The development and critique of validated assessment tools for pre-hospital resuscitation skills

Abstract

Purpose The purpose of this paper is to describe the development of clinically credible skill practice and assessment guides for intraosseous (IO) needle insertion and laryngeal mask airway (LMA) insertion as two essential components of advanced life support (ALS) training. Design/methodology/approach A modified Delphi approach was used to determine expert consensus in the application of IO and LMA devices for the pre-hospital and emergency setting. Nine pre-hospital clinical specialists were recruited to participate in this Delphi study to determine consensus of clinical expert practice. Findings Two rounds were required to obtain a performance and assessment checklist for each skill. Both lists were then further modified to maximise their useability. However, the development of a “validated” checklist using a pre-determined process such as a Delphi approach is challenged. Rather, the implementation of these tools in a stated context, and analysis of the data they generate, is an essential aspect of validation which the Delphi approach does not address. Research limitations/implications Participant feedback regarding the rationale for their scores was limited in this study in order to minimise participant input and maximise completion of all rounds of the study. Further, devices used in the study may no longer be first-line choices with the advent of more modern devices including semi-automatic IO devices and LMAs which do not have inflatable cuffs. The refined checklists are able to be adapted to these newer devices. Practical implications Pre-hospital education contexts which may not have access to expert assessors who are skilled in providing global judgements now have access to clinically relevant skill-specific assessment tools for IO and LMA insertion. Originality/value Worldwide, ALS accreditation and competence is demanded of countless health professionals, and to date, validated practice and assessment guides specifically developed for the emergency setting for which they are used, are not available in the published literature. This paper proposes to fill that gap, in addition to guiding clinical education researchers in strategies to develop valid assessment tools through rigorous critique.