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Paramedics report lack of critical care training

By Kathryn Doyle

NEW YORK (Reuters Health) - Paramedics often have to transport patients in critical condition from one medical facility to another. In a new survey, some said they perform procedures and use tools they haven't been trained in on the way.

The finding that paramedics work beyond their job descriptions was not a surprise to lead author William Raynovich.

"By definition, critical care patients require the highest level of intensive skill and are at the greatest risk of death or chronic disability," Raynovich, of Creighton University EMS Education in Omaha, Nebraska, said.

"It is not just a matter of correctly administering a drug dosage as ordered or adjusting the settings on the equipment as prescribed. The physiologic condition of critical patients deteriorates rapidly and correct assessments and interventions must be quickly performed."

The new study should spark a discussion about paramedic training, Raynovich told Reuters Health.

There are national guidelines for paramedic training and each state defines the scope of care that paramedics provide. But there are no standards for critical care paramedics who take very sick patients from one facility to another.

For their study, the researchers sent surveys to 1,991 paramedics across the U.S. Of the 610 who responded, 317 said they worked in critical care transport.

Four out of five of those paramedics worked on ambulances. The rest treated patients being moved on helicopters or airplanes.

Raynovich and his colleagues asked the respondents what skills and tools they used in transit and whether they had received education in those areas.

Among paramedics who reported using neonatal incubators, 14 percent had received no training in their use.

Likewise, between 11 and 12 percent of those who reported handling blood products, managing patients with chest tubes or using devices to measure pressure inside the skull were not trained to do so.

"It is most troubling that critical care patients are transported by paramedic crews that have not been adequately trained to manage the patient conditions, and the medications that are being administered to the patient, and the equipment that is in use during the transports," Raynovich said.

Inadequate training for paramedics could harm critical care patients, he said.

Paramedics should be trained to deal with the situations and tools they often have to use, Raynovich said. They should not be the primary health worker for patient transport when skills and equipment exceed their training.

The surveyed paramedics said they were often the person in charge of providing care during transport. When transporting children, for instance, close to three-quarters of paramedics reported being the primary caregiver, according to results published in Air Medical Journal.

One way to fix the problem would be to send a nurse or doctor along with the transport team to be the primary caregiver. But that's not always possible, which makes paramedic training all the more important, Raynovich said.

"We have very gifted EMS professionals who are asked to do more with less," Chris Nollette said. "In this case, the less may be training and education on invasive devices and procedures."

Nollette is the past president of the National Association of EMS Educators. He now directs the EMS program at the Ben Clark Training Center at Moreno Valley College in California. He was not involved with the new study.

A quick in-service training to address the skills and equipment on this list wouldn't be an appropriate substitute for more thorough training and education, Nollette told Reuters Health.

"This training and education must also accompany plenty of clinical time in the hospital arena to ensure that the medic has actual patient experience and a support system to identify the needs and problems they will encounter," he said.

SOURCE: http://bit.ly/Hu5zlQ Air Medical Journal, September 2013.

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