From the University of Minnesota (M.E.S., K.M., B.B., E.L., G.J.B.), Minneapolis and; North Memorial Health (S.W., G.J.B.), Robbinsdale, Minnesota.
J Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2):S27-S32. doi: 10.1097/TA.0000000000001800.
The quality of prehospital care impacts patient outcomes. Military efforts have focused on training revision and the creation of high-fidelity simulation models to address potentially survivable injuries. We sought to investigate the applicability of models emphasizing hemorrhage control and airway management to a civilian population.
Prehospital health care providers (PHPs) undergoing their annual training were enrolled. A trauma scenario was simulated with two modules: hemorrhage control and airway management. Experienced raters used a validated tool to assess performance. Pearson correlation, logistic regression, and χ tests were used for analysis.
Ninety-five PHPs participated with a mean experience of 15.9 ± 8.3 years, and 7.4% reported past military training. The PHPs' overall execution rate of the six hemorrhage control measures varied from 38.9% to 88.4%. The median blood loss was 1,700 mL (interquartile range, 1,043-2,000), and the mean global rater score was 25.0 ± 7.4 (scale, 5-40). There was a significant relationship between PHP profession and past military experience to their consideration of blood transfusion and tranexamic acid. An inverse relationship between blood loss and global rater score was found (r = -0.59, n = 88, p = 1.93 × 10). After simulated direct laryngoscope failure in the airway module, 58% of PHPs selected video laryngoscopy over placement of a supraglottic airway. Eighty-six percent of participants achieved bilateral chest rise in the manikin regardless of management method. Participants reported improved comfort with skills after simulation.
Our data reveal marginal performance in hemorrhage control regardless of the PHP's prior experience. The majority of PHPs were able to secure an advanced airway if direct laryngoscope was unavailable with a predisposition for video laryngoscopy over supraglottic airway. Our findings support the need for continued training for PHPs highlighting hemorrhage control maneuvers and increased familiarity with airway management options. Improved participant confidence posttraining gives credence to simulation training.
Prognostic/epidemiological study, level III.
院前医疗质量影响患者预后。军队一直致力于培训改革和创建高保真模拟模型，以解决潜在可救治的创伤。我们试图研究强调控制出血和气道管理的模型在平民中的适用性。
接受年度培训的院前急救医疗人员（PHPs）被纳入研究。模拟了一个创伤场景，分为两个模块：控制出血和气道管理。经验丰富的评估者使用经过验证的工具来评估绩效。采用 Pearson 相关分析、逻辑回归和 χ 检验进行分析。
95 名 PHPs 参与了研究，平均从业经验为 15.9 ± 8.3 年，7.4%的人报告有过去的军事培训经验。PHPs 实施 6 项控制出血措施的总体执行率为 38.9%至 88.4%。中位失血量为 1700 毫升（四分位间距为 1043-2000），全球评估者评分的平均值为 25.0 ± 7.4（评分范围为 5-40）。PHP 的职业和过去的军事经验与他们考虑输血和氨甲环酸之间存在显著关系。失血量与全球评估者评分呈负相关（r=-0.59，n=88，p=1.93×10）。在气道模块模拟直接喉镜失败后，58%的 PHPs 选择视频喉镜而不是放置声门上气道。无论采用何种管理方法，86%的参与者在模型中均实现了双侧胸廓起伏。参与者报告说，模拟后他们对技能的掌握更加熟练和舒适。
无论 PHPs 之前的经验如何，我们的数据显示在控制出血方面的表现都较为一般。如果无法使用直接喉镜，大多数 PHPs 都能够安全地建立高级气道，并且倾向于使用视频喉镜而不是声门上气道。我们的研究结果支持需要继续对 PHPs 进行培训，重点是控制出血的操作，并增加对气道管理选择的熟悉程度。培训后参与者信心的提高证明了模拟培训的有效性。
预后/流行病学研究，III 级。
