Paramedic training for proficient prehospital endotracheal intubation.
BACKGROUND
Emergency airway management is an important component of resuscitation of critically ill patients. Multiple studies demonstrate variable endotracheal intubation (ETI) success by prehospital providers. Data describing how many ETI training experiences are required to achieve high success rates are sparse.


OBJECTIVE
To describe the relationship between the number of prehospital ETI experiences and the likelihood of success on subsequent ETI and to specifically look at uncomplicated first-pass ETI in a university-based training program with substantial resources.


METHODS
We conducted a secondary analysis of a prospectively collected cohort of paramedic student prehospital intubation attempts. Data collected on prehospital ETIs included indication, induction agents, number of direct laryngoscopy attempts, and advanced airway procedures performed. We used multivariable generalized estimating equations (GEE) analysis to determine the effect of cumulative ETI experience on first-pass and overall ETI success rates.


RESULTS
Over a period of three years, 56 paramedic students attempted 576 prehospital ETIs. The odds of overall ETI success were associated with cumulative ETI experience (odds ratio [OR] 1.097 per encounter, 95% confidence interval [CI] = 1.026-1.173, p = 0.006). The odds of first-pass ETI success were associated with cumulative ETI experience (OR 1.061 per encounter, 95% CI = 1.014-1.109, p = 0.009).


CONCLUSIONS
In a training program with substantial clinical opportunities and resources, increased ETI success rates were associated with increasing clinical exposure. However, first-pass placement of the ETT with a high success rate requires high numbers of ETI training experiences that may exceed the number available in many training programs.
Warner
Keir J
KJ
Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington 98104, USA. keirw@u.washington.edu
Carlbom
David
D
Cooke
Colin R
CR
Bulger
Eileen M
EM
Copass
Michael K
MK
Sharar
Sam R
SR
D002170:Canada; D002983:Clinical Competence; D015331:Cohort Studies; D004493:Education / Q000458:organization & administration; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians / Q000193:education*; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards*; D011446:Prospective Studies