Improved prehospital pediatric ALS care after an EMT-paramedic clinical training course.
The objective was to determine the association between the performance rates of pediatric advanced life-support procedures, intubation and vascular access, by emergency medicine technician-paramedics (EMT-P), and introduction of an EMT-P pediatric advanced life support (PALS) clinical course. Prehospital EMT-P care records from January 1990 to December 1991 were retrospectively reviewed to determine endotracheal intubation and vascular access performance rates. These rates were compared with intubation and vascular access performance rates by EMT-Ps from January 1983 to June 1985. In 1986, an EMT-P PALS clinical course was introduced that included rotations during which an EMT-P trainee performed endotracheal intubation of children, under the supervision of a pediatric anesthesiologist, and vascular access, under the supervision of pediatric emergency medicine nurses and physicians. The trainees and all active EMT-Ps were taught the intraosseous infusion procedure. During January 1990 to December 1991, 193 children received prehospital endotracheal intubation attempts and 167 (87%) were intubated. Intubation performance rates for 90 children younger than 18 months of age was 90% and was 83% for 103 children > or = 18 months of age. Vascular access, intravenous or intraosseous, was established in 130 (73%) of the children; no attempt was made in 14 children. The vascular access performance rate was 64% for children younger than 18 months of age and 79% for children > or = 18 months old. Intubation performance rates of EMT-Ps before the EMT-P PALS clinical course (January 1983 to June 1985) were 48% for children younger than 18 months of age and 85% for children > or = 18 months old.(ABSTRACT TRUNCATED AT 250 WORDS)
Losek
J D
JD
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Szewczuga
D
D
Glaeser
P W
PW
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017148:Infusions, Intraosseous / Q000592:standards; D007262:Infusions, Intravenous / Q000592:standards; D007318:Inservice Training / Q000592:standards*; D007442:Intubation, Intratracheal / Q000592:standards; D008020:Life Support Care / Q000592:standards*; D008297:Male; D015397:Program Evaluation; D012189:Retrospective Studies; D014922:Wisconsin