Ann Emerg Med. 1998 Feb;31(2):228-233.
The 1994 basic-EMT (EMT-B) curriculum recommended teaching EMT-Bs the skill of endotracheal intubation. In this study we assessed the success and complication rates of endotracheal intubations in the field by EMT-Bs.
We conducted a prospective clinical trial over a period of 28 months in an urban out-of-hospital EMS system. Four first-responder EMT-B engine companies with paramedic backup received 10 hours' intubation training in three sessions spread over at least 2 weeks. The training module was similar to that of the 1994 EMT-B curriculum and included at least 10 intubations on manikins. The EMTs used manikins with closed chest cavities to learn assessment of endotracheal-tube placement. Patients were eligible for intubation by the EMTs if they were apneic and older than 15 years. We calculated 95% confidence interval (CIs) for intubation success rates.
Sixty-six EMT-Bs passed the training examinations and were authorized to perform intubation in the field. Endotracheal intubation was attempted by EMTs in 103 patients; the attempt was successful in 53 (95% CI, 42% to 61%). All patients who were not intubated by EMT-Bs were intubated by paramedics, with the exception of six cases. One attempt at intubation was made in 52 patients, two attempts in 44, and three in 7. Three unrecognized esophageal intubations occurred.
EMT-Bs trained in a short course successfully intubated about half the patients they encountered in this study. This low intubation success rate calls into question the validity of the endotracheal-intubation training module in the 1994 EMT-B national curriculum. [Sayre MR, Sakles JC, Mistler AF, Evans JL, Kramer AT, Pancioli AM: Field trial of endotracheal intubation by basic EMTs. Ann Emerg Med February 1998;31:228-233.].
1994 年基础 EMT（EMT-B）课程推荐 EMT-B 掌握气管内插管技能。本研究评估 EMT-B 在现场进行气管内插管的成功率和并发症发生率。
我们在一个城市院外 EMS 系统中进行了一项为期 28 个月的前瞻性临床试验。四支配备护理人员后备力量的第一反应 EMT-B 发动机公司在至少 2 周内分 3 次接受了 10 小时的插管培训。培训模块类似于 1994 年 EMT-B 课程，包括至少 10 次在模型上的插管。EMT 使用带有封闭胸腔的模型来学习气管内导管放置的评估。如果患者出现呼吸暂停且年龄大于 15 岁，EMT 即可对其进行插管。我们计算了插管成功率的 95%置信区间（CI）。
66 名 EMT-B 通过了培训考试，并被授权在现场进行插管。EMT 对 103 名患者进行了气管插管尝试；尝试成功 53 例（95%CI，42%至 61%）。除 6 例外，所有未被 EMT-B 插管的患者均由护理人员插管。52 例患者仅进行了 1 次插管尝试，44 例患者进行了 2 次，7 例患者进行了 3 次。发生了 3 例未被识别的食管插管。
在本研究中，经过短期课程培训的 EMT-B 成功插管了他们遇到的大约一半患者。这种低插管成功率使得 1994 年 EMT-B 国家课程中的气管内插管培训模块的有效性受到质疑。[Sayre MR、Sakles JC、Mistler AF、Evans JL、Kramer AT、Pancioli AM：基础 EMT 现场气管内插管试验。《急诊医学年鉴》1998 年 2 月；31:228-233。]
