Heller M, Stoy W A, Shuman L J, Wolfe H, Zavada C A
Emergency Medicine Residency Program of the Lehigh Valley, St. Luke's Hospital, Bethlehem, Penn.
Prehosp Disaster Med. 1994 Jul-Sep;9(3):165-71.
To evaluate the effectiveness of interactive videodisc (IVD) instruction of paramedics through the use of computer analysis of trip sheets.
DESIGN/SETTING: Prospective, controlled, in an urban 9-1-1, paramedic, emergency medical services (EMS) system with total call volume of 62,000/year; 15,000 advanced life support (ALS).
All 150 paramedics in the system received eight hours of IVD instruction covering five subject areas: 1) airway; 2) head/cervical trauma; 3) chest; 4) shock; and 5) cardiac arrest. Trip sheets from 9,943 runs in the pre-IVD period were subjected to computer analysis, and a compliance score was generated using previously developed algorithms that assigned a weight to each omission and commission. After a nine-month IVD training period, 4,303 cases were collected and analyzed in the post-IVD period. Statistical analyses were made using "Student's" t-test and Chi-square with alpha set at 0.05.
Only those records of adult patients who fit one of the five protocols were eligible for computer analysis. Of the 9,943 cases in the pre-IVD group, 480 (4.8%) were excluded, all due to inadequate data recording by the paramedics. A statistically similar portion, 233 (5.4%) of the 4,303 post-IVD instruction cases were excluded (p = .15).
Overall the mean compliance score of the pre-IVD group was 0.65 +/-0.19 (+/-SD). The post-IVD group score was 0.65 +/-0.19 (p = 0.99). Analysis of scores for each algorithm also showed no significant differences. This study had an observed power of .94 to detect a difference in compliance as small as 0.030.
(ABSTRACT TRUNCATED AT 250 WORDS)
通过对出车记录单进行计算机分析，评估交互式视盘（IVD）对护理人员的培训效果。
设计/地点：前瞻性、对照研究，在一个城市9-1-1护理人员紧急医疗服务（EMS）系统中进行，年总呼叫量为62,000次；其中15,000次为高级生命支持（ALS）。
该系统中的150名护理人员均接受了8小时的IVD培训，内容涵盖五个主题领域：1）气道；2）头部/颈部创伤；3）胸部；4）休克；5）心脏骤停。对IVD培训前9943次出车记录单进行计算机分析，并使用先前开发的算法生成合规分数，该算法为每个遗漏和失误赋予权重。经过9个月的IVD培训期后，在IVD培训后阶段收集并分析了4303例病例。使用“学生”t检验和卡方检验进行统计分析，α设定为0.05。
只有符合五个方案之一的成年患者记录才有资格进行计算机分析。在IVD培训前组的9943例病例中，480例（4.8%）被排除，均因护理人员数据记录不充分。在IVD培训后指导的4303例病例中，有233例（5.4%）被排除，比例在统计学上相似（p = 0.15）。
总体而言，IVD培训前组的平均合规分数为0.65±0.19（±标准差）。IVD培训后组的分数为0.65±0.19（p = 0.99）。对每种算法的分数分析也未显示出显著差异。本研究检测到低至0.030的合规差异的观察效能为0.94。
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