title: Pediatric Airway Management and Prehospital Patient Safety: Results of a National Delphi Survey by the Children's Safety Initiative-Emergency Medical Services for Children.
abstract: OBJECTIVE
  The objective of this study was to determine what aspects of prehospital pediatric airway management may contribute to patient safety events.
  
  
  METHODS
  We conducted a 3-phase Delphi survey in prehospital professionals across the United States to identify potential contributors to patient safety events. Respondents ranked how likely factors were to contribute on a 9-point Likert-type scale and were allowed to elaborate through open-ended questions. Analysis was conducted using a mixed-methods approach, including Likert-type responses and open-ended questions which were analyzed for specific themes.
  
  
  RESULTS
  All 3 phases of the survey were completed by 492 participants; 50.8% of respondents were paramedics, 22% were emergency medical technician-basics/first responders, and 11.4% were physicians. Seventy-five percent identified lack of experience with advanced airway management, and 44% identified medical decision making regarding airway interventions as highly likely to lead to safety events. Within the domain of technical skills, advanced airway management was ranked in the top 3 contributors to safety events by 71% of participants, and bag-mask ventilation by 18%. Qualitative analysis of questions within the domains of equipment and technical skills identified endotracheal intubation as the top contributor to safety events, with bag-mask ventilation second. In the domains of assessment and decision making, respiratory assessment and knowing when to perform an advanced airway were ranked most highly.
  
  
  CONCLUSIONS
  This national Delphi survey identified lack of experience with pediatric airway management and challenges in decision making in advanced airway management as high risk for safety events, with endotracheal intubation as the most likely of these.
authors.affiliation: From the *Department of Emergency Medicine, Oregon Health & Science University, Portland, OR; †Division of Pediatric Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; ‡Department of Psychology, Portland State University, Portland; §Oregon Health Authority, Salem; ∥Departments of Obstetrics & Gynecology, and **Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hansen
authors.forename: Garth
authors.initials: G
authors.lastname: Meckler
authors.forename: Kerth
authors.initials: K
authors.lastname: OʼBrien
authors.forename: Phillip
authors.initials: P
authors.lastname: Engle
authors.forename: Caitlin
authors.initials: C
authors.lastname: Dickinson
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dickinson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.forename: William
authors.initials: W
authors.lastname: Lambert
authors.forename: Erika
authors.initials: E
authors.lastname: Cottrell
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
mesh_terms: D058109:Airway Management / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D002983:Clinical Competence; D003697:Delphi Technique; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D006282:Health Personnel; D006801:Humans; D061214:Patient Safety / Q000706:statistics & numerical data*; D010372:Pediatrics; D014481:United States