title: An assessment of paramedic performance during invasive airway management.
abstract: OBJECTIVE
  To assess the performance of paramedics, in a newly-initiated prehospital program, during invasive airway management.
  
  
  METHODS
  An audit of paramedic call reports for a 12-month period from January to December 1997 was performed. Call reports that documented invasive airway management were retrieved and relevant data were extracted using a preformulated data-entry form.
  
  
  RESULTS
  Paramedics attempted tracheal intubation in 453 patients and were successful in 408 (90.1%); 331 of the patients were in cardiopulmonary arrest with vital signs absent (VSA), 101 had medical emergencies, and 21 had trauma-related problems. In the VSA cohort, the tracheas of 96% of the patients were intubated successfully; 80.1% on the first attempt, 10.6% on the second, 4.5% on the third, and 0.9% after more than three attempts. In the medical cohort, the tracheas of 74.3% of the patients were intubated; 60.4% on the first attempt, 11.9% on the second, and 2.9% on the third. In the trauma cohort, 71.4% of the intubations were successful; 66.6% on the first attempt, 26.6% on the second, and 6.6% on the third. There was a difference (p < 0.001) in the incidence of successful intubations comparing the VSA cohort with the medical/trauma cohorts. There was also a difference (p < 0.001) between the success rate for nasal intubations (43 of 68, 63% of patients successfully intubated) and that for oral intubation (365 of 385, 94% of patients).
  
  
  CONCLUSIONS
  This study demonstrated a difference in the paramedics' success rates for tracheal intubation in VSA patients compared with those with preserved airway reflexes and a lower success rate for nasal vs oral tracheal intubation. These differences may be due to inadequate training, technical difficulties experienced in the field, or lack of sufficient exposure to medical/trauma scenarios to gain management experience. Future training to address these issues, both in the initial training phase and in the continuing education program, may be beneficial in improving performance.
authors.affiliation: Department of Anesthesiology, Ottawa Hospital, Ontario, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Rocca
authors.forename: E
authors.initials: E
authors.lastname: Crosby
authors.forename: J
authors.initials: J
authors.lastname: Maloney
authors.forename: G
authors.initials: G
authors.lastname: Bryson
mesh_terms: D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000592:standards*; D004650:Employee Performance Appraisal; D007442:Intubation, Intratracheal / Q000592:standards*; D017063:Outcome Assessment, Health Care