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A randomised study on the comparative performance of German paramedics after technical versus non-technical skills
Hendrik Eismann1, Jörn Halser2, Mathias Robert2
1Hannover Medical School, Department of Anaesthesiology and Intensive Care Medicine, Hannover, Germany.
Background:
The working environment of pre-hospital emergency medicine represents the framework conditions of high-risk organisations. Non-technical skills are an important foundation for successful performance. In Germany, a new job profile - advanced paramedic - was introduced in 2014, which for the first time also included non-technical skills in the curriculum. Another special feature is that for the first time it is regulated how paramedics proceed with selected extended procedures, such as the application of selected medication. The advanced paramedic has a mandatory annual training requirement of 30 hours. Since there are no requirements in terms of content, we investigated whether training of non-technical or technical skills improve the care of a simulated patient. The results should indicate which priorities should be set in training.
Methods:
Teams were randomised while training and debriefing took place depending on the study arm with a focus on technical procedures and non-technical skills. Six months later, we evaluated the performance of the teams in a simulation scenario using "time-key-item-product" score and the use of incident management methods.
Results:
Comparing performance with crisis resource management (CRM)/ non-technical skills and technical training, we found no significant difference in time-key-item-product score (TKIP). There was also no difference in the application of incident management methods. Checklists were only used in small numbers. Over half of the teams failed to complete 75% of the required procedures in the scenario.
Conclusion:
It is noticeable that only a few groups carried out all required procedures. The incomplete treatment suggests that the use of checklists can help emergency teams. Dealing with non-technical skills should be trained intensively, as their use does not yet appear to be routine.