title: Expertise in prehospital endotracheal intubation by emergency medicine physicians-Comparing 'proficient performers' and 'experts'.
abstract: BACKGROUND
  Training requirements to perform safe prehospital endotracheal intubation (ETI) are not clearly known. This study aimed to determine differences in ETI performance between 'proficient performers' and 'experts' according to the Dreyfus & Dreyfus framework of expertise. As a model for 'proficient performers' EMS physicians with a clinical background in internal medicine were compared to EMS physicians with a background in anaesthesiology as a model for 'experts'.
  
  
  METHODS
  Over a one-year period all ETIs performed by the EMS physicians of our institution were prospectively evaluated. 'Proficient performers' and 'experts' were compared regarding incidence of difficult ETI, ability to predict difficult ETI, and decision for ETI.
  
  
  RESULTS
  Mean years of professional experience were similar between the physician groups, but the median ETI experience differed significantly with 18/year for 'proficients' and 304/year for 'experts' (p<0.001). 'Proficient performers' intubated 130 of their 2170 treated patients (6.0%), while 'experts' did so in 146 of 1809 cases (8.1%, p=0.01 for difference). The incidence of difficult ETI was 17.7% for 'proficient performers', and 8.9% for 'experts' (p<0.05). In 4 cases ETI was impossible, all managed by 'proficient performers', but all patients could be ventilated sufficiently. Unexpected difficult ETI occurred in 6.1% for 'proficient performers', and 2.0% for 'experts' (p=0.08).
  
  
  CONCLUSIONS
  In a prehospital setting 'expert' status was associated with a significantly lower incidence of 'difficult ETI' and a higher proportion of ETI decisions. In addition, ability to predict difficult ETI was higher, although non-significant. There was no difference in the incidence of impossible ventilation.
authors: Dept. of Anaesthesiology and Perioperative Intensive Care Medicine, Benjamin Franklin Medical Center of Charité, University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. jan.breckwoldt@charite.de
authors: Jan
authors: J
authors: Breckwoldt
authors: Sebastian
authors: S
authors: Klemstein
authors: Bergit
authors: B
authors: Brunne
authors: Luise
authors: L
authors: Schnitzer
authors: Hans-Richard
authors: HR
authors: Arntz
authors: Hans-Christian
authors: HC
authors: Mochmann
mesh_terms: D058109:Airway Management / Q000592:standards / Q000639:trends; D002983:Clinical Competence; D015331:Cohort Studies; D004502:Education, Medical, Continuing; D004632:Emergency Medical Services / Q000592:standards* / Q000639:trends; D004635:Emergency Medicine / Q000193:education* / Q000379:methods; D005260:Female; D005858:Germany; D006801:Humans; D007442:Intubation, Intratracheal / Q000592:standards* / Q000639:trends; D008297:Male; D011361:Professional Competence; D011446:Prospective Studies; D011786:Quality Control; D017751:Safety Management