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Paramedic perceptions of challenges in out-of-hospital endotracheal intubation.

机译：医护人员对院外气管插管挑战的认识。

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OBJECTIVE: Paramedics often perform endotracheal intubation (ETI), insertion of a breathing tube, on critically ill out-of-hospital patients. Recent studies highlight important paramedic ETI shortcomings including adverse events, errors, and poor outcomes resulting from this procedure. Little is known about workforce perceptions of these events. We sought to identify paramedic and physician perceptions regarding the challenges and pitfalls of out-of-hospital ETI. METHODS: We conducted a qualitative study involving paramedic focus groups sessions and individual interviews with Emergency Medical Services (EMS) physician medical directors. We recorded and transcribed all sessions. We used inductive theory construction to examine, organize, and classify thematic patterns. RESULTS: Fourteen paramedics and 6 physicians participated. Although paramedics and physicians recognized problems with paramedic ETI, all participants strongly felt that paramedics should continue to perform the procedure. Physicians andparamedics disagreed about the ability of paramedics to perform neuromuscular blockade-assisted intubation. Both groups identified aspects of paramedic education, skills acquisition, and maintenance as core issues. Participants also identified broader factors about the structure of emergency services, the role of the medical director, and workforce culture and professionalism. CONCLUSION: Paramedics and EMS physicians attribute paramedic ETI performance to a myriad of factors involving EMS education, organization, oversight, retention, and professionalism. Efforts to improve ETI must include strategies to address multiple aspects of EMS operations and culture.
机译：目的：医护人员经常对重症院外患者进行气管插管（ETI），插入呼吸管。最近的研究强调了辅助医疗ETI的重要缺陷，包括不良事件，错误以及该程序导致的不良结果。员工对这些事件的看法知之甚少。我们试图确定护理人员和医生对院外ETI的挑战和陷阱的看法。方法：我们进行了定性研究，涉及护理人员焦点小组会议和对紧急医疗服务（EMS）医师医疗主任的个人访谈。我们记录并抄录了所有会议。我们使用归纳理论构建来检查，组织和分类主题模式。结果：14位护理人员和6位医生参加了会议。尽管护理人员和医生认识到护理人员ETI的问题，但所有参与者都强烈认为护理人员应继续执行该程序。医师和医护人员不同意医护人员进行神经肌肉阻滞辅助插管的能力。两组都将护理人员教育，技能获取和维护方面视为核心问题。与会者还确定了有关紧急服务结构，医务主任的角色以及员工文化和专业精神的更广泛因素。结论：护理人员和EMS医生将护理人员的ETI表现归因于涉及EMS教育，组织，监督，保留和专业性的众多因素。改善ETI的努力必须包括解决EMS运营和文化多个方面的策略。

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