title: Out-of-Hospital Surgical Airway Management: Does Scope of Practice Equal Actual Practice?
abstract: BACKGROUND
  Pennsylvania, among other states, includes surgical airway management, or cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy.
  
  
  METHODS
  Eighty-six paramedics employed by four ground emergency medical services agencies completed a 22-question written survey that assessed surgical airway attempts, training, skills verification, and perceptions about procedural competency. Descriptive statistics were used to evaluate responses.
  
  
  RESULTS
  Only 20% (17/86, 95% CI [11-28%]) of paramedics had attempted cricothyrotomy, most (13/17 or 76%, 95% CI [53-90%]) of whom had greater than 10 years experience. Most subjects (63/86 or 73%, 95% CI [64-82%]) did not reply that they are well-trained to perform cricothyrotomy and less than half (34/86 or 40%, 95% CI [30-50%]) felt they could correctly perform cricothyrotomy on their first attempt. Among subjects with five or more years of experience, 39/70 (56%, 95% CI [44-68%]) reported 0-1 hours per year of practical cricothyrotomy training within the last five years. Half of the subjects who were able to recall (40/80, 50% 95% CI [39-61%]) reported having proficiency verification for cricothyrotomy within the past five years.
  
  
  CONCLUSIONS
  Paramedics surveyed indicated that cricothyrotomy is rarely performed, even among those with years of experience. Many paramedics felt that their training in this area is inadequate and did not feel confident to perform the procedure. Further study to determine whether to modify paramedic scope of practice and/or to develop improved educational and testing methods is warranted.
authors.affiliation: Albert Einstein Healthcare Network, Department of Emergency Medicine, Philadelphia, Pennsylvania.
authors.forename: Molly
authors.initials: M
authors.lastname: Furin
authors.affiliation: Albert Einstein Healthcare Network, Department of Emergency Medicine, Philadelphia, Pennsylvania.
authors.forename: Melissa
authors.initials: M
authors.lastname: Kohn
authors.affiliation: Albert Einstein Healthcare Network, Department of Emergency Medicine, Philadelphia, Pennsylvania.
authors.forename: Ryan
authors.initials: R
authors.lastname: Overberger
authors.affiliation: Philadelphia University, Department of Emergency Medicine, Philadelphia, Pennsylvania.
authors.forename: David
authors.initials: D
authors.lastname: Jaslow
mesh_terms: D058109:Airway Management / Q000379:methods* / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D004496:Education, Continuing; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education* / Q000592:standards; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D010414:Pennsylvania