European journal of emergency medicine : official journal of the European Society for Emergency Medicine
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The most common method of assessing the quality of medical education is through a selection of qualitative assessments, usually as part of a programme evaluation. Common qualitative assessments include measurements of students' and teachers' participation, outcome measures such as assessment results, and qualitative assessments such as interviews and questionnaires of students and teachers. Programme evaluation can therefore be a process that is both laborious and subject to accusations of a lack of objectivity. ⋯ The assessment tool is less accurate at ranking those training centres whose training is merely 'satisfactory'; whether this is a result of the imprecision of the tool itself or a reflection of the subjective nature of the current assessment (i.e. whether the current evaluation system lacks validity) cannot be stated. In summary, it appears to be possible to use a single quantitative tool to reliably, and with validity, measure the quality of training delivered at a postgraduate medical training centre. Although it is not envisaged that this would, or should, replace ongoing quality assurance systems such as programme evaluations, a validated tool can be derived for a given setting to usefully inform and augment current quality management systems in postgraduate medical education.
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Comparative Study
First-pass intubation success rate during rapid sequence induction of prehospital anaesthesia by physicians versus paramedics.
Endotracheal intubation is a frequently performed procedure for securing the airway in critically injured or ill patients. Performing prehospital intubation may be challenging and intubation skills vary. We reviewed the first-attempt tracheal intubation success rate in a Dutch prehospital setting. ⋯ Prehospital intubations had a significantly higher success rate when performed by helicopter physicians. We promote a low threshold for HEMS deployment in cases of a potentially compromised airway.
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Ketamine is a widely used drug that, depending on the dose administered, may be used as an analgesic or as a sedative or anaesthetic agent. A number of features make it attractive for prehospital use. At Essex and Herts Air Ambulance Trust, as with other services and under the guidance of a standard operating procedure, ketamine is used for both procedural sedation and as an anaesthetic agent for rapid sequence intubation. Guidelines exist that define levels of sedation and detail minimum standards of monitoring and personnel required for each level. ⋯ We describe the use of ketamine over a 4-year period for prehospital procedural sedation. Minimum standards for patient monitoring were documented in only around a quarter of cases.
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Observational Study
Training paramedics in focussed echo in life support.
The aim of this study was to determine whether paramedics can be trained to perform and interpret focussed Echo in Life Support (ELS) for the assessment of cardiac movement and the recognition of reversible causes of cardiac arrest. ⋯ Paramedics can perform focused ELS, integrate attempts into simulated cardiac arrest scenarios and retain some of this knowledge. Further work is required to assess the feasibility of incorporating this into real-world cardiac arrest management.
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The aim of this study was to determine the use of procedural sedation for head trauma-related computed tomography of the brain (CTB) in children and its association with age and Glasgow Coma Scale (GCS) scores. ⋯ Children with head injuries who require CTB are infrequently sedated. Younger children are more likely to receive sedation. These data will be useful for the assessment of CTB-associated risks.