Sunnybrook-Osler Centre for Prehospital Medicine, Toronto, Ontario, Canada.
Prehosp Emerg Care. 2012 Oct-Dec;16(4):535-40. doi: 10.3109/10903127.2012.689930. Epub 2012 Jun 11.
Continuous positive airway pressure (CPAP) has been used effectively in the prehospital environment for a wide range of respiratory emergencies. The feasibility of CPAP when used by primary care paramedics (PCPs) has not been established.
We sought to study the feasibility of prehospital CPAP when used by paramedics trained to the primary care paramedic (PCP) level compared with those trained to the advanced care paramedic (ACP) level. Our hypothesis was that the feasibility of CPAP use by paramedics trained to the PCP level is similar to that of paramedics trained to the ACP level.
We conducted an observational study of 302 consecutive cases of CPAP use over one year beginning June 25, 2009. We defined compliant use as 100% adherence to the provincial CPAP medical directive. The criteria for compliance included specifics of patient presentation, vital signs, and appropriate documentation by the paramedic, as well as proper use, titration, and discontinuation of CPAP equipment according to protocol. Data were abstracted from ambulance call reports.
Using the criteria set out for compliant CPAP use, the highest level of compliance among the ACPs and the PCPs was 98.6% and 98.9%, respectively, for documenting indication for CPAP use. The lowest level of compliance among the ACPs was 84.4% for titration of CPAP during treatment, and the lowest level of compliance among the PCPs was 90% for adherence to criteria for CPAP application according to patients' vital signs. Overall, the criteria for compliant use of CPAP were met for 76.8% (232/302) of the call reports examined. The rate of compliant use of CPAP was 75.9% (161/212) for ACP calls and 78.9% (71/90) for PCP calls. The difference between rates of compliant use for ACP calls versus PCP calls was not statistically significant (χ(2) [1 df] = 0.31, p = 0.66).
This study found no significant difference in the compliant use of prehospital CPAP between paramedics trained to the PCP level and those trained to the ACP level. This study suggests that CPAP use by PCP-level paramedics may be feasible. Further study is required to determine whether compliance translates to safe use of prehospital CPAP by PCP-level paramedics.
持续气道正压通气（CPAP）已被有效地用于广泛的呼吸急症的院前环境中。初级保健护理人员（PCP）使用 CPAP 的可行性尚未确定。
我们旨在研究与高级护理急救人员（ACP）相比，接受初级保健护理人员（PCP）培训的护理人员在院前使用 CPAP 的可行性。我们的假设是，接受 PCP 培训的护理人员使用 CPAP 的可行性与接受 ACP 培训的护理人员相似。
我们进行了一项观察性研究，共纳入了 302 例连续 CPAP 使用病例，研究时间为 2009 年 6 月 25 日至一年。我们将符合标准的使用定义为 100% 遵守省级 CPAP 医疗指令。符合标准的标准包括患者表现、生命体征以及护理人员的适当记录，以及根据协议正确使用、调整和停止 CPAP 设备。数据从救护车呼叫报告中提取。
使用设定的符合 CPAP 使用标准，ACP 和 PCP 的最高符合率分别为 98.6%和 98.9%，记录 CPAP 使用的指征。ACP 中最低的符合率是 84.4%，用于治疗期间 CPAP 的滴定，而 PCP 中最低的符合率是 90%，用于根据患者的生命体征遵守 CPAP 应用标准。总体而言，符合 CPAP 使用标准的呼叫报告占 76.8%（232/302）。ACP 呼叫的 CPAP 符合率为 75.9%（161/212），PCP 呼叫的 CPAP 符合率为 78.9%（71/90）。ACP 呼叫与 PCP 呼叫的 CPAP 符合率之间的差异无统计学意义（χ²[1df]=0.31，p=0.66）。
这项研究没有发现接受 PCP 培训的护理人员与接受 ACP 培训的护理人员在院前 CPAP 的符合标准使用方面存在显著差异。这项研究表明，PCP 水平的护理人员使用 CPAP 是可行的。需要进一步研究以确定 PCP 水平的护理人员的合规性是否转化为院前 CPAP 的安全使用。
