Way David P, Panchal Ashish R, Finnegan Geoffrey I, Terndrup Thomas E
Prehosp Emerg Care. 2017 May-Jun;21(3):354-361. doi: 10.1080/10903127.2016.1263368. Epub 2017 Jan 23.
To develop and derive an instrument for assessing airway management proficiency for paramedics.
Using a validated difficult airway model simulation, we recorded responses to a standard traumatic brain injury scenario requiring airway management in 197 certified paramedics. Discrete items (N = 131) were developed by an expert panel, and referenced to three performance standard subscales (i.e., intubation, ventilation, and backup airway). Responses were scored and subjected to an iterative process to create a more practical number of items for the final Airway Management Proficiency Checklist (AMPC). Tetrachoric correlations were used to evaluate items for relevance. Kuder-Richardson Formula 20 reliabilities were used to assess internal consistency among checklist items. Finally, a Rasch analysis on each subscale was performed to evaluate items for measurement quality. Items were retained if they were determined to fit the Rasch Model.
Items were deleted from the final AMPC for lack of simulation fidelity (26 items), duplicity (15 items), and poor psychometric quality (39 items). In four additional iterations, items were dropped for lack of equipment options (e.g., single mask), lack of instructional clarity (e.g., calculation of GCS score), high inference on the part of the evaluator (6 items), or inadequate measurement of behavioral performance (e.g., passes blade through lips without contacting mouth or teeth). Thirty seven items and three outcome standards (first pass success of the endotracheal tube; assisted ventilation with no interruption of 30 seconds or greater; successful placement of a backup airway device within one attempt) were retained to form three hypothesized subscales.
The AMPC represents a psychometrically derived instrument that identified important tasks required for comprehensive airway management. The 37-item instrument will contribute to improving training and measuring the performance of paramedic's airway management skills.
开发并推导一种用于评估护理人员气道管理熟练度的工具。
使用经过验证的困难气道模型模拟，我们记录了197名认证护理人员对需要气道管理的标准创伤性脑损伤场景的反应。由一个专家小组制定了离散项目（N = 131），并参考了三个性能标准子量表（即插管、通气和备用气道）。对反应进行评分，并经过反复过程，为最终的气道管理熟练度检查表（AMPC）创建更实用数量的项目。使用四分相关系数来评估项目的相关性。使用库德-理查森公式20信度来评估检查表项目之间的内部一致性。最后，对每个子量表进行拉施分析，以评估项目的测量质量。如果确定项目符合拉施模型，则予以保留。
由于缺乏模拟逼真度（26项）、重复性（15项）和心理测量质量差（39项），最终的AMPC中删除了一些项目。在另外四轮反复过程中，由于缺乏设备选项（例如单面罩）、指导不清晰（例如格拉斯哥昏迷量表评分的计算）、评估者推断性高（6项）或行为表现测量不足（例如刀片穿过嘴唇而未接触口腔或牙齿）而删除了一些项目。保留了37个项目和三个结果标准（气管内导管首次插入成功；辅助通气不间断30秒或更长时间；一次尝试成功放置备用气道装置），以形成三个假设的子量表。
AMPC是一种经过心理测量推导的工具，它确定了全面气道管理所需的重要任务。这个包含37个项目的工具将有助于改进培训并衡量护理人员气道管理技能的表现。
