Alan A Garner MBBS, FACEM, MSc, PhD, Andrew Scognamiglio MD, Dr Anna Lee BPharm, MPH, PhD
{"title":"可互换操作员模型在澳大利亚直升机紧急医疗服务中插管的性能特点和并发症","authors":"Alan A Garner MBBS, FACEM, MSc, PhD, Andrew Scognamiglio MD, Dr Anna Lee BPharm, MPH, PhD","doi":"10.1111/1742-6723.70052","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>The Inter-Changeable Operator Model (ICOM) enables paramedics and flight nurses to perform intubations interchangeably with team physicians in prehospital critical care. However, literature on ICOM characteristics and performance is limited.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a retrospective, observational study of an ICOM operating within an Australian Helicopter Emergency Medical Service over a nine-year period. First pass success, major complication rates and clinically important time intervals were compared between first intubator groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 413 patients met the inclusion criteria, with paramedics performing the majority of first intubation attempts (379/413, 91.8%). Physicians primarily conducted second intubation attempts and managed high-risk patients. In unadjusted analysis, the risk of major complication in the paramedic/supervised registrar group was not lower than the most senior physician intubator group (relative risk [RR] 0.59, 95% confidence interval [CI]: 0.26–1.32; <i>P</i> = 0.198) and after adjustment the risk was also not lower (RR 0.60, 95% CI: 0.24–1.54; <i>P</i> = 0.289). First pass failure occurred in 12 (3.1%) and 1 (4.8%) patients intubated by paramedic/supervised registrar and most senior physician groups, respectively (<i>P</i> = 0.498). The median (95% CI) adjusted difference in contact to intubation time between paramedic/supervised registrar first intubator and most senior physician groups was −2 min (−7 to 3; <i>P</i> = 0.392). Total adjusted scene time was also not significantly different between groups (median difference 2 min, 95% CI: −3 to 7; <i>P</i> = 0.500).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Paramedics conducting most intubations within an ICOM are both safe and efficient. Larger studies are required to examine differences between physician subgroups.</p>\n </section>\n </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 3","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70052","citationCount":"0","resultStr":"{\"title\":\"Performance characteristics and complications of an Inter-Changeable Operator Model for intubation in an Australian helicopter emergency medical service\",\"authors\":\"Alan A Garner MBBS, FACEM, MSc, PhD, Andrew Scognamiglio MD, Dr Anna Lee BPharm, MPH, PhD\",\"doi\":\"10.1111/1742-6723.70052\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>The Inter-Changeable Operator Model (ICOM) enables paramedics and flight nurses to perform intubations interchangeably with team physicians in prehospital critical care. However, literature on ICOM characteristics and performance is limited.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We conducted a retrospective, observational study of an ICOM operating within an Australian Helicopter Emergency Medical Service over a nine-year period. First pass success, major complication rates and clinically important time intervals were compared between first intubator groups.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 413 patients met the inclusion criteria, with paramedics performing the majority of first intubation attempts (379/413, 91.8%). Physicians primarily conducted second intubation attempts and managed high-risk patients. In unadjusted analysis, the risk of major complication in the paramedic/supervised registrar group was not lower than the most senior physician intubator group (relative risk [RR] 0.59, 95% confidence interval [CI]: 0.26–1.32; <i>P</i> = 0.198) and after adjustment the risk was also not lower (RR 0.60, 95% CI: 0.24–1.54; <i>P</i> = 0.289). First pass failure occurred in 12 (3.1%) and 1 (4.8%) patients intubated by paramedic/supervised registrar and most senior physician groups, respectively (<i>P</i> = 0.498). The median (95% CI) adjusted difference in contact to intubation time between paramedic/supervised registrar first intubator and most senior physician groups was −2 min (−7 to 3; <i>P</i> = 0.392). Total adjusted scene time was also not significantly different between groups (median difference 2 min, 95% CI: −3 to 7; <i>P</i> = 0.500).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Paramedics conducting most intubations within an ICOM are both safe and efficient. 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Performance characteristics and complications of an Inter-Changeable Operator Model for intubation in an Australian helicopter emergency medical service
Objective
The Inter-Changeable Operator Model (ICOM) enables paramedics and flight nurses to perform intubations interchangeably with team physicians in prehospital critical care. However, literature on ICOM characteristics and performance is limited.
Methods
We conducted a retrospective, observational study of an ICOM operating within an Australian Helicopter Emergency Medical Service over a nine-year period. First pass success, major complication rates and clinically important time intervals were compared between first intubator groups.
Results
A total of 413 patients met the inclusion criteria, with paramedics performing the majority of first intubation attempts (379/413, 91.8%). Physicians primarily conducted second intubation attempts and managed high-risk patients. In unadjusted analysis, the risk of major complication in the paramedic/supervised registrar group was not lower than the most senior physician intubator group (relative risk [RR] 0.59, 95% confidence interval [CI]: 0.26–1.32; P = 0.198) and after adjustment the risk was also not lower (RR 0.60, 95% CI: 0.24–1.54; P = 0.289). First pass failure occurred in 12 (3.1%) and 1 (4.8%) patients intubated by paramedic/supervised registrar and most senior physician groups, respectively (P = 0.498). The median (95% CI) adjusted difference in contact to intubation time between paramedic/supervised registrar first intubator and most senior physician groups was −2 min (−7 to 3; P = 0.392). Total adjusted scene time was also not significantly different between groups (median difference 2 min, 95% CI: −3 to 7; P = 0.500).
Conclusions
Paramedics conducting most intubations within an ICOM are both safe and efficient. Larger studies are required to examine differences between physician subgroups.
期刊介绍:
Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine.
Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.