Standardised data reporting from pre-hospital advanced airway management – a nominal group technique update of the Utstein-style airway template

Sunde, Geir Arne; Kottmann, Alexandre; Heltne, Jon-Kenneth; Sandberg, Mårten; Gellerfors, Mikael; Krüger, Andreas; Lockey, David; Sollid, Stephen J. M.

doi:10.1186/s13049-018-0509-y

Cited by 42 publications

(44 citation statements)

References 86 publications

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“…Several consensus-based templates for reporting in EMS and p-EMS have been created (e.g., trauma, airway handling and cardiac arrest) [14,15,26,36], and studies have proven that data collection according to such templates are feasible [12,16,37]. However, to increase the relevance of templates, variables should be coordinated.…”

Section: Discussionmentioning

confidence: 99%

“…There is no consensus in the literature on how to report mission times [15,25,26] and the experts had several suggestions, i.e., exact times (hh:mm), time intervals (dispatch time, on-scene time, etc.) and time reported as year/month/day/hour of event.…”

Section: Event Operational Descriptorsmentioning

confidence: 99%

“…Templates for uniform documentation may facilitate international multi-centre studies, thereby increasing the quality of evidence [11]. Such templates, designed through expert agreement, are valuable and feasible, but they need to be updated on a regular basis due to developments in available equipment and treatment options [12][13][14][15]. The p-EMS template has been incorporated for daily use in Finland, but it has not yet been implemented in other European countries.…”

Section: Introductionmentioning

confidence: 99%

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Template for documenting and reporting data in physician-staffed pre-hospital services: a consensus-based update

Tønsager

Krüger

Ringdal

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background: Physician-staffed emergency medical services (p-EMS) are resource demanding, and research is needed to evaluate any potential effects of p-EMS. Templates, designed through expert agreement, are valuable and feasible, but they need to be updated on a regular basis due to developments in available equipment and treatment options. In 2011, a consensus-based template documenting and reporting data in p-EMS was published. We aimed to revise and update the template for documenting and reporting in p-EMS. Methods: A Delphi method was applied to achieve a consensus from a panel of selected European experts. The experts were blinded to each other until a consensus was reached, and all responses were anonymized. The experts were asked to propose variables within five predefined sections. There was also an optional sixth section for variables that did not fit into the pre-defined sections. Experts were asked to review and rate all variables from 1 (totally disagree) to 5 (totally agree) based on relevance, and consensus was defined as variables rated ≥4 by more than 70% of the experts.Results: Eleven experts participated. The experts generated 194 unique variables in the first round. After five rounds, a consensus was reached. The updated dataset was an expanded version of the original dataset and the template was expanded from 45 to 73 main variables. The experts approved the final version of the template.Conclusions: Using a Delphi method, we have updated the template for documenting and reporting in p-EMS. We recommend implementing the dataset for standard reporting in p-EMS.

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Section: Discussionmentioning

confidence: 99%

Section: Event Operational Descriptorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Template for documenting and reporting data in physician-staffed pre-hospital services: a consensus-based update

Tønsager

Krüger

Ringdal

et al. 2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

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“…Questionnaires were developed to investigate service standard operating procedures (SOP) and individual clinician practice. The questionnaires were developed with pre-hospital care experts and were informed by the oxygenation strategies described in the updated Utstein-style pre-hospital advanced airway template [29]. So that responses regarding oxygenation strategies were reliable, care was taken in clearly defining oxygenation strategies through PHEA.…”

Section: Methodsmentioning

confidence: 99%

Oxygenation strategies prior to and during prehospital emergency anaesthesia in UK HEMS practice (PREOXY survey)

Boulton

Mashru²,

Lyon

2020

Scand J Trauma Resusc Emerg Med

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Background Maintaining effective oxygenation throughout the process of Pre-Hospital Emergency Anaesthesia (PHEA) is critical. There are multiple strategies available to clinicians to oxygenate patients both prior to and during PHEA. The optimal pre-oxygenation technique remains unclear, and it is unknown what techniques are being used by United Kingdom Helicopter Emergency Medical Services (HEMS). This study aimed to determine the current pre- and peri-PHEA oxygenation strategies used by UK HEMS services. Methods An electronic questionnaire survey was delivered to all UK HEMS services between 05 July and 26 December 2019. Questions investigated service standard operating procedures (SOPs) and individual clinician practice regarding oxygenation strategies prior to airway instrumentation (pre-oxygenation) and oxygenation strategies during airway instrumentation (apnoeic oxygenation). Service SOPs were obtained to corroborate questionnaire replies. Results Replies were received from all UK HEMS services (n = 21) and 40 individual clinicians. All services specified oxygenation strategies within their PHEA/RSI SOP and most referred to pre-oxygenation as mandatory (81%), whilst apnoeic oxygenation was mandatory in eight (38%) SOPs. The most commonly identified pre-oxygenation strategies were bag-valve-mask without PEEP (95%), non-rebreathable face mask (81%), and nasal cannula at high flow (81%). Seven (33%) services used Mapleson C circuits, whilst there were eight services (38%) that did not carry bag-valve-masks with PEEP valve nor Mapleson C circuits. All clinicians frequently used pre-oxygenation, however there was variability in clinician use of apnoeic oxygenation by nasal cannula. Nearly all clinicians (95%) reported manually ventilating patients during the apnoeic phase, with over half (58%) stating this was their routine practice. Differences in clinician pre-hospital and in-hospital practice related to availability of humidified high flow nasal oxygenation and Mapleson C circuits. Conclusions Pre-oxygenation is universal amongst UK HEMS services and is most frequently delivered by bag-valve-mask without PEEP or non-rebreathable face masks, whereas apnoeic oxygenation by nasal cannula is highly variable. Multiple services carry Mapleson C circuits, however many services are unable to deliver PEEP due to the equipment they carry. Clinicians are regularly manually ventilating patients during the apnoeic phase of PHEA. The identified variability in clinical practice may indicate uncertainty and further research is warranted to assess the impact of different strategies on clinical outcomes.

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“…However, inclement environmental conditions, poor lighting, and scene hazards (including bystander interference) can create suboptimal conditions in which to perform an already challenging clinical intervention. [12][13][14][15] In the majority of cases, RSI is performed close to the scene before transferring the patient to a waiting ambulance or helicopter, which perhaps extends the prehospital time. Performing RSI in a helicopter cabin could protect the patient from inclement conditions and has the potential to reduce scene time 13 and the overall timeline from point of injury to hospital.…”

mentioning

confidence: 99%

Feasibility of Prehospital Rapid Sequence Intubation in the Cabin of an AW169 Helicopter

McHenry¹,

Curtis²,

Avest

et al. 2020

Air Medical Journal

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Prehospital rapid sequence intubation (RSI) is an important aspect of prehospital care for helicopter emergency medical services (HEMS). This study examines the feasibility of in-aircraft (aircraft on the ground) RSI in different simulated settings. Methods: Using an AW169 aircraft cabin simulator at Air Ambulance Kent Surrey Sussex, 3 clinical scenarios were devised. All required RSI in a "can intubate, can ventilate" (easy variant) and a "can't intubate, can't ventilate" scenario (difficult variant). Doctor-paramedic HEMS teams were video recorded, and elapsed times for prespecified end points were analyzed. Results: Endotracheal intubation (ETI) was achieved fastest outside the simulator for the easy variant (median = 231 seconds, interquartile range = 28 seconds). Time to ETI was not significantly longer for in-aircraft RSI compared with RSI outside the aircraft, both in the easy (p = .14) and difficult variant (p = .50). Wearing helmets with noise distraction did not impact the time to intubation when compared with standard inaircraft RSI, both in the easy (p = .28) and difficult variant (p = .24). Conclusion: In-aircraft, on-the-ground RSI had no significant impact on the time to successful completion of ETI. Future studies should prospectively examine in-cabin RSI and explore the possibilities of in-flight RSI in civilian HEMS services.

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Standardised data reporting from pre-hospital advanced airway management – a nominal group technique update of the Utstein-style airway template

Cited by 42 publications

References 86 publications

Template for documenting and reporting data in physician-staffed pre-hospital services: a consensus-based update

Template for documenting and reporting data in physician-staffed pre-hospital services: a consensus-based update

Oxygenation strategies prior to and during prehospital emergency anaesthesia in UK HEMS practice (PREOXY survey)

Feasibility of Prehospital Rapid Sequence Intubation in the Cabin of an AW169 Helicopter

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