Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.
Scand J Trauma Resusc Emerg Med. 2010 Apr 21;18:22. doi: 10.1186/1757-7241-18-22.
Endotracheal intubation (ETI) has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement.
We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS). The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it.
In the risk assessment, we assigned a high probability (29%) for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers.
Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.
气管插管（ETI）一直被认为是院前高级生命支持的重要组成部分。然而，对于像麻醉师这样的气道专家来说，院前 ETI 也是一项复杂的干预措施，他们在作为院前急诊医师工作时也会进行这项操作。因此，我们希望调查麻醉师在严重创伤患者院前气道管理中的质量，并确定可能需要改进的领域。
我们根据预测贝叶斯方法对一个典型的配备麻醉师的挪威直升机紧急医疗服务（HEMS）进行了风险评估。风险评估的主要重点是患者尽管有院前 ETI 指征，但到达急诊室时未进行 ETI 的事件。
在风险评估中，我们评估了一个患者尽管有院前 ETI 指征但未进行 ETI 就到达的事件，其可能性很高（29%）。然而，风险评估中确定了几个不确定性因素，这些因素与数据质量、ETI 使用指征、患者结局以及 ETI 提供者特殊培训的需求有关。
我们的风险评估表明，在研究的 HEMS 中，有院前 ETI 指征的创伤患者极有可能未接受 ETI。评估中确定的不确定性因素应进一步调查，以更好地了解评估的问题和对患者的后果。更好的院前气道管理数据质量可能有助于减少这些不确定性。
