cross sectional study on the acceptance of pre-hospital continuous positive airway pressure ventilation among ambulance paramedic in an urban emergency medical service system in a developing country

To assess the acceptance among the developing country urban paramedics towards pre-hospital continuous positive airway pressure [CPAP] ventilation. A cross-sectional prospective study was conducted among the ambulance paramedics working at the pre-hospital care unit of the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia from March 2012 to August 2012 on ambulance paramedics. Questionnaires were used to assess their experience, knowledge, and perception, while their competencies were assessed using an Objective Structured Clinical Examination by 2 independent-calibrated raters on the use of the Boussignac CPAP system. Twenty-six ambulance paramedics qualified for this study with an average work experience of 5.59 +/- 3.53 years. A total of 76.9% had no formal training for CPAP during their study years. Knowledge of CPAP apparatus-arrangement sequence scored as 88.5% correct, while 96.2% scored `Good` to `Very-good` in the ability to diagnose conditions that warrant its use. A total of 76.9% were confident to monitor patients on CPAP, and 61.5% in applying the device. However, only 53.8% were confident to start the CPAP, and 38.5% to troubleshoot if any problem arose. For perceptions, 96.2% felt it was easy to learn CPAP, while 88.5% felt that paramedics could use it without supervision, and 80.8% felt that it should not be confined to the Emergency Department setting. A total of 96.1% were competent in CPAP application. Developing country urban ambulance paramedics possessed adequate knowledge, positive attitudes, and demonstrated good CPAP application skills. However, lack of confidence towards decision to initiate and troubleshoot of potential complications were the main obstacles hindering its use

Improving door-to-doctor and door-to-analgesia time in a tertiary teaching hospital emergency department through a novel 'Red Box' system

To evaluate the effectiveness of a new patient flow system, 'The Red Box' on the quality of patient care in respect of the time taken for the care to be delivered to the patient. A pre-post study was conducted looking at the door-to-doctor [DTD] and door-to-analgesia [DTA] times for cases presenting to the Emergency Department [ED] of a tertiary teaching hospital 'The National University of Malaysia Medical Center' between the periods of July and September 2005 against July and September 2008. Demographic data, ED presentation time, time seen by first doctor, and time first analgesia given were collected in both periods and analyzed. A total of 1,000 cases were enrolled. Group A [pre-Red Box] and group B [post-Red Box] comprised 500 cases each. The mean DTD time for group A was 29 minutes [SD +/- 3 minutes] and for group B was 3 minutes [SD +/- 1 minute], with a 98.8% reduction [p<0.001]. For DTA time, group A recorded a mean of 46 minutes [SD +/- 3 minutes], and group B recorded a mean of 9 minutes [SD +/- 2 minutes], an 80.4% reduction [p<0.001]. The implementation of a red box system improved the quality of emergency patient care in the ED of a tertiary teaching hospital as evidenced by significant reductions in DTD and DTA time