Paramedic Perception of Endotracheal Intubation Performance: an Examination of Irish Advanced Paramedic Demographics, Characteristics, Confidence and Perceived Barriers to the Performance of Advanced Airway Management.

Abstract BackgroundMuch research has occurred internationally with regard to the prehospital ETI (endotracheal intubation), however to date little is known of Paramedics perception of the procedure. In order to gain insight into procedural perception Irish Advanced Paramedics (AP) were invited to participate in an electronic survey. This survey attempted to gather information surrounding AP’s experience of education for and performance of ETI, to identify procedural barriers and gain insight in to the continuing developmental needs of AP’s to maintain confidence and competence in ETI performance. MethodsAn online questionnaire was created and AP’s employed by the National Ambulance Service and the Dublin Fire Brigade, were invited to participate. The objective was to measure the characteristics, attitudes and perceived barriers to ETI by AP’s in Ireland. Participants were asked to categorise their personal characteristics of ETI (frequency, techniques, barriers) through a series of 36 structured questions and answers. ResultsOf the 524 AP surveyed the response rate was 27% (n=140) 77.9% of respondents perform ETI 10 times or less per year. 26.6% of respondents maintain a personal airway management log book. 97.8% of respondents reported ETI as being an important AP skill. Most felt confident at performing the procedure but felt it was of moderate difficulty. There was a lack of consensus on the definition of a failed intubation attempt. Initial supervised intubation practice in Hospital or the clinical skill lab was felt to be very important. Most respondents felt that there should be a minimum number of intubations performed by a paramedic each year, and that if this number was not achieved in the pre-hospital setting in-hospital practice should be an available alternative.Conclusion ETI is perceived to be an important skill by Paramedics. In practice there is wide variances in standards of data reporting, continuing assessment and competency assurance in ETI. A hybrid approach of individuals maintaining an airway portfolio which encompasses a clinical airway logbook, self-directed airway simulation with periodic senior peer appraisal and in-hospital clinical feedback may be the best approach for Paramedics with limited pre-hospital advanced airway management opportunities.