美国匹兹堡大学发现对护理人员的训练存在缺陷

 
根据2005年8月期《重症监护医学》的一项研究报道，急诊医学研究人员发现，在患者被送到医院的时候，许多护理人员不具备足够的急诊气管插管的临床经验。

气管内插管（ETI）是一种急诊医疗程序，用于向患者肺内输送氧气。使用过去一年的患者资料，美国匹兹堡大学医学院的研究人员分析检查了护理人员操作的插管频率。他们发现三分之二的护理人员每年操作的插管次数少于3次，而且总计40％的护理人员根本没有操作过。尽管该项研究显示空中医疗人员和城市护理人员操作气管的机会多一些，但是这些差异非常之小。

在美国的护理学生通常被要求在毕业之前完成5次插管手术，与急诊科住院医生相比，他们被要求35次操作，或者麻醉科住院医生则在毕业之前必须完成50次操作。以前对综合医疗手术的研究表明，错误发生率、不良事件、预后很差都与手术经验的多少有关系。

美国匹兹堡大学医学院急诊医学助理教授、该篇论文的主要作者Henry E. Wang说“我们需要找到更好的办法，对护理人员操作这种困难手术的能力进行培训，或者找到更好更简单的方法来处理气道。”
 
Paramedic-Training Challenges
 
Emergency medical researchers have found that many paramedics do not have enough clinical experience in the insertion of emergency breathing tubes in patients before arriving at a hospital, according to a study in the August 2005 issue of Critical Care Medicine.

Endotrachial intubation (ETI) is an emergency medical procedure performed to deliver oxygen into a patient’s lungs. Using patient data over one year, researchers at the University of Pittsburgh School of Medicine (PA, USA) examined the frequency of intubation performed by paramedics. They found that two-thirds of paramedics performed intubation less than three times per year while 40% performed no intubations at all. Although the study showed that air medical and urban paramedics were exposed to slightly more intubation procedures, these differences were small.

Paramedic students in the United States are required to perform only five intubation procedures before graduation, compared to emergency medicine residents, who are required to perform 35, or anesthesiology residents, who must complete 50 before graduation. Prior studies of complex medical procedures have shown that the occurrence of errors, adverse events, and poor outcomes is associated with the volume of procedural experience.

“We need to find better ways to train paramedics to perform this very difficult procedure or find better and simpler ways to manage the airway,” said lead author Henry E. Wang, M.D., M.P.H., assistant professor of emergency medicine at the University of Pittsburgh School of Medicine.