Regions Hospital, Emergency Medical Services, 640 Jackson Street, Mail Stop 13801B, Saint Paul, MN 55101, USA.
Prehosp Emerg Care. 2013 Jul-Sep;17(3):379-85. doi: 10.3109/10903127.2013.764949. Epub 2013 Feb 14.
The primary aims of this study were to determine whether the frequency of placement, type of advanced airway, and settings of advanced airway placement (clinical vs. field) have changed for paramedic students over the last 11 years, and to describe regional differences regarding the same set of variables.
This study was a retrospective review of prospectively reported airway procedures documented by paramedic students in Fisdap ( http://www.fisdap.net ). Students were included if they graduated from a paramedic program, had procedure entries verified by a preceptor, and provided consent for research. Exclusion criteria included students who had a total number of airway placements ≥2 standard deviations from the mean or had 0 airway placements recorded, and programs with <10 graduating students total over the study period. Airway device types and educational settings were descriptively compared over the 11-year study period by year and region.
A total of 8,934 paramedic student records were reviewed, with 2,811 excluded based on a priori criteria, leaving 6,123 records for analysis. In each year, the median number of airway devices placed per student was greater in the clinical setting. Endotracheal intubation (ETI) was more common than alternative airway placement in both the field and clinical settings. The median number of clinical ETIs per student has remained relatively constant at 7. The median number of field ETIs per student ranged from 0 to 1 over the study period, with a median alternative airway placement rate of 0 for both clinical and field settings. For all regions, the majority of procedures were performed in a clinical environment. The median number of clinical alternative airway device placements was 0 for all regions. The number of clinical ETIs ranged from 5 to 11 per student, with the highest number of ETIs per student in the West North Central and New England regions and the lowest in the West South Central and East South Central regions.
Paramedic students gain the majority of their advanced airway experience in the clinical setting. ETI remains more common than alternative airway placement, although there is significant geographic variation in the number of ETIs per student. High rates of clinical intubations do not correlate with high rates of field intubations.
本研究的主要目的是确定在过去 11 年中，急救医学生进行高级气道放置的频率、高级气道的类型以及高级气道放置的环境（临床或现场）是否发生了变化，并描述同一组变量的区域差异。
这是一项对通过 Fisdap（http://www.fisdap.net）记录的急救医学生前瞻性气道程序进行回顾性研究。如果学生毕业于急救医学项目，其程序记录得到带教老师的验证，并同意进行研究，则纳入研究。排除标准包括气道放置总数超过平均值 2 个标准差或记录为 0 个气道放置的学生，以及在研究期间总毕业学生人数<10 人的项目。在 11 年的研究期间，通过年份和地区描述性比较气道装置类型和教育环境。
共审查了 8934 名急救医学生的记录，根据事先设定的标准排除了 2811 名学生，留下 6123 名学生进行分析。每年，学生在临床环境下进行的气道设备放置中位数都较大。在现场和临床环境中，气管内插管（ETI）比替代气道放置更常见。学生临床 ETI 中位数相对稳定，每年为 7 次。学生的现场 ETI 中位数在研究期间从 0 到 1 不等，临床和现场环境的替代气道放置率中位数均为 0。对于所有地区，大多数程序都是在临床环境中进行的。所有地区的临床替代气道设备放置中位数均为 0。临床 ETI 数量从每个学生 5 到 11 不等，西中北部和新英格兰地区每个学生的 ETI 数量最高，中西部和东南中部分区的 ETI 数量最低。
急救医学生在临床环境中获得了大部分高级气道经验。ETI 仍然比替代气道放置更常见，尽管学生的 ETI 数量存在显著的地域差异。临床插管率高并不与现场插管率高相关。
