self-abasement were detrimental to teamwork during resuscitation.

Relationship Between Resuscitation Team Members’ Self-Efficacy and Team Competence During In-Hospital Cardiac Arrest

“…Previous studies have often been small (2,4,5) or were conducted in a single center (4)(5)(6); analyzed only one type of resuscitation team member (2)(3)(4)(5)(6) or trainees (4,5) rather than multidisciplinary clinical teams; assessed participants outside of clinical settings (4,5); or did not assess nontechnical aspects of resuscitation (2,4,6). This large, multicenter study analyzed interdisciplinary teams during high-fidelity, in situ simulations of IHCA resuscitation to investigate the impact of resuscitation team members' self-efficacy on resuscitation team competence.…”

“…Self-efficacy is important to develop in resuscitation team members but is not synonymous with competence. Associations between self-efficacy and competence in cardiac resuscitations have been inconsistent, indicating a need for further study in this topic (2)(3)(4)(5)(6).…”