title: Feasibility of basic emergency medical technicians to perform selected advanced life support interventions.
abstract: OBJECTIVE
  Emergency medical technician-basic (EMT-B) providers often provide the initial care to victims of out-of-hospital cardiac arrest. While automated external defibrillators enable EMT-B providers to deliver rescue shocks, patients in cardiac arrest may require additional interventions that EMT-B providers may not presently deliver. We sought to evaluate the feasibility of training EMT-B providers to provide additional cardiac resuscitation procedures using the laryngeal mask airway (LMA) and intraosseous (IO) access.
  
  
  METHODS
  In this prospective observational study, we trained 18 EMT-B providers to use the LMA and IO drill (EZ-IO) in a three-hour educational session. Working in two-person teams, the rescuers performed a simulated ventricular fibrillation resuscitation. We evaluated placement success as well as elapsed time to placement of the LMA and EZ-IO.
  
  
  RESULTS
  EMT-B providers successfully placed the LMA in 14 of 18 scenarios (78%; 95% confidence interval, 52% to 94%), with a mean of two attempts for placement. Subjects successfully placed the EZ-IO in 17 of 18 scenarios (94%; 95% confidence interval, 73% to 100%), all on the first attempt. The median time to LMA placement following the third shock was 109 seconds (interquartile range, 58-158) and the median time to EZ-IO placement was 72 seconds (interquartile range, 50-93) after LMA placement.
  
  
  CONCLUSIONS
  EMT-B providers demonstrated moderate success in performing advanced-level cardiac resuscitation interventions. These observations suggest potential for expanding the role of basic-level rescuers in cardiopulmonary resuscitation.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. guyettefx@upmc.edu
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.forename: Thomas
authors.initials: T
authors.lastname: Platt
authors.forename: Brian
authors.initials: B
authors.lastname: Suffoletto
authors.forename: David
authors.initials: D
authors.lastname: Hostler
authors.forename: Henry E
authors.initials: HE
authors.lastname: Wang
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000193:education*; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D017214:Laryngeal Masks; D008297:Male; D016544:Patient Simulation; D011446:Prospective Studies