Guiding Emergency Treatment With Extended Focused Assessment With Sonography in Trauma by Emergency Responders (GET eFASTER).

OBJECTIVE: Prehospital medicine has struggled to manage critical patients without the resources available to hospital-based teams. Point-of-care ultrasound could bridge this resource gap by providing critical insight into the pathology of trauma patients. This study aimed to determine if early positive extended focused assessment with sonography in trauma (eFAST) identification would lead to improved patient outcomes. METHODS: This is a prospective observational trial that took place from February 1, 2019, to August 13, 2021. Paramedics, with no prior ultrasound experience, at a single ground ambulance agency were trained in obtaining and interpretating eFAST examinations. RESULTS: Thirty-seven paramedics were trained and performed a total of 502 eFAST examinations with a total correct interpretation rate of 97.35%. There was a sensitivity of 30.0%/75.0%, specificity of 98.75%/94.05%, a positive predictive value of 33.33%/37.5%, a negative predictive value of 98.55%/98.75%, a positive likelihood ratio of 24.05/12.6, and a negative likelihood ratio of 0.71/0.27 for all exam/patient-only scans. The time spent on scene for eFAST and non-eFAST calls was not significantly different (F3, 2,512 = 2.59, P = .051, η2 = .003). CONCLUSION: Although we were able to show successful training and interpretation of eFAST with paramedics, given the low prevalence of disease, our study did not show eFAST use improving patient outcome. However, the large likelihood ratio suggests its benefit may lie with appropriate trauma resource utilization.

High Risk, Low Volume: Evaluation of a Reusable Cricothyrotomy Model in a Paramedic Difficult Airway Training Course.

OBJECTIVE: Cricothyrotomy is rarely performed by prehospital providers. Developing this low-frequency, high-acuity skill and maintaining competence is difficult; thus, using a realistic training model is paramount to successful training. The aim of this study was to evaluate a 3-dimensional-printed bleeding cricothyrotomy trainer in increasing paramedic comfort level and procedural competence as defined by completing the procedure unassisted without error. METHODS: Model implementation took place during mandatory biannual difficult airway training courses for all paramedics employed by a hospital-based ambulance agency. Participating paramedics performed 3 surgical cricothyrotomies using the bleeding trainer and subsequently completed an anonymous written survey that evaluated the comfort level of providers in performing a surgical cricothyrotomy both before and after training using a 10-point visual analog scale. RESULTS: Forty-four paramedics participated in the difficult airway training course. All (44/44) completed the postsurvey. Participants noted that their procedural skill comfort level improved after the training took place (average improvement of 3 ± 1.93). Participants also indicated that the high-fidelity trainer played a significant role in their increased comfort after skills training. CONCLUSION: The bleeding cricothyrotomy model evaluated provides a high-fidelity, cost-effective means of teaching and maintaining a rare, lifesaving skill that is rarely performed in the field.

Beyond Tools: Continuous High-Fidelity Training at the Center of Successful First-Pass Intubation in Ground Emergency Medical Services.

OBJECTIVE: Increased emphasis on the use of video laryngoscopy in emergency medical services has potentially caused providers to forfeit the skills required to perform direct laryngoscopy. The purpose of this study was to determine if the introduction of a continuous high-fidelity training program improves first-pass intubation success in a non-rapid sequence induction ground-based emergency medical services agency with an established video laryngoscopy program. METHODS: This is a retrospective analysis of quality improvement data of advanced airway management performed by an ambulance service between 2012 and 2019. A mandatory biannual high-fidelity simulation training curriculum was introduced at the beginning of 2017. RESULTS: A total of 459 patients underwent intubation attempts during the 7-year study period. First-pass intubation success improved from 57.6% to 81.4%, an improvement of 23.8% (95% confidence interval [CI], 15.4-31.5; P < .001), and overall intubation success improved from 77% to 91%, an improvement of 14.1% (95% CI, 7.3-20.3; P < .001). The average number of intubation attempts per patient decreased by 0.19 (95% CI, 0.09-0.29; P < .0003). The mean time of arrival to intubation time increased by 2.21 minutes (95% CI, 0.84-3.58; P = .0016). CONCLUSION: Implementation of a high-fidelity airway training program is associated with improvements in overall endotracheal intubation and first-pass endotracheal intubation success rates in all adult patient categories.