Duncan Leah, Falahat Michael, Hartpence Connor, Ruddle Deryk S, Ofei-Dodoo Samuel
Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS.
Family Medicine Residency Program at Ascension Via Christi Hospital.
Kans J Med. 2023 Feb 21;16(1):53-55. doi: 10.17161/kjm.vol16.18938. eCollection 2023.
When emergency medical services (EMS) personnel respond to emergencies, the decisions they make often can mean life or death for the patient. This is especially true in the case of advanced airway management. Protocols are set in place to ensure that the least invasive airway management techniques are used initially before more invasive techniques. The purpose of this study was to determine how often EMS personnel followed this protocol, while adequately achieving the goals of appropriate oxygenation and ventilation.
This retrospective chart review was approved by the Institutional Review Board of the University of Kansas Medical Center. The authors reviewed the Wichita/Sedgewick County EMS system for cases during 2017 in which patients required airway support. We examined de-identified data to determine if invasive methods were applied in sequence. Cohen's kappa coefficient (κ) and immersion-crystallization approach were used to analyze the data.
A total of 279 cases were identified in which EMS personnel used advanced airway management techniques. In 90% (n = 251) of cases, less invasive techniques were not used prior to more invasive techniques and in 80% (n = 222) of cases, the more invasive technique was used alone. A dirty airway was the most common reason for the EMS personnel's choice of using more invasive approaches in achieving the goals of appropriate oxygenation and ventilation.
Our data showed that EMS personnel in Sedgwick County/Wichita, Kansas often deviated from the advanced airway management protocols when caring for patients in need of respiratory intervention. Dirty airway was the main reason for using a more invasive approach in achieving the goals of appropriate oxygenation and ventilation. It is important to understand reasons why deviations in protocol were occurring to ensure that current protocols, documentation, and training practices are effective in producing the best possible patient outcomes.
当紧急医疗服务（EMS）人员对紧急情况做出响应时，他们所做的决定往往关乎患者的生死。在高级气道管理方面尤其如此。已制定了相关规程，以确保在采用侵入性更强的技术之前，首先使用侵入性最小的气道管理技术。本研究的目的是确定EMS人员遵循该规程的频率，同时充分实现适当氧合和通气的目标。
这项回顾性图表审查获得了堪萨斯大学医学中心机构审查委员会的批准。作者回顾了威奇托/塞奇威克县EMS系统在2017年期间患者需要气道支持的病例。我们检查了去识别化的数据，以确定侵入性方法是否按顺序应用。使用科恩kappa系数（κ）和沉浸-结晶法对数据进行分析。
共识别出279例EMS人员使用高级气道管理技术的病例。在90%（n = 251）的病例中，在采用侵入性更强的技术之前未使用侵入性较小的技术，在80%（n = 222）的病例中，仅使用了侵入性更强的技术。气道不干净是EMS人员在实现适当氧合和通气目标时选择使用侵入性更强方法的最常见原因。
我们的数据表明，堪萨斯州塞奇威克县/威奇托的EMS人员在护理需要呼吸干预的患者时，经常偏离高级气道管理规程。气道不干净是在实现适当氧合和通气目标时使用侵入性更强方法的主要原因。了解规程偏差发生的原因很重要，以确保当前的规程、文件记录和培训实践能够有效地产生最佳的患者治疗效果。
