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February 18, 2010

Study: Experience matters in out-of-hospital intubation

Reuters Health Medical News

Intubation Study Overview

By Art Hsieh, EMS1 Editorial Advisor

This article provides support to the theory that the greater the proficiency of the clinician, the higher the survival rate of his or her patients compared to another practitioner with less proficiency. In the article, the researchers used the number of successful intubations performed by an EMS provider as a marker for proficiency. They find that the greater the number of successful intubations completed by the paramedic, the greater likelihood of a patient surviving from medical cardiac arrest and nonarrest situations. The study did not find that proficiency in intubation success was correlated to traumatic nonarrest patients.

A greater lesson to learn from these types of studies is to not correlate proficiency to experience. It can be easy to start down that slippery slope; an EMS provider with 10 years of experience is not necessarily the same person with one year of experience repeated ten times. The key is to achieve consistency in competency. You want to feel that you are learning from every patient encounter and from every technical procedure that you perform, even if the outcome is not what was desired.

Whenever possible, conduct a "reflection on action" after each case. Ask yourself, What went well? What could I have done better? If I compare this case to other similar cases, what was similar? What was different? As you inspect your thinking and reasoning processes, you might recognize that there were particulars about the case that would be worth remembering later on. For more serious or critical cases, consider doing this type of exercise with your partner or crew. It's good to get different opinions that allow everyone to see all sides.

As it is with these types of reports, recognize that you will want to look at the article directly. Review how the study was done, what its limitations were, and the validity of the conclusions drawn by the researchers.

NEW YORK — Experience matters for out-of-hospital intubation during a cardiac arrest or a medical illness, a new study shows, with patient survival linked to the volume of procedures the rescuer has done in the past.

In general, experience didn't seem to matter for out-of-hospital intubation of heart-beating trauma patients, but it did make a difference for certain subsets, its authors say.

According to the report in the February 8th online issue of the Annals of Emergency Medicine, cardiac arrest patients treated by a very experienced rescuer (>50 intubations) were 48% more likely to survive than those treated by a rescuer with low experience (1 to 10 intubations).

With medical non-arrest patients, the corresponding benefit was 55%.

To assess how out-of-hospital intubation experience affects patient outcomes, Dr. Henry E. Wang, from the University of Alabama at Birmingham, and colleagues analyzed data from Pennsylvania's statewide emergency medicine database.

Tracheal experience was defined as cumulative tracheal intubation from 2000 to 2005.

The study involved 4846 rescuers who intubated 33,117 patients between 2003 and 2005, including 21,753 in cardiac arrests, 8162 heart-beating patients with medical illnesses, and 3202 heart-beating trauma victims.

While the overall analysis showed no effect of rescuer experience on survival of trauma patients who were not in cardiac arrest, analysis by the type of emergency care did.

Specifically, the authors found that among trauma patients treated by non-urban emergency services, survival odds did improve as rescuer experience improved.

Related Resource:
Read the study abstract

Outside of urban areas, trauma patients treated by very experienced rescuers were nearly six times more likely to survive than those treated by rescuers with little experience.

Copyright 2010 Reuters Health

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