The Discrepancy Between Subjective and Objective Performance on Setup of Mechanical Cardiopulmonary Resuscitation (MCPR) Among Emergency Medical Technicians in Taipei

• Main Authors: Wen-Shuo Yang, 楊文碩
• Other Authors: Wei-Chu Chie
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/r64335

碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 107 === Background Mechanical cardiopulmonary resuscitation (MCPR) devices have been broadly adopted in prehospital emergency care and fully equipped in every ambulance of Taipei City Fire Department (TFD). The quality assurance of MCPR includes formulated training materials, well-trained instructors, and quality control by the ambulance division of TFD. However, some emergency medical technicians (EMTs) cannot set up MCPR devices efficiently, leading to poor outcomes in out-of-hospital cardiac arrest (OHCA). Hence, we randomly selected EMTs in Taipei and tested their ability to set up MCPR devices in the prehospital setting, looking into factors which affect their performance. Methods In this cross-sectional study, we visited 45 stations of TFD without prior notice and tested a total of 210 EMTs. Three EMTs were tested each time as a team, and their roles were randomly assigned. They set up MCPR devices on a CPR training manikin, with the whole process being filmed. Each EMT would self-evaluate their overall performance and the time of chest compression interruptions. We then analyzed the differences between objective scores and those self-assessment scores with descriptive statistics, Chi-square test, Wilcoxon signed-rank test (matched pairs), two-sample Wilcoxon rank-sum (Mann-Whitney) test, and logistic regression. Results The median times of chest compression interruptions are 10 (subjective) and 16 (objective) seconds (p<0.001). The median overall scores are 8 (subjective) and 5.5 (objective) out of 10 (p<0.001). On the other hand, for EMT2, emergency medical knowledge positively correlated with overall performance (OR 2.15, 95% CI 1.31-3.52); for EMTP (paramedic), confidence negatively correlated with overall performance (OR 0.66, 95% CI 0.45-0.97). Finally, successful teamwork led to significantly higher percentage of complete chest recoil (OR 1.03, 95% CI 1.01-1.05) and chest compression fraction (CCF) (OR 1.21, 95% CI 1.03-1.43). Conclusion This study suggested that the recognition of chest compression interruptions is vital for EMTs to shorten those intervals and therefore improve the quality of chest compression. The correlation between knowledge/confidence and overall performance also provides insights for developing future EMT training courses. Moreover, our results once again underline the importance of teamwork during CPR and the installation of MCPR devices. A team-oriented EMT training model, the introduction of the third personnel (as team leader) for OHCA cases, more CPR training manikins for EMTs, as well as frequent practice and quality control, should increase the survival rate of OHCA patients in Taipei.