Waveform capnography in a South African prehospital service: Knowledge assessment of paramedics

Abstract

Background Waveform capnography has proven to be of great value in the provision of safe patient care especially in the intubated patient. Although seldom available, or used in African contexts, capnography has become standard practice in well-resourced out-of-hospital services for confirmation of intubation, and optimization of resuscitation and ventilation. To date there has been little research into the knowledge of out-of-hospital staff, both local and internationally, utilising capnography. This study describes the knowledge of paramedics who use waveform capnography in the out-of-hospital environment. Methods A cohort of advanced life support qualified paramedics in a private ambulance service in South Africa undertook a web-based survey around their background, training and use of capnography. Participants’ knowledge was assessed by exploring their interpretation of waveform capnography and establishing attitudes pertaining to training and constraints of availability of capnography. Results Seventy eight paramedics responded, and most (91%) indicated they were likely to use capnography when the tool was available. The majority of training in capnography had been during their primary qualification (85%). Most participants indicated that they would like further training (91%). Use of capnography for confirmation of endotracheal tube placement and quality of compressions during cardiopulmonary resuscitation was well understood (correct in 94% and 84% respectively), while more complicated knowledge such as waveform changes during ventilation (66%) and the effect of hypovolaemia (48%) on capnography were lacking. Conclusion Paramedics report using waveform capnography extensively when it is available in the South African out-of-hospital environment. Although the knowledge around capnography and its usage was found to be good in most areas, more complicated scenarios exposed flaws in the knowledge of many paramedics and suggest the need for improved and ongoing training, as well as incorporation into curricula as the field develops across the continent.

Variation in Prehospital Protocols for Pediatric Respiratory Distress Management in the United States

“…Waveform capnography can assist early apnea detection and monitoring response to treatment of bronchospasm 32 . Although paramedics have reported a high comfort level in using capnography, few protocols required using waveform capnography for respiratory monitoring 33 . Furthermore, our prior work has demonstrated differences in the assessment of pediatric versus adult patients, including the documentation of vital signs, which is likely associated with decreased experience evaluating pediatric patients 34 .…”

“…32 Although paramedics have reported a high comfort level in using capnography, few protocols required using waveform capnography for respiratory monitoring. 33 Furthermore, our prior work has demonstrated differences in the assessment of pediatric versus adult patients, including the documentation of vital signs, which is likely associated with decreased experience evaluating pediatric patients. 34 Given this limited exposure to pediatric patients, increased use of waveform capnography in monitoring pediatric prehospital patients could enhance the evaluation and continual monitoring of pediatric patients in a noninvasive manner.…”

Prehospital Airway Management for Trauma Patients by First Responders in Six Sub‐Saharan African Countries and Five Other Low‐ and Middle‐Income Countries: A Scoping Review

“…With limited research on the state of prehospital AM in resource‐limited settings, the majority of studies included in this scoping review were case–control and retrospective cohort studies (12/17), [13, 14, 17, 27–29, 31, 33, 35, 36, 38, 39] while a limited selection of included studies were observational or qualitative in nature (5/17) [26, 30, 32, 34, 37]. Of the studies meeting inclusion criteria, first responder curricula teaching ABC were most common, found in 11 studies, followed by ET intubation in eight studies.…”