Albuterol by EMT-Bs; Pediatric Prehospital Training Comparison; Child Safety Seats

Albuterol for Bronchospasm by EMT-Bs

Markenson D, Foltin G, Tunik M et al. Albuterol sulfate administration by EMT-Basics: Results of a demonstration project. Preh Emer Care 8(1):34–40, Jan.–Mar. 2004.

Abstract: Objectives—1) To evaluate the ability to train Emergency Medical Technicians-Basic (EMT-Bs) to accurately identify bronchospasm and, based on a treatment protocol, administer albuterol sulfate via nebulization as a standing order; 2) To measure the improvement in patient condition after treatment. Methods—Following approval by the Commissioner of Health and Institutional Review Board, EMS agencies were enrolled to participate in the study, and EMT-Bs were trained using a four-hour curriculum. For each patient, a prehospital data collection form was completed, including identifying data for the EMT-B, patient assessment and history information. Also, pre- and post-treatment assessments and hospital data collection forms were completed, including the emergency department physician’s diagnosis, assessment of bronchospasm, number of albuterol treatments received in the emergency department, and final disposition of the patient.

Results—During a one-year study period, EMT-Bs treated 190 patients as part of the project. Across all values, patients showed a clinical improvement as a result of the therapy. Concurrence in the assessment of bronchospasm by the EMT-B with an emergency department physician was found in 87.4% of the cases. When including allergic reaction, anaphylaxis, bronchiolitis and chronic obstructive pulmonary disease in the diagnosis list of bronchospasm, the accuracy rate increased to more than 94%.

Conclusions—This study indicated EMT-Bs were highly successful in their evaluation of bronchospasm. Based on this level of accuracy, the authors suggest that it is safe for emergency medical service systems and medical directors to develop protocols that allow EMT-Bs to administer albuterol via nebulizer for bronchospasm based on their assessment.

Comment: This is another study demonstrating that EMT-Bs can, with a limited amount of additional training, accurately identify and safely treat patients with additional medications and procedures. A study from rural California presented similar results when EMTs were trained to insert a Combitube and administer naloxone, glucagon, nitroglycerine, albuterol, activated charcoal and epinephrine. The training to properly assess and treat using these “advanced” skills should be further studied. EMS systems that have prolonged paramedic response times should look at supplementing their EMT-B scope of practice with one or more of these items.

Pediatric Prehospital Training Comparison

Sanddal ND, Sanddal TL, Pullum JD et al. A randomized, prospective, multisite comparison of pediatric prehospital training methods. Ped Emer Care 20(2):94–100, Feb. 2004.

Abstract summary: Objective—Results of prehospital pediatric continuing education using train-the-trainer and CD-ROM training methods were compared to each other and to a control group. The null hypothesis was that no differences would be found in pre-training and post-training measurements of knowledge and performance by either training method.

Methods—This was a prospective trial involving 12 sites. Random selections were made from ambulance service lists provided by three state emergency medical services (EMS) agencies. Pre-intervention and post-intervention (12-month) measurements included a written examination and two performance scenarios videotaped for independent panel evaluation. Training was either an interactive CD-ROM or standard classroom instruction using a train-the-trainer model. Mean differences in written, performance and combined scores were analyzed.

Results—Differences were noted in the combined and performance scores for the CD-ROM intervention group. No differences were noted in written measurements between or among the groups. Conclusion—In this small sample, interactive CD-ROM training shows promise for improving performance. The research design, with additional guards against sample size attrition, may provide a model for multisite EMS education research.