Bradley J S, Billows G L, Olinger M L, Boha S P, Cordell W H, Nelson D R
Emergency Medicine and Trauma Center, Methodist Hospital, Indianapolis, IN, USA.
Ann Emerg Med. 1998 Jul;32(1):26-32. doi: 10.1016/s0196-0644(98)70095-2.
To determine whether basic emergency medical technicians (EMT-B) can perform prehospital oral endotracheal intubation with success rates comparable to those of paramedics.
This was a nonrandomized, controlled trial using historical controls. Seven basic life support emergency medical services systems in six counties and their corresponding emergency departments in rural Indiana participated. Eighty-seven full-time EMTs with no prior or concurrent paramedic training volunteered for intubation training. Apneic prehospital patients aged 16 years or older without an active gag reflex or massive facial trauma were eligible for intubation and study enrollment. The EMTs completed a 9-hour didactic and airway manikin training course in direct laryngoscopic endotracheal intubation. The course was adapted from the national paramedic curriculum.
Thirty-four (39%) of the EMT-Bs attempted to intubate 57 eligible patients. In 49.1% of these patients, successful endotracheal tube placement was confirmed by the receiving physician (95% confidence interval, 36.4% to 61.9%); in contrast, the prehospital intubation success rates from three previous studies of manikin-trained paramedics ranged from 76.9% to 90.6% (P < .001). Complications included five (9%) inadvertent extubations, two endotracheal tube cuff ruptures, two prolonged intubation attempts, and one mainstem bronchus intubation. There were no unrecognized esophageal intubations. Two of the seven EMS agencies did not report any intubation data.
Rural EMTs with didactic and airway manikin training failed to achieve prehospital intubation success rates comparable to those of paramedic controls. Possible explanations include training deficiencies, poor skill transference from manikin to human intubation, infrequent intubation experiences, and inconsistent supervision.
确定基础急救医疗技术员（EMT - B）能否在院前进行口腔气管插管，其成功率是否与护理人员相当。
这是一项使用历史对照的非随机对照试验。印第安纳州农村六个县的七个基础生命支持急救医疗服务系统及其相应的急诊科参与了研究。87名此前未接受过护理人员培训且未同时接受护理人员培训的全职EMT自愿参加插管培训。年龄在16岁及以上、无主动咽反射或严重面部创伤的院前呼吸暂停患者符合插管及研究入组条件。EMT完成了为期9小时的关于直接喉镜气管插管的理论教学和气道模型培训课程。该课程改编自国家护理人员课程。
34名（39%）EMT - B尝试为57名符合条件的患者插管。其中49.1%的患者经接收医生确认气管插管成功（95%置信区间，36.4%至61.9%）；相比之下，此前三项针对接受模型培训的护理人员的院前插管成功率在76.9%至90.6%之间（P <.001）。并发症包括5例（9%）意外拔管、2例气管插管套囊破裂、2例插管尝试时间延长以及1例主支气管插管。未出现未被识别的食管插管情况。七个急救医疗服务机构中有两个未报告任何插管数据。
接受理论教学和气道模型培训的农村EMT未能取得与护理人员对照组相当的院前插管成功率。可能的原因包括培训不足、从模型到人体插管的技能转移不佳、插管经验不频繁以及监督不一致。
