Gilligan P, Bhatarcharjee C, Knight G, Smith M, Hegarty D, Shenton A, Todd F, Bradley P
Bradford Royal Infirmary, Bradford, UK.
Emerg Med J. 2005 Sep;22(9):628-32. doi: 10.1136/emj.2004.015321.
In many emergency departments advanced life support (ALS) trained nurses do not assume a lead role in advanced resuscitation. This study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation.
A prospective study was conducted at five emergency departments and one nurses' association meeting. All participants went through the same scenario. Details recorded included baseline blood pressure and pulse rate, time in post, time of ALS training, and subjective stress score (1 = hardly stressed; 10 = extremely stressed). Scoring took into account scenario understanding, rhythm recognition, time to defibrillation, appropriateness of interventions, and theoretical knowledge.
Of 57 participants, 20 were ALS trained nurses, 19 were ALS trained emergency senior house officers (SHOs), and 18 were emergency SHOs without formal ALS training. The overall mean score for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. Nurses found the experience less stressful (subjective stress score 5.78/10) compared with doctors without ALS training (6.5/10). The mean time taken to defibrillate from the appearance of a shockable rhythm on the monitor by the nurses and those SHOs without ALS training was 42 and 40.8 seconds, respectively.
ALS trained nurses performed as well as ALS trained and non ALS trained emergency SHOs in a simulated cardiac arrest situation and had greater awareness of the potentially reversible causes of cardiac arrest. Thus if a senior or middle grade doctor is not available to lead the resuscitation team, it may be appropriate for experienced nursing staff with ALS training to act as ALS team leaders rather than SHOs.
在许多急诊科，接受过高级生命支持（ALS）培训的护士在高级复苏中并不担任主导角色。本研究调查了先前接受过ALS培训的急诊护士在模拟心脏骤停情况下是否能提供良好的团队领导能力。
在五个急诊科和一次护士协会会议上进行了一项前瞻性研究。所有参与者都经历相同的场景。记录的详细信息包括基线血压和脉搏率、在岗时间、ALS培训时间以及主观压力评分（1 = 几乎没有压力；10 = 压力极大）。评分考虑了场景理解、心律识别、除颤时间、干预措施的适当性以及理论知识。
57名参与者中，20名是接受过ALS培训的护士，19名是接受过ALS培训的急诊高级住院医师（SHOs），18名是未接受过正式ALS培训的急诊SHOs。未接受ALS培训的医生的总体平均得分为69.5%，接受过ALS培训的医生为72.3%，接受过ALS培训的护士为73.7%。与未接受ALS培训的医生（6.5/10）相比，护士觉得这种经历压力较小（主观压力评分为5.78/10）。护士和未接受ALS培训的SHOs从监护仪上出现可除颤心律到进行除颤的平均时间分别为42秒和40.8秒。
在模拟心脏骤停情况下，接受过ALS培训的护士与接受过ALS培训和未接受过ALS培训的急诊SHOs表现相当，并且对心脏骤停潜在的可逆转原因有更高的认识。因此，如果没有高级或中级医生来领导复苏团队，那么接受过ALS培训的经验丰富的护理人员担任ALS团队领导者可能比SHOs更合适。
