South Central Ambulance Service NHS Trust, Hampshire Division, Sparrowgrove, Otterbourne, UK.
Emerg Med J. 2009 Dec;26(12):888-91. doi: 10.1136/emj.2008.064642.
Ambulance paramedics are now trained routinely in advanced airway skills, including tracheal intubation. Initial training in this skill requires the insertion of 25 tracheal tubes, and further ongoing training is attained through clinical practice and manikin-based practice. In contrast, training standards for hospital-based practitioners are considerably greater, requiring approximately 200 tracheal intubations before practice is unsupervised. With debate growing regarding the efficacy of paramedic intubation, there is a need to assess current paramedic airway practice in order to review whether initial training and maintenance of skills provide an acceptable level of competence with which to practice advanced airway skills.
All ambulance patient report forms (anonymised) for the period 1 January 2007 to 31 December 2007 were reviewed, and data relating to airway management were collected. Paramedic and technician identification codes were used to determine the number of airway procedures undertaken on an individual basis.
Of the 269 paramedics, 128 (47.6%) had undertaken no intubation and 204 (75.8%) had undertaken one or less intubation in the 12-month study period. The median number of intubations per paramedic during the 12-month period was 1.0 (range 0-11). A total of 76 laryngeal mask insertion attempts were recorded by 41 technicians and 30 paramedics. The median number of laryngeal mask insertions per paramedic/technician during the 12-month period was 0 (range 0-2). A survey of ongoing continuing professional development across all ambulance trusts demonstrated no provision for adequate training to compensate for the lack of clinical exposure to advanced airway skills.
Paramedics use advanced airway skills infrequently. Continuing professional development programmes within ambulance trusts do not provide the necessary additional practice to maintain tracheal intubation skills at an acceptable level. Advanced airway management delivered by ambulance crews is likely to be inadequate with such infrequent exposure to the skill.
现在，急救人员通常接受高级气道技能的培训，包括气管插管。这项技能的初步培训需要插入 25 根气管导管，进一步的持续培训则通过临床实践和基于模型的实践来获得。相比之下，医院从业者的培训标准要高得多，大约需要进行 200 次气管插管才能进行无人监督的练习。由于关于急救人员插管效果的争论不断，因此需要评估当前急救人员的气道实践，以审查初始培训和技能维护是否提供了可接受的高级气道技能实践能力水平。
回顾了 2007 年 1 月 1 日至 12 月 31 日期间的所有救护车患者报告表（匿名），并收集了与气道管理相关的数据。使用急救人员和技术员识别码来确定每个急救人员进行气道程序的数量。
在 269 名急救人员中，有 128 名（47.6%）从未进行过插管，而在 12 个月的研究期间，有 204 名（75.8%）进行过一次或更少的插管。在 12 个月期间，每名急救人员的插管中位数为 1.0 次（范围 0-11 次）。记录了 41 名技术员和 30 名急救人员共 76 次喉罩插入尝试。在 12 个月期间，每名急救人员/技术员的喉罩插入中位数为 0（范围 0-2 次）。对所有救护车信托机构的持续专业发展情况进行调查表明，没有提供足够的培训来弥补缺乏对高级气道技能的临床接触。
急救人员很少使用高级气道技能。救护车信托机构内的持续专业发展计划没有提供必要的额外实践来维持气管插管技能的可接受水平。由于接触该技能的频率如此之低，因此，急救人员的高级气道管理可能不足。
