Pilbery Richard
Yorkshire Ambulance Service NHS Trust.
Br Paramed J. 2018 Sep 1;3(2):8-15. doi: 10.29045/14784726.2018.09.3.2.7.
Endotracheal intubation has been considered a core skill for all paramedics since the inception of the profession in the 1970s, and continues to be taught within the majority of pre-registration paramedic training programmes. However, the standards of both training and assessment of competence in intubation vary considerably between institutions; this has been compounded by reduced opportunities for supervised clinical practice within the operating theatre environment.The College of Paramedics' Airway Working Group commissioned a rapid evidence review, to inform a consensus statement on paramedic intubation, with the research question: How do paramedics learn and maintain the skill of tracheal intubation?
Rapid evidence reviews are literature reviews that use methods to accelerate or streamline the traditional systematic review process. Randomised controlled trials, quasi-randomised controlled trials, prospective and retrospective observational studies, systematic reviews and qualitative studies, published from 1970 onwards, were all eligible for inclusion. The search was restricted to paramedics/paramedic students and learning/maintaining the skill of tracheal intubation.
A comprehensive search of CINAHL, MEDLINE and Google Scholar was undertaken. Ten papers were classed as sufficiently relevant for inclusion. They identified that there is no clear definition of a paramedic having 'learnt' the skill of intubation. Suggested measures include first-pass success of 90% for pre-hospital intubation, or a range of measures, such as intubation success and complication rates, laryngoscopy technique and decision-making. Intubation training should use a range of modalities, including didactic lectures, videos and practical sessions on multiple types of airway manikins. Supervision by experienced faculty is required.Little is known about how paramedics maintain their skill in intubation, given the lack of clinical opportunity. Yearly skills retraining can help, and can be enhanced by demonstrations/lectures from experienced faculty.
Further research is needed to understand how paramedics maintain their skill in intubation, given the limited opportunities to use the skill in a clinical setting and lack of opportunities with UK ambulance services for retraining.
自20世纪70年代护理人员职业诞生以来，气管插管一直被视为所有护理人员的一项核心技能，并且在大多数预注册护理人员培训项目中仍在教授。然而，插管培训和能力评估的标准在不同机构之间差异很大；手术室环境中监督临床实践的机会减少，这使情况更加复杂。护理人员学院气道工作组委托进行了一项快速证据审查，以形成一份关于护理人员插管的共识声明，研究问题为：护理人员如何学习和保持气管插管技能？
快速证据审查是一种文献综述，使用各种方法来加速或简化传统的系统综述过程。1970年以后发表的随机对照试验、半随机对照试验、前瞻性和回顾性观察性研究、系统综述和定性研究均符合纳入标准。搜索仅限于护理人员/护理专业学生以及学习/保持气管插管技能。
对护理学与健康领域数据库（CINAHL）、医学文献数据库（MEDLINE）和谷歌学术进行了全面搜索。十篇论文被认为足够相关而被纳入。它们指出，对于护理人员“学会”插管技能没有明确的定义。建议的衡量标准包括院前插管首次成功率达到90%，或者一系列指标，如插管成功率和并发症发生率、喉镜检查技术和决策能力。插管培训应采用多种方式，包括理论讲座、视频以及在多种类型气道模型上进行的实践课程。需要有经验的教员进行监督。鉴于缺乏临床机会，关于护理人员如何保持插管技能知之甚少。每年进行技能再培训可能会有帮助，经验丰富的教员进行示范/讲座可以加强培训效果。
鉴于在临床环境中使用该技能的机会有限，且英国救护车服务部门缺乏再培训机会，需要进一步研究以了解护理人员如何保持插管技能。
