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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: [email protected]
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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 

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