From the Paramedicine Program (A.M.), Griffith University School of Medicine, Gold Coast, Queensland; Holsworth Research Initiative (J.R.H.), La Trobe University, Bendigo, Victoria; Paramedicine Program (S.S.), Charles Sturt University, Port Macquarie, New South Wales; Paramedicine Program (A.H.), Australian Catholic University, Brisbane, Queensland; Charles Sturt University (C.S.), School of Biomedical Sciences, Bathurst; and Charles Sturt University (J.W.), School of Biomedical Sciences, Orange, New South Wales, Australia.
Simul Healthc. 2022 Aug 1;17(4):234-241. doi: 10.1097/SIH.0000000000000613. Epub 2021 Nov 3.
Paramedic duties include assessing, treating, and maneuvering patients in physically challenging environments. Whether clinical skills and patient care are affected by these occupational demands is unknown. High-fidelity simulation affords the opportunity to study this in a controlled setting.
Using a randomized crossover design, 11 regional paramedicine students and graduates (mean ± SD age = 23 ± 2 years) completed two, 20-minute high-fidelity simulations that included cardiopulmonary resuscitation (CPR) immediately after either an acute bout of occupational physical activity (OPA) or a rest period (REST). Heart rate, respiratory rate, and mean arterial pressure were measured throughout. Clinical performance was scored using the Global Rating Score and a patient care record. Measures of CPR efficacy were recorded in the manikin.
There were no significant differences in Global Rating Score ( P = 0.07, ES = 0.03) or CPR efficacy between conditions. Patient care record accuracy was higher after the OPA versus REST simulations (mean ± SD = 61.8 ± 12.6% vs. 55.5 ± 12.0%, P = 0.03, ES = 0.5). Mean heart rate was higher during OPA simulations versus REST simulations (121 ± 14 vs. 84 ± 9 beats per minute, P < 0.01, ES = 3.1), as was mean respiratory rate (19 ± 3 vs. 16 ± 3 breaths per minute, P < 0.01, ES = 1.0). Mean arterial pressure was higher for OPA versus REST at simulation start (105 ± 11.3 vs. 95.8 ± 11.8 mm Hg, P = 0.01, Effect Size = 0.8), although not different after simulation.
Paramedicine students including recent graduates performed as well, or better, in a simulated clinical scenario immediately after occupation-specific acute physical exertion compared with a REST, despite higher physiological exertion. Whether this is the case for more experienced but potentially less physically fit paramedics in the workforce warrants investigation.
急救员的职责包括在身体挑战的环境中评估、治疗和搬运患者。目前尚不清楚这些职业需求是否会影响临床技能和患者护理。高保真模拟为在受控环境中研究这一点提供了机会。
采用随机交叉设计，11 名地区急救医学学生和毕业生（平均 ± 标准差年龄=23 ± 2 岁）完成了两次 20 分钟的高保真模拟，其中包括心肺复苏（CPR），在急性职业体力活动（OPA）后或休息期（REST）后立即进行。整个过程中测量心率、呼吸频率和平均动脉压。使用全球评分和患者护理记录对临床绩效进行评分。记录模拟人身上的 CPR 效果测量值。
在全球评分（P = 0.07，ES = 0.03）或 CPR 效果方面，两种情况下没有显着差异。OPA 模拟后患者护理记录的准确性高于 REST 模拟（平均值 ± 标准差=61.8 ± 12.6% vs. 55.5 ± 12.0%，P = 0.03，ES = 0.5）。OPA 模拟时的平均心率高于 REST 模拟（121 ± 14 与 84 ± 9 次/分钟，P < 0.01，ES = 3.1），呼吸频率也是如此（19 ± 3 与 16 ± 3 次/分钟，P < 0.01，ES = 1.0）。OPA 时的平均动脉压高于 REST，模拟开始时为 105 ± 11.3 与 95.8 ± 11.8 mmHg，P = 0.01，效应量= 0.8），但模拟后没有差异。
包括最近毕业的学生在内的急救医学学生在进行特定职业的急性体力活动后，在模拟临床场景中的表现与 REST 一样好，或者更好，尽管生理上的消耗更大。在劳动力中，经验更丰富但身体状况可能较差的急救人员是否也是如此，这值得进一步调查。
