Paramedic training challenges highlighted by University of Pittsburgh study

PITTSBURGH, July 18 Across the United States, many patients require insertion of emergency breathing tubes before arriving to a hospital, but emergency medicine researchers at the University of Pittsburgh School of Medicine have found that many paramedics the highest level of prehospital providers do not get enough clinical experience in this life-saving skill. These findings are reported in the August issue of the journal Critical Care Medicine. The journal's findings are now available online at www.ccmjournal.com.

Endotracheal intubation (ETI) is an emergency medical procedure whereby trained medical personnel place a clear, flexible plastic tube into a patient's windpipe to deliver oxygen to the lungs. Paramedics collectively perform approximately 12,000 intubations every year in Pennsylvania.

Using patient data from the Pennsylvania Emergency Medical Services Patient Care Report from Jan. 1 to Dec. 31, 2003, the Pittsburgh researchers looked at the frequency of intubation performed by individual paramedics. They found that two-thirds of Pennsylvania paramedics performed intubation less than three times per year, and 40 percent performed no intubations at all.

"We need to find better ways to train paramedics to perform this very difficult procedure or find better and simpler ways to manage the airway," said Henry E. Wang, M.D., M.P.H., assistant professor of emergency medicine and lead author of the study.

Previous studies of complex medical procedures have shown that the occurrence of errors, adverse events and poor outcomes is associated with the volume of procedural experience.

Paramedic students in the United States are required to perform only five intubation procedures before graduation, compared to emergency medicine residents, who are required to perform 35, or anesthesiology residents, who must complete 50, before graduation.

"The entire health care delivery system is going through an evolutionary proces


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