title: Knowledge, attitude, and practice regarding cricoid pressure of ED personnel at a large U.S. teaching hospital.
abstract: BACKGROUND
  Application of cricoid pressure (CP) is an important step during rapid sequence intubation. Previous surveys of anesthesia personnel showed a knowledge deficiency in the recommended level of cricoid force. There has been no previous attempt to assess the adequacy of knowledge of ED personnel in the application of CP. The objective of this study was to assess the theoretic knowledge of ED personnel about CP.
  
  
  METHODS
  We carried out a convenience sample of all ED personnel present at the morbidity and mortality meeting of a major US teaching hospital. A questionnaire-based survey was distributed; respondents were unaware of the questions or the nature of the survey before participating.
  
  
  RESULTS
  In total, 83 completed questionnaires were returned by 38 residents, 25 attending physicians, and 20 nurses. Many of the respondents knew the anatomic structure to which CP is applied. However, 24 respondents (14 nurses and 10 residents) thought that CP is applied to both the cricoid and thyroid cartilage. Interestingly, 70% of the nurses in this survey gave an incorrect response to the question on the anatomic localization of CP. Many of the participants in this survey either were unsure of the recommended amount of cricoid force in the asleep patient or quoted values that were too low. The majority of respondents rated their training in CP application as either poor or nonexistent. Most were able to name 2 contraindications to the application of CP.
  
  
  CONCLUSIONS
  The theoretic knowledge about CP is poor in this survey from staff at a major US teaching hospital. Poor theoretic knowledge could lead to poor technique in the application of CP. More specific education and training are needed to improve the clinical use of CP and possibly increase patient safety.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109-0048, USA. onafiu@med.umich.edu
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Stuart
authors.initials: S
authors.lastname: Bradin
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Tremper
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D003413:Cricoid Cartilage; D004635:Emergency Medicine / Q000193:education / Q000379:methods; D016529:Emergency Nursing / Q000193:education / Q000379:methods; D004638:Emergency Treatment / Q000379:methods* / Q000451:nursing; D007722:Health Knowledge, Attitudes, Practice; D006301:Health Services Needs and Demand; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D008505:Medical Staff, Hospital / Q000193:education / Q000523:psychology; D008824:Michigan; D015402:Nursing Education Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology; D011312:Pressure; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control; D011795:Surveys and Questionnaires