Critical care paramedics' experiences of performing an emergency scalpel cricothyroidotomy: a qualitative study.

Introduction: A scalpel cricothyroidotomy or front of neck access (FONA) is a rarely performed part of airway management for when other steps have failed and the patient cannot be intubated or ventilated. Increasingly advanced and specialist paramedics are being trained to perform this procedure within the pre-hospital environment. Methods: Advanced and specialist paramedics within a UK ambulance service that had performed a FONA were invited to participate in this qualitative research. Semi-structured interviews were used to gather information on the participants' experiences. This information underwent thematic analysis to develop codes which were then grouped into themes. Results: Seven participants were interviewed between December 2020 and January 2021. Three main themes were identified: the procedure, isolation and training. The main complications described were bleeding in excess of expectations, moving structures, surgical emphysema and a false track. Conclusion: Complications appeared common; training to perform a FONA should include complications and an approach to their management similar to other airway management procedures. Isolation was a common theme within this study, however remote support from a peer appeared beneficial.

Presence of a pre-hospital enhanced care team reduces on scene time and improves triage compliance for stab trauma.

BACKGROUND: A reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage. This study investigated the relationship between presence of pre-hospital enhanced care teams (ECT) (Critical Care Paramedics (CCPS) or Helicopter Emergency Medical Service (HEMS)), on the scene time and triage compliance, of penetrating trauma patients in a UK ambulance service. The primary outcome was whether scene time reduces when an ECT is present. A secondary outcome was whether the presence of an ECT improved compliance with the trust's Major Trauma Decision Tree (MTDT). METHODS: All suspected penetrating trauma incidents involving a patient's torso were identified from the Trust's computer-aided dispatch (CAD) system between 31st March 2017 and 1st April 2018. Only patients who sustained central penetrating trauma were included. Any incidents involving firearms were excluded due to the prolonged times that can be involved when waiting for specialist police units. Data relevant to scene time for each eligible incident were retrieved, along with the presence or absence of an ECT. The results were analysed to identify trends in the scene times and compliance with the MTDT. RESULTS: One hundred seventy-one patients met the inclusion criteria, with 165 having complete data. The presence of an ECT improved the median on-scene time in central stabbing by 38% (29m50s vs. 19m0s, p = 0.03). The compliance with the trust's MTDT increased dramatically when an ECT is present (81% vs. 37%, odds ratio 7.59, 95% CI, 3.70-15.37, p < 0.0001). CONCLUSIONS: The presence of an ECT at a central stabbing incident significantly improved the scene time and triage compliance with a MTDT. Ambulance services should consider routine activation of ECTs to such incidents, with subsequent service evaluation to monitor patient outcomes. Ambulance services should continue to strive to reduce scene times in the context of central penetrating trauma.