Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-19T12:19:58.093Z Has data issue: false hasContentIssue false
  • English
  • Français

Creation and Validation of a Novel Mobile Simulation Laboratory for High Fidelity, Prehospital, Difficult Airway Simulation

Published online by Cambridge University Press:  17 August 2016

Jason J. Bischof ,
Ashish R. Panchal ,
Geoffrey I. Finnegan  and
Thomas E. Terndrup
Jason J. Bischof
Affiliation:
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OhioUSA
Ashish R. Panchal
Affiliation:
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OhioUSA
Geoffrey I. Finnegan
Affiliation:
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OhioUSA
Thomas E. Terndrup*
Affiliation:
Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OhioUSA
*
Correspondence: Thomas Terndrup, MD 370 W. 9th Ave. Columbus, Ohio 43210 USA E-mail: thomas.terndrup@osumc.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Endotracheal intubation (ETI) is a complex clinical skill complicated by the inherent challenge of providing care in the prehospital setting. Literature reports a low success rate of prehospital ETI attempts, partly due to the care environment and partly to the lack of consistent standardized training opportunities of prehospital providers in ETI.

Hypothesis/Problem

The availability of a mobile simulation laboratory (MSL) to study clinically critical interventions is needed in the prehospital setting to enhance instruction and maintain proficiency. This report is on the development and validation of a prehospital airway simulator and MSL that mimics in situ care provided in an ambulance.

Methods

The MSL was a Type 3 ambulance with four cameras allowing audio-video recordings of observable behaviors. The prehospital airway simulator is a modified airway mannequin with increased static tongue pressure and a rigid cervical collar. Airway experts validated the model in a static setting through ETI at varying tongue pressures with a goal of a Grade 3 Cormack-Lehane (CL) laryngeal view. Following completion of this development, the MSL was launched with the prehospital airway simulator to distant communities utilizing a single facilitator/driver. Paramedics were recruited to perform ETI in the MSL, and the detailed airway management observations were stored for further analysis.

Results

Nineteen airway experts performed 57 ETI attempts at varying tongue pressures demonstrating increased CL views at higher tongue pressures. Tongue pressure of 60 mm Hg generated 31% Grade 3/4 CL view and was chosen for the prehospital trials. The MSL was launched and tested by 18 paramedics. First pass success was 33% with another 33% failing to intubate within three attempts.

Conclusions

The MSL created was configured to deliver, record, and assess intubator behaviors with a difficult airway simulation. The MSL created a reproducible, high fidelity, mobile learning environment for assessment of simulated ETI performance by prehospital providers.

BischofJJ, PanchalAR, FinneganGI, TerndrupTE. Creation and Validation of a Novel Mobile Simulation Laboratory for High Fidelity, Prehospital, Difficult Airway Simulation. Prehosp Disaster Med. 2016;31(5):465–470.

Keywords

airway managementEMSendotracheal intubationprehospitalsimulation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 5 , October 2016 , pp. 465 - 470
Copyright
© World Association for Disaster and Emergency Medicine 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Wang, HE, Peitzman, AB, Cassidy, LD, Adelson, PD, Yealy, DM. Out-of-hospital endotracheal intubation and outcome after traumatic brain injury. Ann Emerg Med. 2004;44(5):439-450.CrossRefGoogle ScholarPubMed
2. Bochicchio, GV, Ilahi, O, Joshi, M, Bochicchio, K, Scalea, TM. Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury. J Trauma. 2003;54(2):307-311.CrossRefGoogle Scholar
3. Davis, DP, Fakhry, SM, Wang, HE, et al. Paramedic rapid sequence intubation for severe TBI: perspectives from an expert panel. Prehosp Emerg Care. 2007;11(1):1-8.Google Scholar
4. Lecky, F, Bryden, D, Little, R, Tong, N, Moulton, C. Emergency intubation for acutely ill and injured patients. Cochrane Database Syst Rev. 2008;(2):CD001429.Google ScholarPubMed
5. Jemmett, ME, Kendal, KM, Fourre, MW, Burton, JH. Unrecognized misplacement of endotracheal tubes in a mixed urban to rural Emergency Medical Services setting. Acad Emerg Med. 2003;10(9):961-965.Google Scholar
6. Jones, JH, Murphy, MP, Dickson, RL, Somerville, GG, Brizendine, EJ. Emergency physician-verified out-of-hospital intubation: miss rates by paramedics. Acad Emerg Med. 2004;11(6):707-709.Google Scholar
7. Silvestri, S, Ralls, GA, Krauss, B, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005;45(5):497-503.CrossRefGoogle ScholarPubMed
8. Terndrup, TE, Cherry, RA, Madden, CM, Cantor, RM, McCabe, JB. The impact of a didactic session on the success of feline endotracheal intubation by paramedics. Pediatr Emerg Care. 1989;5(3):153-157.CrossRefGoogle ScholarPubMed
9. Terndrup, TE, Kanter, RK, Cherry, RA. A comparison of infant ventilation methods performed by prehospital personnel. Ann Emerg Med. 1989;18(6):607-611.CrossRefGoogle ScholarPubMed
10. Phelan, MP, Moscati, R, D’Aprix, T, Miller, G. Paramedic use of the endotracheal tube introducer in a difficult airway model. Prehosp Emerg Care. 2003;7(2):244-246.Google Scholar
11. Cormack, RS, Lehane, J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39(11):1105-1111.CrossRefGoogle ScholarPubMed
12. Jordan, GM, Silsby, J, Bayley, G, Cook, TM, Difficult Airway Society. Evaluation of four manikins as simulators for teaching airway management procedures specified in the difficult airway society guidelines, and other advanced airway skills. Anaesthesia. 2007;62(7):708-712.Google Scholar
13. Voyagis, GS, Kyriakis, KP, Roussaki-Danou, K, Bastounis, EA. Evaluating the difficult airway. An epidemiological study. Minerva Anestesiol. 1995;61(12):483-489.Google Scholar
14. Lubin, J, Carter, R. The feasibility of daily mannequin practice to improve intubation success. Air Med J. 2009;28(4):195-197.CrossRefGoogle ScholarPubMed
15. Ilgen, JS, Sherbino, J, Cook, DA. Technology-enhanced simulation in emergency medicine: a systematic review and meta-analysis. Acad Emerg Med. 2013;20(2):117-127.CrossRefGoogle Scholar
16. Barsuk, D, Ziv, A, Lin, G, et al. Using advanced simulation for recognition and correction of gaps in airway and breathing management skills in prehospital trauma care. Anesth Analg. 2005;100(3):803-809.Google Scholar
17. Kobayashi, L, Patterson, MD, Overly, FL, Shapiro, MJ, Williams, KA, Jay, GD. Educational and research implications of portable human patient simulation in acute care medicine. Acad Emerg Med. 2008;15(11):1166-1174.CrossRefGoogle ScholarPubMed