Pollock M J, Brown L H, Dunn K A
Department of Emergency Medicine, East Carolina University School of Medicine, Greenville, North Carolina 27858, USA.
Prehosp Emerg Care. 1997 Oct-Dec;1(4):263-8. doi: 10.1080/10903129708958821.
The National Standard Curriculum for paramedics is currently being revised. There is little scientific evidence of what does and what does not work in prehospital care, and of whether the National Standard Curriculum prepares paramedics for the field. To provide some basis for the current revisions to the National Standard Curriculum, the authors determined which prehospital skills are perceived by paramedics to be the most important, and whether the emphasis placed on those skills during initial and continuing education programs corresponds with the perceived importance.
Surveys listing 21 paramedic skills were mailed to the directors of 41 EMS agencies who agreed to participate in the study. The directors distributed the surveys to 1,364 paramedics affiliated with their organizations. The participants were asked to rate the importance of each skill, and the emphasis placed on each skill during their initial and continuing education. Skills were ranked on a scale of 0 to 4, with 0 representing no importance or emphasis, and 4 representing the most possible importance or emphasis.
Six-hundred of the 1,364 (44%) surveys were returned. Respondents had a mean of 9.9 +/- 5.6 years of EMS experience, and 5.4 +/- 4.0 years of experience as paramedics. The three skills ranked highest in importance were: 1) endotracheal intubation; 2) defibrillation; and 3) assessment. Importance in prehospital care was ranked equal to or higher than emphasis in both initial and continuing education for all skills except splinting and urinary catheterization, which received higher rankings for emphasis in initial education. Emphasis in initial education equaled or exceeded the emphasis in continuing education for all skills except intraosseous infusion.
The perceived importance of most prehospital skills is very high, and exceeds the emphasis placed on those skills during both initial and continuing education programs. These findings have implications for medical directors, EMS instructors, and persons involved with the revision of the National Standard Curriculum.
护理人员国家标准课程目前正在修订。关于院前急救中哪些措施有效、哪些无效，以及国家标准课程是否能让护理人员胜任实际工作，几乎没有科学依据。为给当前国家标准课程的修订提供一些依据，作者确定了护理人员认为最重要的院前急救技能，以及在初始教育和继续教育项目中对这些技能的重视程度是否与认知的重要性相符。
向同意参与研究的41个急救医疗服务机构的负责人邮寄了列出21项护理人员技能的调查问卷。负责人将问卷分发给其所在机构的1364名护理人员。参与者被要求对每项技能的重要性以及在初始教育和继续教育中对每项技能的重视程度进行评分。技能的评分范围为0至4分，0分表示不重要或未受重视，4分表示最重要或最受重视。
1364份调查问卷中有600份（44%）被收回。受访者的急救医疗服务平均经验为9.9±5.6年，护理人员平均经验为5.4±4.0年。重要性排名最高的三项技能是：1）气管插管；2）除颤；3）评估。除夹板固定和导尿术外，所有技能在院前急救中的重要性排名均等于或高于初始教育和继续教育中的重视程度，夹板固定和导尿术在初始教育中的重视程度排名更高。除骨内输液外所有技能在初始教育中的重视程度均等于或超过继续教育中的重视程度。
大多数院前急救技能的认知重要性非常高，且超过了初始教育和继续教育项目中对这些技能的重视程度。这些发现对医疗主任、急救医疗服务教员以及参与国家标准课程修订的人员具有启示意义。
