Standardised data reporting from pre-hospital advanced airway management - a nominal group technique update of the Utstein-style airway template

Background Pre-hospital advanced airway management with oxygenation and ventilation may be vital for managing critically ill or injured patients. To improve pre-hospital critical care and develop evidence-based guidelines, research on standardised high-quality data is important. We aimed to identify which airway data were most important to report today and to revise and update a previously reported Utstein-style airway management dataset. Methods We recruited sixteen international experts in pre-hospital airway management from Australia, United States of America, and Europe. We used a five-step modified nominal group technique to revise the dataset, and clinical study results from the original template were used to guide the process. Results The experts agreed on a key dataset of thirty-two operational variables with six additional system variables, organised in time, patient, airway management and system sections. Of the original variables, one remained unchanged, while nineteen were modified in name, category, definition or value. Sixteen new variables were added. The updated dataset covers risk factors for difficult intubation, checklist and standard operating procedure use, pre-oxygenation strategies, the use of drugs in airway management, airway currency training, developments in airway devices, airway management strategies, and patient safety issues not previously described. Conclusions Using a modified nominal group technique with international airway management experts, we have updated the Utstein-style dataset to report standardised data from pre-hospital advanced airway management. The dataset enables future airway management research to produce comparable high-quality data across emergency medical systems. We believe this approach will promote research and improve treatment strategies and outcomes for patients receiving pre-hospital advanced airway management.publishedVersio

Establishing quality indicators for prehospital advanced airway management: a modified nominal group technique consensus process

Background: Prehospital advanced airway management is a complex intervention composed of numerous steps, interactions, and variables that can be delivered to a high standard in the prehospital setting. Standard research methods have struggled to evaluate this complex intervention because of considerable heterogeneity in patients, providers, and techniques. In this study, we aimed to develop a set of quality indicators to evaluate prehospital advanced airway management. Methods: We used a modified nominal group technique consensus process comprising three email rounds and a consensus meeting among a group of 16 international experts. The final set of quality indicators was assessed for usability according to the National Quality Forum Measure Evaluation Criteria. Results: Seventy-seven possible quality indicators were identified through a narrative literature review with a further 49 proposed by panel experts. A final set of 17 final quality indicators composed of three structure-, nine process-, and five outcome-related indicators, was identified through the consensus process. The quality indicators cover all steps of prehospital advanced airway management from preoxygenation and use of rapid sequence induction to the ventilatory state of the patient at hospital delivery, prior intubation experience of provider, success rates and complications. Conclusions: We identified a set of quality indicators for prehospital advanced airway management that represent a practical tool to measure, report, analyse, and monitor quality and performance of this complex intervention.publishedVersio

Rétrospective study of médical requirements for avalanche rescue missions: a necessary step to find opportunities for quality improvement in avalanche rescue

Contexte : les opérations de secours en cas d'avalanche reposent principalement sur les services médicaux de sauvetage héliporté et comportent des aspects de sauvetage technique et des situations médicales complexes dans des conditions difficiles. Récemment, une adéquation étonnamment faible de la prise en charge des victimes d'avalanche a été mise en évidence, suggérant la nécessité d'une amélioration de sa qualité. Dans notre étude, nous analysons les exigences, en termes de sauvetage technique et de compétences médicales, requises par les membres d'équipage des services médicaux de sauvetage héliporté pour les opérations de secours en cas d'avalanche, ainsi que leur exposition clinique. L'étude vise à identifier les domaines qui devraient faire l'objet de futurs efforts d'amélioration de la qualité. Méthode : étude rétrospective des opérations de secours en cas d'avalanche de la Rega (service médical de sauvetage héliporté suisse) entre 2001 et 2015, incluant toutes les missions où au moins un patient a été emporté par une avalanche, retrouvé dans les premières 24h après l'alarme et transporté. Résultats : nos analyses ont inclus 422 missions (596 patients). Les équipages ont été fréquemment confronté à des aspects de sauvetage technique comme le treuillage (29%), la localisation et le dégagement de victimes d'avalanches (48%), et des accidents à victimes multiples (32%). Quarante-sept pour cent des patients présentaient une menace vitale potentielle ou avérée ; 29% étaient en arrêt cardiaque. La prise en charge médicale des victimes sur le lieu de l'avalanche a nécessité un large éventail de compétences médicales, tant basiques qu'avancées. L'exposition clinique des membres d'équipage était faible, 56% des médecins ayant participé à une seule mission de sauvetage en cas d'avalanche au cours de la période étudiée. Conclusions : nos données fournissent une bonne mesure de base et un point de départ précieux pour améliorer notre compréhension des défis rencontrés lors des missions de sauvetage en cas d'avalanche. Nous suggérons en outre des mesures d'amélioration de la qualité qui pourraient être immédiatement utiles pour les services médicaux de sauvetage héliporté opérant dans des conditions similaires. Une approche coordonnée utilisant un processus consensuel pour déterminer des indicateurs de qualité ainsi qu'un minimal data set spécifique aux missions de sauvetage en cas avalanche semble être la prochaine étape logique

Avalanche accidents causing fatalities: are they any different in the summer?

Pasquier, Mathieu, Olivier Hugli, Alexandre Kottmann, and Frank Techel. Avalanche accidents causing fatalities: are they any different in the summer? High Alt Med Biol. 16:000-000, 2016. AIMS: This retrospective study investigated the epidemiology of summer avalanche accidents that occurred in Switzerland and caused at least one fatality between 1984 and 2014. Summer avalanche accidents were defined as those that occurred between June 1st and October 31st. RESULTS: Summer avalanches caused 21 (4%) of the 482 avalanches with at least one fatality occurring during the study period, and 40 (6%) of the 655 fatalities. The number of completely buried victims per avalanche and the proportion of complete burials among trapped people were lower in summer than in winter. Nevertheless, the mean number of fatalities per avalanche was higher in summer than in winter: 1.9 ± 1.2 (standard deviation; range 1-6) versus 1.3 ± 0.9 (range 1-7; p < 0.001). Trauma was the presumed cause of death in 94% (33 of 35) in summer avalanche accidents. Sixty-five percent of fully buried were found due to visual clues at the snow surface. CONCLUSIONS: Fatal summer avalanche accidents caused a higher mean number of fatalities per avalanche than winter avalanches, and those deaths resulted mostly from trauma. Rescue teams should anticipate managing polytrauma for victims in summer avalanche accidents rather than hypothermia or asphyxia; they should be trained in prehospital trauma life support and equipped accordingly to ensure efficient patient care

Establishing quality indicators for prehospital advanced airway management: a modified nominal group technique consensus process

Background: Prehospital advanced airway management is a complex intervention composed of numerous steps, interactions, and variables that can be delivered to a high standard in the prehospital setting. Standard research methods have struggled to evaluate this complex intervention because of considerable heterogeneity in patients, providers, and techniques. In this study, we aimed to develop a set of quality indicators to evaluate prehospital advanced airway management. Methods: We used a modified nominal group technique consensus process comprising three email rounds and a consensus meeting among a group of 16 international experts. The final set of quality indicators was assessed for usability according to the National Quality Forum Measure Evaluation Criteria. Results: Seventy-seven possible quality indicators were identified through a narrative literature review with a further 49 proposed by panel experts. A final set of 17 final quality indicators composed of three structure-, nine process-, and five outcome-related indicators, was identified through the consensus process. The quality indicators cover all steps of prehospital advanced airway management from preoxygenation and use of rapid sequence induction to the ventilatory state of the patient at hospital delivery, prior intubation experience of provider, success rates and complications. Conclusions: We identified a set of quality indicators for prehospital advanced airway management that represent a practical tool to measure, report, analyse, and monitor quality and performance of this complex intervention.publishedVersio

Feasibility of quality indicators on prehospital advanced airway management in a physician-staffed emergency medical service: survey-based assessment of the provider point of view.

OBJECTIVE We aimed to determine the feasibility of quality indicators (QIs) for prehospital advanced airway management (PAAM) from a provider point of view. DESIGN The study is a survey based feasibility assessment following field testing of QIs for PAAM. SETTING The study was performed in two physician staffed emergency medical services in Switzerland. PARTICIPANTS 42 of the 44 emergency physicians who completed at least one case report form (CRF) dedicated to the collection of the QIs on PAAM between 1 January 2019 and 31 December 2021 participated in the study. INTERVENTION The data required to calculate the 17 QIs was systematically collected through a dedicated electronic CRF. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were provider-related feasibility criteria: relevance and acceptance of the QIs, as well as reliability of the data collection. Secondary outcomes were effort to collect specific data and to complete the CRF. RESULTS Over the study period, 470 CRFs were completed, with a median of 11 per physician (IQR 4-17; range 1-48). The median time to complete the CRF was 7 min (IQR 3-16) and was considered reasonable by 95% of the physicians. Overall, 75% of the physicians assessed the set of QIs to be relevant, and 74% accepted that the set of QIs assessed the quality of PAAM. The reliability of data collection was rated as good or excellent for each of the 17 QIs, with the lowest rated for the following 3 QIs: duration of preoxygenation, duration of laryngoscopy and occurrence of desaturation during laryngoscopy. CONCLUSIONS Collection of QIs on PAAM appears feasible. Electronic medical records and technological solutions facilitating automatic collection of vital parameters and timing during the procedure could improve the reliability of data collection for some QIs. Studies in other services are needed to determine the external validity of our results

Standardised data reporting from pre-hospital advanced airway management - a nominal group technique update of the Utstein-style airway template

Background: Pre-hospital advanced airway management with oxygenation and ventilation may be vital for managing critically ill or injured patients. To improve pre-hospital critical care and develop evidence-based guidelines, research on standardised high-quality data is important. We aimed to identify which airway data were most important to report today and to revise and update a previously reported Utstein-style airway management dataset. Methods: We recruited sixteen international experts in pre-hospital airway management from Australia, United States of America, and Europe. We used a five-step modified nominal group technique to revise the dataset, and clinical study results from the original template were used to guide the process. Results: The experts agreed on a key dataset of thirty-two operational variables with six additional system variables, organised in time, patient, airway management and system sections. Of the original variables, one remained unchanged, while nineteen were modified in name, category, definition or value. Sixteen new variables were added. The updated dataset covers risk factors for difficult intubation, checklist and standard operating procedure use, pre-oxygenation strategies, the use of drugs in airway management, airway currency training, developments in airway devices, airway management strategies, and patient safety issues not previously described. Conclusions: Using a modified nominal group technique with international airway management experts, we have updated the Utstein-style dataset to report standardised data from pre-hospital advanced airway management. The dataset enables future airway management research to produce comparable high-quality data across emergency medical systems. We believe this approach will promote research and improve treatment strategies and outcomes for patients receiving pre-hospital advanced airway management

Additional file 2: of Identification of the technical and medical requirements for HEMS avalanche rescue missions through a 15-year retrospective analysis in a HEMS in Switzerland: a necessary step for quality improvement

Box plots. (DOCX 349 kb

Establishing quality indicators for prehospital advanced airway management: a modified nominal group technique consensus process

Background: Prehospital advanced airway management is a complex intervention composed of numerous steps, interactions, and variables that can be delivered to a high standard in the prehospital setting. Standard research methods have struggled to evaluate this complex intervention because of considerable heterogeneity in patients, providers, and techniques. In this study, we aimed to develop a set of quality indicators to evaluate prehospital advanced airway management. Methods: We used a modified nominal group technique consensus process comprising three email rounds and a consensus meeting among a group of 16 international experts. The final set of quality indicators was assessed for usability according to the National Quality Forum Measure Evaluation Criteria. Results: Seventy-seven possible quality indicators were identified through a narrative literature review with a further 49 proposed by panel experts. A final set of 17 final quality indicators composed of three structure-, nine process-, and five outcome-related indicators, was identified through the consensus process. The quality indicators cover all steps of prehospital advanced airway management from preoxygenation and use of rapid sequence induction to the ventilatory state of the patient at hospital delivery, prior intubation experience of provider, success rates and complications. Conclusions: We identified a set of quality indicators for prehospital advanced airway management that represent a practical tool to measure, report, analyse, and monitor quality and performance of this complex intervention