A number of studies have shown that patients undergoing endotracheal intubation in a prehospital setting have worse outcomes than similarly injured or critically ill patients intubated in the emergency department. There has been speculation that this may be because paramedics have low intubation success and safety rates. Paramedics, particularly those in rural areas, have few opportunities for intubation;similarly trained paramedics and nursing transport teams who intubate more frequently have better success and safety profiles. The overall objective of the present proposal is to assess whether medical simulation can enhance the safety and proficiency profile of paramedics performing prehospital endotracheal intubation, and whether feedback from an airway management expert observing the simulation enhances skill retention after 12 and 24 months. Since no validated proficiency assessment tool currently exists to measure the skill of paramedics in airway management, one will be developed and tested. Using this tool, 500 paramedics in south central Pennsylvania, in primarily rural counties, will undergo simulation training similar to that require for certification. A baseline assessment of proficiency will be obtained. One group will be randomized to receive simulation training similar to that required for certification, while the othr group will receive feedback from an airway management expert linked to the simulation test site via a 2-way audio-video feed. Both groups of paramedics will be reassessed at 12-, and 24 months to determine whether skill level was maintained or whether skills deteriorated, and whether expert intervention had any impact on skill retention.

Public Health Relevance

Patients receiving out-of-hospital endotracheal intubations (ETI) after traumatic brain injury or cardiopulmonary arrest often have higher rates of complications and death, perhaps due to inexperience performing ETI. In this study, we propose developing a validated proficiency assessment tool to measure paramedic skill in ETI during simulation, then using this tool to measure skill level in rural paramedics after either standard certification simulation training in airway management, or training with intervention and feedback from airway management experts. Both groups will then be followed and reassessed after 12 and 24 months to determine whether skills have been retained.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
1R18HS021456-01
Application #
8339221
Study Section
Special Emphasis Panel (HSQR)
Program Officer
Henriksen, Kerm
Project Start
2012-07-01
Project End
2015-04-30
Budget Start
2012-07-01
Budget End
2013-04-30
Support Year
1
Fiscal Year
2012
Total Cost
Indirect Cost
Name
Pennsylvania State University
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
129348186
City
Hershey
State
PA
Country
United States
Zip Code
17033
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Way, David P; Panchal, Ashish R; Finnegan, Geoffrey I et al. (2017) Airway Management Proficiency Checklist for Assessing Paramedic Performance. Prehosp Emerg Care 21:354-361
Brown, Samuel M; Duggal, Abhijit; Hou, Peter C et al. (2017) Nonlinear Imputation of PaO2/FIO2 From SpO2/FIO2 Among Mechanically Ventilated Patients in the ICU: A Prospective, Observational Study. Crit Care Med 45:1317-1324
Panchal, Ashish R; Finnegan, Geoffrey; Way, David P et al. (2016) Assessment of Paramedic Performance on Difficult Airway Simulation. Prehosp Emerg Care :1-10
Bischof, Jason J; Panchal, Ashish R; Finnegan, Geoffrey I et al. (2016) Creation and Validation of a Novel Mobile Simulation Laboratory for High Fidelity, Prehospital, Difficult Airway Simulation. Prehosp Disaster Med 31:465-70