Comparison of tidal volumes, minute ventilation, and respiratory frequencies delivered by paramedic and respiratory care students with pocket mask versus demand valve.
BACKGROUND
The importance of establishing the airway and providing ventilation during resuscitation is well recognized; however, the effectiveness of demand-valve ventilation has not been fully addressed.


METHODS
We examined the differences in respiratory frequency (f), tidal volume (VT), and minute ventilation (VE) achieved by 15 emergency medical technicians (EMT) in a paramedic training course (EMT-4) and 16 second-year respiratory care students (RC) when ventilating a mannequin by three different methods: Laerdal pocket mask, a mask designed for mouth-to-mask ventilation (Method I), demand valve with one hand (Method II), and demand valve with two hands (Method III).


RESULTS
The RC f was much higher for all three methods compared to the EMT-4. The EMT-4 demonstrated larger VT for each method compared to the RC. The RC only achieved acceptable VT with Method III. The EMT-4 and RC demonstrated statistically significant differences in VE between each method. However, the clinical importance of these differences for EMT-4 is negligible. Although the mean values indicated achievement of minimum VTS by the EMT-4 with the pocket mask, 40% were unable to do so at 1 minute and 60% at 5 minutes. A great difference was seen in VE produced by RC with Method I at both 1 and 5 minutes vs Methods II and III.


CONCLUSIONS
EMT-4 appear to have superior ventilation skills compared to RC. Superior performance skills may be related to (1) different instructional methodologies, (2) effects of various amounts of experience in ventilating actual victims, and (3) greater familiarity of EMTs with the demand valve. As a consequence of this study, we are re-evaluating the instructional methodology used in our programs; we encourage other programs to do the same. We recommend that EMS providers and hospitals consider changing to an acceptable alternate mask in light of these and previous data.
Fluck
R R
RR
SUNY-Health Science Center, Syracuse.
Sorbello
J G
JG
D003162:Competency-Based Education / Q000592:standards; D004634:Emergency Medical Technicians / Q000193:education*; D005069:Evaluation Studies as Topic; D006801:Humans; D008348:Manikins; D008397:Masks / Q000592:standards; D009518:New York; D012138:Respiratory Therapy / Q000193:education* / Q000592:standards; D012151:Resuscitation / Q000295:instrumentation; D012122:Ventilators, Mechanical / Q000592:standards*