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Implementing In Situ Simulation of High-Risk/Low-Volume Emergency Situations for Pediatric Transport Teams 为儿科运输团队实施高风险/低容量紧急情况的现场模拟
Q3 Nursing Pub Date : 2025-08-29 DOI: 10.1016/j.amj.2025.07.005
Jacob N. Qurashi MD, MPH, CFRN, C-NPT , Jennifer Shelby BS, RN , Aleta Kay Martin BSRC, RRT-NPS, CHSOS, CHSE , Archana V. Dhar MD, FAAP

Objective

Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is a rare phenomenon (0.33% and 0.18%, respectively). The ability to maintain high-quality manual CPR in a moving vehicle with limited personnel and equipment impacts its effectiveness. There are limited data about neonatal and pediatric transport teams training staff on resuscitation during transport. This study evaluated the feasibility of in situ, simulation-based CPR training for a tertiary hospital’s pediatric-neonatal transport team to better replicate real-world constraints.

Methods

Critical care teams—each comprising a nurse, respiratory therapist, and paramedic—completed an in situ simulation aboard a moving ambulance. Generally, 18 participants formed 6 teams, managing a hypoxia-induced bradycardia scenario requiring CPR. Operational metrics, teamwork, and resource management were evaluated. Post-simulation, participants completed a deidentified survey.

Results

The mean participant age was 41.7 (standard deviation [SD] = 8.29) years with 8.9 (SD = 6.19) years of transport experience; 27% had not previously performed CPR during transport. Median time for bag-valve-mask initiation was 0.47 (SD = 0.41) minutes, CPR start was 0.62 (SD = 0.65) minutes, epinephrine administration was 1.25 (SD = 1.61) minutes, and contact with medical command was 1.40 (SD = 0.76) minutes. Post-simulation, 89% preferred in situ training over traditional simulation. Confidence improvements in prehospital care, logistics, and team resource management were negatively correlated with years of transport experience (P < .05).

Conclusion

In situ simulation enhances training fidelity, improves provider confidence, and may be especially valuable for onboarding new transport team members, supporting safer patient care during transport.
目的在新生儿和儿童转运过程中进行心肺复苏(CPR)是一种罕见的现象(分别为0.33%和0.18%)。在人员和设备有限的移动车辆中维持高质量手动心肺复苏术的能力影响其有效性。关于新生儿和儿科运输团队在运输过程中对工作人员进行复苏培训的数据有限。本研究评估了一家三级医院的儿科-新生儿转运团队在现场进行基于模拟的心肺复苏术培训的可行性,以更好地复制现实世界的限制。方法重症监护小组——每个小组由一名护士、呼吸治疗师和护理人员组成——在一辆移动的救护车上完成了现场模拟。一般来说,18名参与者组成6个小组,处理缺氧引起的心动过缓情况,需要心肺复苏术。对操作指标、团队合作和资源管理进行了评估。模拟结束后,参与者完成了一份匿名调查。结果参与者平均年龄为41.7岁(标准差[SD] = 8.29),交通经验8.9年(SD = 6.19);27%的患者在转运过程中未做过心肺复苏术。气囊-瓣膜-面罩启动的中位时间为0.47 (SD = 0.41)分钟,心肺复苏术开始的中位时间为0.62 (SD = 0.65)分钟,肾上腺素给药的中位时间为1.25 (SD = 1.61)分钟,与医疗指挥部联系的中位时间为1.40 (SD = 0.76)分钟。与传统的模拟相比,89%的人更喜欢现场培训。院前护理、物流和团队资源管理方面的信心改善与运输经验年数呈负相关(P < 0.05)。结论原位模拟提高了培训的保真度,提高了医护人员的信心,对新运输团队成员的培训尤其有价值,支持运输过程中更安全的患者护理。
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引用次数: 0
Prehospital Whole Blood in Trauma—A Scoping Review 院前全血在创伤中的应用综述
Q3 Nursing Pub Date : 2025-08-27 DOI: 10.1016/j.amj.2025.07.009
Catherine M. Kuza MD, FASA, FCCM , Andrea H. Denton MILS , Stephanie Streit MD , Joseph Rossano MD, MS, FAAP, FACC , Sarita Chung MD , Joshua M. Tobin MD, MSc

Objective

The management of blood resuscitation in hemorrhagic shock in trauma patients is evolving. Prehospital whole blood (WB) re-emerged into practice to correct coagulopathy, replace blood loss, and improve survival. This scoping review evaluated the use of prehospital WB in adult trauma patients with hemorrhagic shock.

Methods

We performed a literature search using PubMed, Embase, and CINAHL, including studies published between January 2015 and March 2024.

Results

A total of 10 studies (n = 9,621) were reviewed. Studies included 2 case series, 1 prospective randomized controlled trial, and 7 observational studies. Eight studies evaluated civilian patient populations (1 non-trauma, 7 trauma) and 2 were military (1 trauma, 1 mixed trauma/non-trauma).

Conclusion

Prehospital WB programs are feasible and relatively safe. They may be beneficial in trauma and other populations; however, the reviewed studies are poor in quality and suboptimal in study design. Thus, definitive recommendations cannot be made. Additional studies are required.
目的创伤失血性休克患者的血液复苏处理不断发展。院前全血(WB)重新出现在纠正凝血功能障碍,补充失血,提高生存率的实践中。本综述评估院前WB在成人创伤失血性休克患者中的应用。方法使用PubMed、Embase和CINAHL进行文献检索,包括2015年1月至2024年3月间发表的研究。结果共纳入10项研究(n = 9621)。研究包括2个病例系列、1个前瞻性随机对照试验和7个观察性研究。8项研究评估了平民患者群体(1例非创伤,7例创伤),2项研究评估了军人患者群体(1例创伤,1例混合创伤/非创伤)。结论院前WB方案是可行且相对安全的。它们可能对创伤患者和其他人群有益;然而,所回顾的研究质量较差,研究设计欠佳。因此,不能提出明确的建议。需要进行更多的研究。
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引用次数: 0
Considerations for Regional Anaesthesia in the Prehospital Environment 院前环境中区域麻醉的考虑
Q3 Nursing Pub Date : 2025-08-27 DOI: 10.1016/j.amj.2025.07.007
Laurence J. Lewandowski-Barrett MBBS , Chris King MBBCHIR
Regional anesthesia has become an established and effective form of in-hospital pain relief, offering significant benefits than systemic analgesia. Its application in the prehospital setting remains limited and underused. The prehospital environment poses many different challenges compared with in-hospital care, and, therefore, practice cannot necessarily be directly translated. This review explores the current prehospital applications of regional anesthesia, perceived advantages, and indications. It evaluates contraindications and complications, in particular the risk of masking compartment syndrome and iatrogenic nerve injury in the traumatically injured patient, and the implications for prolongation of scene time. Finally, it addresses some of the practical, logistical, safety, and training considerations for implementation.
区域麻醉已成为一种建立和有效的院内镇痛形式,提供比全身镇痛显著的好处。它在院前环境中的应用仍然有限和未充分利用。与院内护理相比,院前环境带来了许多不同的挑战,因此,实践不一定直接转化。本文综述了目前院前区域麻醉的应用、优势和适应症。它评估了禁忌症和并发症,特别是创伤性损伤患者的掩蔽室综合征和医源性神经损伤的风险,以及对延长现场时间的影响。最后,讨论了实现过程中的一些实际、后勤、安全和培训方面的考虑。
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引用次数: 0
Debriefing in Physician-Staffed Helicopter Emergency Medical Services: A Quality Improvement Study 医师直升飞机紧急医疗服务的报告:质量改进研究
Q3 Nursing Pub Date : 2025-08-26 DOI: 10.1016/j.amj.2025.06.013
Elisa Willoch , Christian Tappert MD, PhD , Andreas Krüger MD, PhD , Helge Haugland MD, PhD

Objective

In Norway, physician-staffed helicopter emergency medical services (HEMS) provide critical care for patients needing advanced prehospital treatment. To measure the quality of care, 15 quality indicators (QIs) are monitored, including the occurrence of “debriefing,” a discussion aimed at promoting communication, team learning, and safety. At Trondheim HEMS, the “debriefing” quality indicator has been identified as underperforming compared with other Nordic HEMS bases, suggesting missed opportunities for communication and learning. Given that human error is a major factor in adverse events both in medicine and aviation, enhancing debriefing practices may be crucial for improving quality and safety. The objective of this study was to assess the impact of two interventions on debriefing rates.

Methods

In this prospective quality improvement study at Trondheim HEMS, HEMS crews recorded debriefing occurrences in a QI database. The primary measure was the debriefing rate per shift, analyzed using statistical process control. Before the interventions, baseline data were collected in a 2-month period. The first intervention involved placing reminder posters in high-traffic areas. The second intervention provided feedback through a continuously displayed chart of debriefing performance, allowing crews to compare their rates to overall trends. Each intervention lasted 2 months, followed by washout periods where interventions were removed to evaluate sustained effects.

Results

The first intervention had no significant improvement in debriefing rates. Notable variation between physicians was observed during the first intervention and washout period. The second intervention stabilized the process and increased the average debriefing rate from 58% in the baseline period to 71% during the intervention. This continued during the following washout period.

Conclusion

Prominent variation in performance between physicians indicates a lack of framework for debriefing to occur. The increased debriefing rate is still not ideal. Further approaches are needed to improve debriefing practices in the service.
目的在挪威,配备医生的直升机紧急医疗服务(HEMS)为需要先进院前治疗的患者提供重症护理。为了测量护理的质量,15个质量指标(QIs)被监控,包括“汇报”的发生,这是一种旨在促进沟通、团队学习和安全的讨论。在特隆赫姆医疗卫生服务中心,与北欧其他医疗卫生服务基地相比,“汇报”质量指标表现不佳,表明错过了交流和学习的机会。鉴于人为错误是医疗和航空不良事件的主要因素,加强汇报做法可能对提高质量和安全至关重要。本研究的目的是评估两种干预措施对述职率的影响。方法:在特隆赫姆医疗服务中心进行的前瞻性质量改进研究中,医疗服务中心工作人员在质量质量数据库中记录了汇报情况。主要指标是每班的汇报率,使用统计过程控制进行分析。在干预之前,基线数据在2个月期间收集。第一项干预措施是在交通繁忙的地区张贴提醒海报。第二个干预措施通过连续显示的汇报表现图表提供反馈,使工作人员能够将他们的费率与总体趋势进行比较。每次干预持续2个月,随后是洗脱期,在此期间取消干预以评估持续效果。结果第一次干预对述情率无显著改善。在第一次干预和洗脱期,医生之间观察到显著的差异。第二次干预稳定了这一过程,并将平均汇报率从基线期的58%提高到干预期间的71%。这种情况在接下来的洗脱期继续存在。结论医生之间表现的显著差异表明缺乏进行汇报的框架。增加的汇报率仍然不理想。需要采取进一步的办法来改进军中的汇报做法。
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引用次数: 0
Aeromed: Navigating India’s Skyways to Save Lives 航空:导航印度的空中道路以拯救生命
Q3 Nursing Pub Date : 2025-08-25 DOI: 10.1016/j.amj.2025.07.003
Tejinder Singh Lakhwani PhD, Yerasani Sinjana PhD
This case study evaluates the strategic growth, operational challenges, and decision-making complexities faced by Aeromed International Rescue Services Pvt. Ltd., India's leading air ambulance provider. Established in 2013 by Dr. Amod Jaiswal, Aeromed has expanded from a single-charter operation to conducting >300 missions annually, serving patients across India and neighboring countries. The case opens with a real-time scenario involving an extracorporeal membrane oxygenation (ECMO)-supported emergency transfer from Guwahati to Chennai, framing Aeromed’s commitment to its core value: “Critical Care. Anywhere. Anytime.” The narrative traces Aeromed’s evolution from initial market entry, expansion into tier 2 and tier 3 cities, technological innovations such as ECMO and neonatal air transport, and resilience during the coronavirus disease 2019 pandemic. At the center of the case is a strategic dilemma in 2024, where Aeromed must choose 1 of the following 3 growth paths: invest in artificial intelligence-driven triage and dispatch platforms, deepen regional access through private helipad infrastructure, or scale nationally and internationally through a licensing/franchise model. Through analytical frameworks such as SWOT, SALT, and PESTLE and exhibits including cost analyses and service data, learners are encouraged to critically evaluate Aeromed’s mission, scalability, and financial sustainability.
本案例研究评估了印度领先的空中救护提供商Aeromed International Rescue Services Pvt. Ltd.所面临的战略增长、运营挑战和决策复杂性。由Amod Jaiswal博士于2013年创立的Aeromed已经从单一包机业务扩展到每年执行300次任务,为印度和邻国的患者提供服务。该案例以一个实时场景开场,涉及由体外膜氧合(ECMO)支持的从古瓦哈蒂到金奈的紧急转移,这体现了Aeromed对其核心价值的承诺:“重症监护”。任何地方。任何时候都可以。”叙述了航空公司从最初的市场进入,扩展到二三线城市,ECMO和新生儿航空运输等技术创新,以及2019年冠状病毒病大流行期间的应变能力的演变。案例的核心是2024年的战略困境,Aeromed必须在以下三种增长路径中选择一种:投资人工智能驱动的分类和调度平台,通过私人直升机停机坪基础设施深化区域准入,或通过许可/特许经营模式在国内和国际上扩张。通过SWOT、SALT和PESTLE等分析框架以及包括成本分析和服务数据在内的展品,鼓励学习者批判性地评估Aeromed的使命、可扩展性和财务可持续性。
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引用次数: 0
Point of Care Laboratory Testing and its Effect on Confidence in Clinical Decision Making 护理点实验室检测及其对临床决策信心的影响
Q3 Nursing Pub Date : 2025-08-21 DOI: 10.1016/j.amj.2025.06.011
Karen R. Bourdon RN, BSN , Chase J. Canter BS, FP-C

Background

Performing and interpreting point of care laboratory testing is an advanced skill that requires additional training outside of a critical care transport providers primary education. Providers must be knowledgeable and confident in their ability to perform all clinical tasks to exude competence. Limited evaluations of self-efficacy and perceived confidence exist in the CCT, point-of-care testing realm.

Objective

This study aims to evaluate perceived confidence in clinical decision making of providers utilizing point-of-care testing (POCT) in the CCT setting.

Methods

A cross-sectional survey was administered to providers of a CLIA licensed critical care transport team. The survey was of electronic format, queried demographics and subjective concepts using a psychometric response scale. The survey was anonymous and voluntary. Both critical care nurses/paramedics of this CLIA licensed agency, who operate under an EM, FAEMS medical director, who is the certified laboratory director, were eligible to participate in the survey. Providers not employed at the agency prior to receiving CLIA licensure were excluded.

Results

Survey participants included critical care nurses (70%) and critical care paramedics (30%), all whom (n=10) self-identified as board certified through BCEN or IBSC. Experience in critical care transport varied finding 0-3 years (40%), 4-7 years (30%), and 10+ years (30%). All survey participants agreed or strongly agreed with concepts regarding POCT and its positive effect on patient safety and quality of care with recent laboratory results. Likewise, all participants agreed or strongly agreed their clinical acumen increased as did their confidence interpreting laboratory results because of required quarterly education. Participants found the availability of POCT increased their confidence in clinical decision making as well as made clinical decision making easier. 30% of providers attested to questioning the appropriateness of the care they provided prior to having POCT availability with 50% answering neutral and 20% disagreeing to that statement.

Conclusion

This survey highlights the positive impact of POCT on CCT providers confidence in clinical decision making. The results demonstrate that POCT enhances clinical acumen and fosters greater confidence among providers when interpreting laboratory results, while improving patient safety and care quality. The findings suggest that ongoing education and access to POCT contributes to the providers sense of subjective competence, making clinical decisions more streamlined. However, a portion of providers expressed uncertainty in the appropriateness of care before the availability of POCT, indicating areas for further investigation into the impact of POCT on patient safety and clinical outcomes. This survey underscores the importance of continued tra
执行和解释护理点实验室测试是一项高级技能,需要在重症监护运输提供者的小学教育之外进行额外的培训。提供者必须对他们执行所有临床任务的能力有知识和信心,以表现出能力。有限的评估自我效能感和感知信心存在于CCT,点护理测试领域。目的本研究旨在评估在CCT环境下使用即时护理测试(POCT)的提供者在临床决策中的感知信心。方法对CLIA许可的重症监护运输团队的提供者进行横断面调查。该调查采用电子形式,使用心理测量反应量表询问人口统计数据和主观概念。这项调查是匿名和自愿的。该CLIA持牌机构的危重病护理护士/辅助医务人员均有资格参加调查,他们在EM、FAEMS医务主任(注册实验室主任)的管理下运作。在获得CLIA许可之前未受雇于该机构的供应商被排除在外。结果调查参与者包括重症护理护士(70%)和重症护理护理人员(30%),所有(n=10)自认为是通过BCEN或IBSC认证的董事会成员。重症监护转运经验各不相同,0-3年(40%)、4-7年(30%)和10年以上(30%)。根据最近的实验室结果,所有调查参与者都同意或强烈同意POCT的概念及其对患者安全和护理质量的积极影响。同样,所有的参与者都同意或强烈同意他们的临床敏锐度提高了,他们解释实验室结果的信心也增加了,因为需要每季度进行一次教育。参与者发现POCT的可用性增加了他们对临床决策的信心,并使临床决策更容易。30%的医疗服务提供者证实在有POCT可用性之前质疑他们提供的护理的适当性,50%的人回答中立,20%的人不同意这一说法。结论本研究突出了POCT对CCT提供者临床决策信心的积极影响。结果表明,POCT提高了临床敏锐度,并在解释实验室结果时增强了提供者的信心,同时提高了患者的安全性和护理质量。研究结果表明,持续的教育和获得POCT有助于提供者的主观能力感,使临床决策更加精简。然而,一部分医疗服务提供者表示,在POCT可用之前,他们对护理的适当性不确定,这表明POCT对患者安全和临床结果的影响有待进一步调查。这项调查强调了在有条件现金转移治疗环境中持续培训和支持的重要性,以优化POCT的使用,改善患者的预后和安全性。随着POCT在CCT中的持续增长,进一步的研究应该探讨POCT对临床结果和提供者行为的影响。
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引用次数: 0
Comparing Workloads of Night Shift and Day Shift Workers in Critical Care Ground Transport 重症监护地面运输中夜班与白班工作负荷的比较
Q3 Nursing Pub Date : 2025-08-21 DOI: 10.1016/j.amj.2025.06.012
Zane Z. Grimm RN, BSN, CFRN , Nolan R. Suchora RN, BSN, CFRN

Background

With the expansion of critical care ground transportation call volumes will increase. The increase in volume as a trend in healthcare is shifted towards daylight shift workers compared to their counterparts. Having the added aspect of transport distance in interfacility transportation adds an increased workload with increasing distances.

Objective

We aim to examine the relationship between distance traveled and patient volume to determine the correlation in workload between night shift workers and day shift workers in the interfacility critical care transport setting. The value of this information may be utilized to determine appropriate staffing levels and/or the need for crew downtime.

Methods

Utilizing quantitative data including call volume and Total transport mileage from a critical care transport service.

Results

A total of 1293 patients were treated and transported 78,838.78 miles via critical care ground ambulance. Day shift workers transported 701 or 54% of the total patients. These patients were transported a total of 41,427.06 miles averaging 59.09 miles per patient. Night shift workers transported 592 patients or 46% of the total patients. These patients were transported a total of 36,298.42 miles averaging 61.31 miles per patient. Dayshift workers averaged 1.92 transports per shift compared to the 1.62 transports per shift of the night shift workers. The night shift workers, however, averaged 37.8 miles per shift compared to the 30.7 miles of day shift workers.

Conclusion

Night shift workers in critical care ground transportation travel more miles with a lesser volume compared to their counterparts in the daytime who transport a higher quantity with lesser mileage, resulting in equal workloads.
随着重症监护的扩大,地面运输呼叫量将会增加。与同行相比,随着医疗保健趋势的增加,数量转向了白班工人。在设施间运输中,随着距离的增加,运输距离的增加也增加了工作量。目的探讨医院间重症监护转运中夜班和白班工作人员工作量的关系。这些信息的价值可用于确定适当的人员配备水平和/或机组人员停机时间的需要。方法利用定量数据,包括呼叫量和总运输里程从一个重症监护运输服务。结果重症救护地面救护车共救治1293例患者,运送78,838.78英里。白班工人运送了701名患者,占总数的54%。这些患者总共被运送了41,427.06英里,平均每位患者59.09英里。夜班工人运送了592名患者,占患者总数的46%。这些患者总共被运送了36,298.42英里,平均每位患者61.31英里。白班工人平均每班搬运1.92次,夜班工人平均每班搬运1.62次。然而,夜班工人平均每班行驶37.8英里,白班工人平均每班行驶30.7英里。结论与白班重症监护地面运输人员相比,夜班重症监护地面运输人员的运输里程多,运输量少,运输量大,两者的工作量相等。
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引用次数: 0
General Information 一般信息
Q3 Nursing Pub Date : 2025-08-21 DOI: 10.1016/S1067-991X(25)00247-0
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引用次数: 0
Simulation-Based Rapid Plan-Do-Study Act Cycles for Airway Management Checklist Development and Quality Improvement 基于模拟的气道管理检查表开发和质量改进的快速计划-执行-研究行动周期
Q3 Nursing Pub Date : 2025-08-21 DOI: 10.1016/j.amj.2025.06.010
Jesse Conterato , Ryan K. Newbury , Andrew D. Cathers , Craig F. Tschautscher , Brittney Bernardoni

Objective

Intubation of critically ill patients is a high stakes procedure. Across the healthcare industry, procedural checklists have been recognized as a successful tool for improving patient safety and outcomes. While intubation checklists may improve patient outcomes and reduce complications, the content comprising a checklist is not standardized and varies widely. This novel approach to intubation checklist development embeds quality improvement Plan-Do-Study-Act (PDSA) cycles within healthcare team-based intubation simulations to efficiently elicit feedback and garner buy-in from relevant stakeholders.

Methods

Plan: A multidisciplinary group of critical care transport (CCT) providers drafted the initial intubation checklist using a modified Delphi process reviewing checklists from external CCT transport programs.

Do

This draft checklist was then trialed in two simulation-based educational sessions for CCT providers at a single institution. During each session, four groups of CCT providers rotated through an intubation workshop. During each workshop, providers utilized the intubation checklist in three brief simulated intubation scenarios of escalating complexity.

Study

After each intubation scenario, the participants provided semi-structured feedback regarding content and use of the checklist.

Act

Between intubation workshops, this feedback informed serial modifications to the checklist. This iterative process of refining, trialing, and soliciting feedback repeated over eight cycles.

Results

Feedback from providers addressed multiple components of the checklist, including both its functionality and clinical implications. Changes were made to simplify wording in order to improve clarity and length of the checklist. Participant feedback also informed resequencing of checklist items to produce a more natural flow within clinical scenarios. The visual characteristics of the checklist, including color and font, were modified to improve visual tracking and flow. The clinical and operational implications of including certain checklist items were discussed, including the use of specific equipment and medications.

Conclusion

Integrating quality improvement processes into educational simulation facilitated efficient intubation checklist development. Utilizing PDSA cycles embedded within simulation, rapid iterative adjustments were made over two 3 hour sessions based on end-user feedback from CCT providers. Additionally, soliciting provider feedback promoted team engagement and buy-in for future implementation of this intubation checklist in patient care.
目的危重病人的气管插管是一项高风险的手术。在整个医疗保健行业,程序检查清单已被公认为提高患者安全性和结果的成功工具。虽然插管检查表可以改善患者的预后并减少并发症,但检查表的内容并不标准化,而且差异很大。这种新颖的插管检查表开发方法在基于医疗团队的插管模拟中嵌入了质量改进计划-执行-研究-行动(PDSA)循环,以有效地获得反馈并获得相关利益相关者的支持。方法:一个由重症监护转运(CCT)提供者组成的多学科小组使用改进的德尔菲过程审查外部CCT转运项目的清单,起草了初始插管清单。该清单草案随后在同一机构的CCT提供者的两次模拟教育会议中进行了试验。在每次会议期间,四组有条件现金转移治疗提供者轮流参加插管研讨会。在每次研讨会期间,提供者在三个简单的模拟插管场景中使用插管检查表。研究在每个插管场景后,参与者提供关于检查表内容和使用的半结构化反馈。在插管研讨会期间,这些反馈通知了对检查表的一系列修改。这个细化、试验和征求反馈的迭代过程重复了八个周期。结果:来自供应商的反馈涉及检查表的多个组成部分,包括其功能和临床意义。修改是为了简化措辞,以提高清单的清晰度和长度。参与者的反馈也告知了重新排序清单项目,以在临床场景中产生更自然的流程。修改检查表的视觉特征,包括颜色和字体,以改善视觉跟踪和流程。讨论了列入某些核对表项目的临床和业务影响,包括具体设备和药物的使用。结论将质量改进流程融入教学模拟中,有助于有效地制定插管检查表。利用模拟中嵌入的PDSA周期,根据CCT供应商的最终用户反馈,在两个3小时的会议中进行快速迭代调整。此外,征求提供者的反馈促进了团队的参与,并为将来在患者护理中实施该插管检查表提供了支持。
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引用次数: 0
Description of Critical Care Transport First Pass Endotracheal Intubation Failures 重症监护运输第一次气管插管失败的描述
Q3 Nursing Pub Date : 2025-08-21 DOI: 10.1016/j.amj.2025.06.005
Abby L. Blake DO , Kalle J. Fjeld MD , Pietra Oelke , Matthew A. Roginski MD, MPH , Patricia R. Atchinson DO

Objective

Describe first pass endotracheal intubation failures as well as associated patient and procedural factors in a rural critical care transport service.

Methods

Retrospective chart review of patients ≥18 years intubated by a mixed rotor wing and ground critical care transport service (nurse-paramedic teams) between January 2017 and June 2024. Direct and video laryngoscopy was available during the study period. The primary outcome was incidence of first pass failure. One intubation attempt was defined as the insertion of the laryngoscopy past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt. Secondary outcomes included reason for failure as well as association of patient and procedural factors with failure.

Results

There were 389 intubations performed with 53 (13.6%) first pass failures. The most common reasons for failure were hypoxia (7, 13.2%), contamination (22, 41.5%), and anatomy (32, 60.4%). Multiple reasons for failure were cited in 15 first pass intubation attempts (28.3%). There was an association between first pass failure and predicted difficult airway OR 2.66 (95% CI 1.47-4.80). There was no association between operator type and first pass success rate. There was no association of first pass failure with bougie use, direct laryngoscopy, location of intubation, or pre-intubation hypoxia.

Conclusion

First pass failure occurred in approximately one in eight intubations. This descriptive analysis of intubation failure provides a starting point for further quality improvement work. Future work should incorporate systematic review of intubations with objective data (i.e. video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe performance errors and allow for iterative quality improvement in a learning healthcare system.
目的探讨农村危重病转运服务中首次气管插管失败及相关的患者和程序因素。方法回顾性分析2017年1月至2024年6月期间由混合旋翼和地面重症监护运输服务(护理-护理团队)插管的≥18岁患者。研究期间可进行直接喉镜检查和视频喉镜检查。主要观察指标为首次通过失败的发生率。一次插管尝试被定义为喉镜穿过嘴唇插入。第一次插管失败被定义为在第一次插管尝试时未能将气管内插管通过声带。次要结局包括失败的原因以及患者和手术因素与失败的关系。结果共行插管389例,首次插管失败53例(13.6%)。最常见的失败原因是缺氧(7.13.2%)、污染(22.41.5%)和解剖(32.60.4%)。首次插管失败的15例(28.3%)有多种原因。首次通过失败与预测气道困难OR之间存在关联,OR为2.66 (95% CI 1.47-4.80)。操作者类型与首次通过成功率之间没有关联。首次通过失败与布基使用、直接喉镜检查、插管位置或插管前缺氧没有关联。结论首次插管失败发生率约为1 / 8。这种对插管失败的描述性分析为进一步的质量改进工作提供了一个起点。未来的工作应结合客观数据(如视频记录喉镜)插管的系统回顾,并使用气道衰竭分类法来描述性能错误,并允许在学习医疗保健系统中迭代改进质量。
{"title":"Description of Critical Care Transport First Pass Endotracheal Intubation Failures","authors":"Abby L. Blake DO ,&nbsp;Kalle J. Fjeld MD ,&nbsp;Pietra Oelke ,&nbsp;Matthew A. Roginski MD, MPH ,&nbsp;Patricia R. Atchinson DO","doi":"10.1016/j.amj.2025.06.005","DOIUrl":"10.1016/j.amj.2025.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>Describe first pass endotracheal intubation failures as well as associated patient and procedural factors in a rural critical care transport service.</div></div><div><h3>Methods</h3><div>Retrospective chart review of patients ≥18 years intubated by a mixed rotor wing and ground critical care transport service (nurse-paramedic teams) between January 2017 and June 2024. Direct and video laryngoscopy was available during the study period. The primary outcome was incidence of first pass failure. One intubation attempt was defined as the insertion of the laryngoscopy past the lips. First pass failure was defined as failure to place an endotracheal tube through the vocal cords on the first intubation attempt. Secondary outcomes included reason for failure as well as association of patient and procedural factors with failure.</div></div><div><h3>Results</h3><div>There were 389 intubations performed with 53 (13.6%) first pass failures. The most common reasons for failure were hypoxia (7, 13.2%), contamination (22, 41.5%), and anatomy (32, 60.4%). Multiple reasons for failure were cited in 15 first pass intubation attempts (28.3%). There was an association between first pass failure and predicted difficult airway OR 2.66 (95% CI 1.47-4.80). There was no association between operator type and first pass success rate. There was no association of first pass failure with bougie use, direct laryngoscopy, location of intubation, or pre-intubation hypoxia.</div></div><div><h3>Conclusion</h3><div>First pass failure occurred in approximately one in eight intubations. This descriptive analysis of intubation failure provides a starting point for further quality improvement work. Future work should incorporate systematic review of intubations with objective data (i.e. video-recorded laryngoscopy) and the use of an airway failure taxonomy to describe performance errors and allow for iterative quality improvement in a learning healthcare system.</div></div>","PeriodicalId":35737,"journal":{"name":"Air Medical Journal","volume":"44 5","pages":"Page 433"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Air Medical Journal
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