Buaprasert Phudit, Sri-On Jiraporn, Sukhuntee Jareeda, Asawajaroenkul Ranu, Buanhong Onchuda, Khiaodee Trairat, Keetawattananon Worrapat, Tiyawat Gawin
Department of Emergency Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand.
Open Access Emerg Med. 2021 Jun 21;13:249-256. doi: 10.2147/OAEM.S311376. eCollection 2021.
Training on how to perform a prehospital extended focused assessment with sonography in trauma (EFAST) has resulted in improved outcomes for trauma patients in several countries. The result of previous studies showed good accuracy despite minimal training. However, data on the diagnostic accuracy among untrained paramedic students and the course length in middle-income countries is scarce. In Thailand, the current paramedic education does not include training on prehospital ultrasounds. In the present study, we aimed to investigate the diagnostic accuracy of EFAST among ultrasound-naïve paramedic students and factors that are associated with successful posttest training.
Final-year paramedic students attending a 4-year university program were included in this study. A 2-h didactic training session and 1-h hands-on workshop were led by experienced emergency physicians. The diagnostic indices for EFAST interpretation were obtained pretraining and posttraining. The participants' ultrasound image acquisition was also evaluated individually on a mannequin model using a standardized assessment tool.
In total, 47 paramedic students were voluntarily enrolled and underwent EFAST training. Of these participants, 31 (66%) reported having >1 year of experience in the prehospital field. Four were advanced emergency medical technicians before becoming paramedic students. The sensitivity, specificity, positive predictive value, and negative predictive value after training were 85.7% (95% CI, 81.5-89.3), 81.6% (95% CI, 74.2-87.6), 91.6% (95% CI, 87.9-94.4), and 71% (95% CI, 63.3-77.8), respectively. Previous prehospital experience was not associated with accuracy.
This study demonstrated that paramedic students in Thailand were able to achieve a competency comparable with that of other medical professionals in a simulated environment. The total 3 h training course was sufficient for them to acquire EFAST skills.
在多个国家，关于如何进行创伤院前超声重点评估（EFAST）的培训已使创伤患者的治疗效果得到改善。先前研究结果显示，即便培训极少，诊断准确性也很高。然而，在中等收入国家，未经培训的护理专业学生的诊断准确性及课程时长方面的数据却很匮乏。在泰国，目前的护理人员教育并不包括院前超声培训。在本研究中，我们旨在调查从未接触过超声的护理专业学生进行EFAST检查的诊断准确性以及与培训后测试成功相关的因素。
本研究纳入了参加四年制大学课程的护理专业四年级学生。由经验丰富的急诊医生进行为期2小时的理论培训课程和1小时的实践工作坊。在培训前和培训后获取EFAST解读的诊断指标。还使用标准化评估工具在人体模型上单独评估参与者的超声图像采集情况。
共有47名护理专业学生自愿报名参加EFAST培训。在这些参与者中，31人（66%）报告有超过1年的院前领域工作经验。4人在成为护理专业学生之前是高级急救医疗技术员。培训后的敏感性、特异性、阳性预测值和阴性预测值分别为85.7%（95%CI，81.5 - 89.3）、81.6%（95%CI，74.2 - 87.6）、91.6%（95%CI，87.9 - 94.4）和71%（95%CI，63.3 - 77.8）。先前的院前经验与准确性无关。
本研究表明，泰国的护理专业学生在模拟环境中能够达到与其他医学专业人员相当的能力水平。总共3小时的培训课程足以让他们掌握EFAST技能。
