Ono Yuko, Tanigawa Koichi, Kakamu Takeyasu, Shinohara Kazuaki, Iseki Ken
Emergency and Critical Care Medical Center, Fukushima Medical University, Fukushima, Japan.
Department of Pharmacology, School of Medicine, Fukushima Medical University, Fukushima, Japan.
BMJ Open. 2018 Jul 13;8(7):e021858. doi: 10.1136/bmjopen-2018-021858.
Clinical procedural experience and confidence are both important when performing complex medical procedures. Since out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among prehospital rescuers as well as their confidence in performing ETI and confidence-associated factors.
Population-based cross-sectional study conducted from January to September 2017.
Northern Japan, including eight prefectures.
Emergency life-saving technicians (ELSTs) authorised to perform ETI.
Annual ETI exposure and confidence in performing ETI, according to a five-point Likert scale. To determine factors associated with ETI confidence, differences between confident ELSTs (those scoring 4 or 5 on the Likert scale) and non-confident ELSTs were evaluated.
Questionnaires were sent to 149 fire departments (FDs); 140 agreed to participate. Among the 2821 ELSTs working at responding FDs, 2620 returned the questionnaire (response rate, 92.9%); complete data sets were available for 2567 ELSTs (complete response rate, 91.0%). Of those 2567 respondents, 95.7% performed two or fewer ETI annually; 46.6% reported lack of confidence in performing ETI. Multivariable logistic regression analysis showed that years of clinical experience (adjusted OR (AOR) 1.09; 95% CI 1.05 to 1.13), annual ETI exposure (AOR 1.79; 95% CI 1.59 to 2.03) and the availability of ETI skill retention programmes including regular simulation training (AOR 1.31; 95% CI 1.02 to 1.68) and operating room training (AOR 1.44; 95% CI 1.14 to 1.83) were independently associated with confidence in performing ETI.
ETI is an uncommon event for most ELSTs, and nearly half of respondents did not have confidence in performing this procedure. Since confidence in ETI was independently associated with availability of regular simulation and operating room training, standardisation of ETI re-education that incorporates such methods may be useful for prehospital rescuers.
在进行复杂的医疗程序时，临床操作经验和信心都很重要。由于院外气管插管（ETI）是一项复杂的干预措施，我们试图阐明院前救援人员的临床ETI经验，以及他们进行ETI的信心和与信心相关的因素。
2017年1月至9月进行的基于人群的横断面研究。
日本北部，包括八个县。
被授权进行ETI的紧急救生技术员（ELST）。
根据五点李克特量表评估年度ETI暴露情况和进行ETI的信心。为了确定与ETI信心相关的因素，评估了有信心的ELST（李克特量表得分4或5）和没有信心的ELST之间的差异。
向149个消防部门（FD）发送了问卷；140个部门同意参与。在响应的FD工作的2821名ELST中，2620人返回了问卷（回复率92.9%）；2567名ELST有完整的数据集（完整回复率91.0%）。在这2567名受访者中，95.7%的人每年进行两次或更少的ETI；46.6%的人表示对进行ETI缺乏信心。多变量逻辑回归分析表明，临床经验年限（调整后的OR（AOR）1.09；95%CI 1.05至1.13）、年度ETI暴露情况（AOR 1.79；95%CI 1.59至2.03）以及包括定期模拟培训（AOR 1.31；95%CI 1.02至1.68）和手术室培训（AOR 1.44；95%CI 1.14至1.83）在内的ETI技能保持计划的可用性与进行ETI的信心独立相关。
对于大多数ELST来说，ETI是一种不常见的情况，近一半的受访者对进行此程序没有信心。由于对ETI的信心与定期模拟和手术室培训的可用性独立相关，纳入此类方法的ETI再教育标准化可能对院前救援人员有用。
