Background
Methods
The expert panel
Data point definitions
Core data variables
System variables
Patient variables
Post-intervention variables
Specific data issues
The nominal group technique
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Unpublished literature review of pre-hospital airway management and outcome by one of the authors (SS)
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Recent guidelines from SSAI on pre-hospital airway management [12]
Results
Data variable number | Data variable name | Type of data | Data variable categories or values | Definition of data variable |
---|---|---|---|---|
1 | Highest Level of EMS provider on scene | Ordinal | 1 = EMS non-Paramedic 2 = EMS-Paramedic 3 = Nurse 4 = Physician 5 = Unknown | Highest level of EMS provider on scene, excluding any non-EMS personnel (bystanders, family, etc) |
2 | Airway devices available on scene | Nominal | 1 = Bag Mask Ventilation 2 = SAD 3 = ETT 4 = Surgical airway 5 = None 6 = Unknown | Airway devices available on scene and provider on-scene who knows how to use it (select all that apply) |
3 | Drugs for airway management available on scene | Nominal | 1 = Sedatives 2 = NMBA 3 = Analgesics/opioids 4 = Local/topic anaesthetic 5 = None | Drugs used for airway management, available on scene and someone competent to administer them (select all that apply) |
4 | Main type of transportation | Nominal | 1 = Ground ambulance 2 = Helicopter ambulance 3 = Fixed-wing ambulance 4 = Private or public vehicle 5 = Walk-in 6 = Police 7 = Other 8 = Not transported 9 = Unknown | Main type of transportation vehicle (if multiple selected, vehicle used for the majority of the transportation phase) |
5 | Response time | Continuous | Minutes | Time from when the Emergency Medical Communication Centre operator initiates transmission of the dispatch message to the first resource/unit time of arrival on the scene of the first unit, as reported by the first unit |
Data variable number | Data variable name | Type of data | Data variable categories or values | Definition of data variable |
---|---|---|---|---|
6 | Co-morbidity | Ordinal | 1 = No (ASA-PS = 1) 2 = Yes (ASA-PS = 2-6) 3 = Unknown | ASA-PS definition 1 = A normal healthy patient 2 = A patient with mild systemic disease 3 = A patient with severe systemic disease 4 = A patient with severe systemic disease that is a constant threat to life 5 = A moribund patient who is not expected to survive without the operation 6 = A declared brain-dead patient whose organs are being removed for donor purposes |
7 | Age | Continuous | YY or MM | Years rounded down. Ages under 1 year are reported in decimals (e.g., 6 month = 0.5 year) |
8 | Gender | Nominal | 1 = Female 2 = Male 3 = Unknown | Patient gender |
9 | Patient category | Nominal | 1 = Blunt trauma (incl. burns and strangulation) 2 = Penetrating trauma 3 = Non trauma (incl. drowning and asphyxia) 4 = Unknown | Dominating reason for emergency treatment |
10 | Indication for airway intervention | Nominal | 1 = Decreased level of consciousness 2 = Hypoxemia 3 = Ineffective ventilation 4 = Existing airway obstruction 5 = Impending airway obstruction 6 = Combative or uncooperative 7 = Relief of pain or distress 8 = Cardiopulmonary arrest 9 = Other, specify | Dominating indication for airway intervention |
11 | Respiratory rate, initial | Continuous | Number/ Not recorded | First value recorded by the EMS provider on scene |
12a | Systolic blood pressure, initial | Continuous | Number/ Not recorded | First value recorded by the EMS provider on scene |
13a | Heart rate, initial | Continuous | Number/ Not recorded | First value recorded by the EMS provider on scene |
14 | GCS, initial (m/v/e) | Ordinal | Motor 1-6 Verbal 1-5 Eyes 1-4 Not recorded | First value recorded by the EMS provider on scene See also GCS definitions |
15a | SpO2, initial; state: with or without supplemental O2 | Continuous and nominal | Number/Not recorded 1 = Without supplemental O2 2 = With supplemental O2 3 = Unknown if supplemental O2 | First value recorded by the EMS provider on scene |
Data variable number | Data variable name | Type of data | Data variable categories or values | Definition of data variable |
---|---|---|---|---|
16 | Post-intervention ventilation | Nominal | 1 = Spontaneous 2 = Controlled 3 = Mixed 4 = Unknown | How is patient ventilated following airway management? If both spontaneous and controlled, choose mixed. |
12b | Post-intervention systolic blood pressure (SBP) | Continuous | Number/Not recorded | First value recorded by the EMS provider after finalised airway management |
15b | Post-intervention SpO2 | Continuous | Number/Not recorded | First value recorded by the EMS provider after finalised airway management |
17a | Post-intervention EtCO2 | Continuous | Number/Not recorded | First value recorded by the EMS provider after finalised airway management |
12c | Post-intervention SBP on arrival | Continuous | Number/Not recorded | First value recorded by the EMS provider after patient arrives at hospital |
13b | Post intervention heart rate | Continuous | Number/Not recorded | First value recorded by the EMS provider after finalised airway management |
15c | Post-intervention SpO2 on arrival | Continuous | Number/Not recorded | First value recorded by the EMS provider after patient arrives at hospital |
17b | Post-intervention EtCO2 on arrival | Continuous | Number/Not recorded | First value recorded by the EMS provider after patient arrives at hospital |
18 | Survival status | Nominal | 1 = Dead on-scene or on arrival 2 = Alive on hospital arrival 3 = Unknown | Patient survival status: EMS treatment and on arrival at hospital |
19 | Attempts at airway intervention | Nominal | 1 = One attempt 2 = Multiple attempts by one provider 3 = Multiple attempts by two or more providers 4 = Unknown | Number of attempts at securing the airway with a supraglottic airway device (SAD) or tracheal intubation (TI). |
20 | Complications | Nominal | 1 = ETT misplaced in oesophagus 2 = ETT misplaced in right mainstem bronchus 3 = Teeth trauma 4 = Vomiting and/or aspiration 5 = Hypoxia 6 = Bradycardia 7 = Hypotension 8 = Other, define 9 = None recorded | Problems and mechanical complications recognised on scene and caused by airway management. Physiologic complications (5, 6, and 7) are regarded as such if they were not present before airway intervention and were recorded during or immediately after airway management. The following definitions are used: hypoxia: SpO2 < 90% bradycardia: pulse rate <60 bpm hypotension: SBP < 90 |
21 | Drugs used to facilitate airway procedure | Nominal | 1 = Sedatives 2 = NMBA 3 = Analgesics/opioids 4 = Local/topic anaesthetic 5 = None | Drugs used to facilitate the airway intervention. Select all that apply |
22 | Intubation success | Nominal | 1 = Success on first attempt 2 = Success after more than one attempt and one rescuer 3 = Success after more than one attempt and multiple rescuers 3 = Not successful | Successful intubation defined as tube verified in the trachea. An intubation attempt is defined as attempted laryngoscopy with the intent to intubate |
23 | Device used in successful airway management | Nominal | 1 = Bag Mask Ventilation 2 = SAD 3 = Oral TI 4 = Nasal TI 5 = Surgical airway 6 = None 7 = Unknown | Device used to manage successful airway or device in place when patient is delivered at hospital/ED |
Discussion on inclusion/exclusion criteria and core data variables
Inclusion criteria
Exclusion criteria
Fixed system variables
Data variable number | Data variable name | Type of data | Data variable categories or values | Definition of data variable |
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1 | Population | Continuous | Number | Population count in the primary response area of the EMS |
2 | Area | Continuous | Number | Area in sq km or sq miles of primary response area of the EMS |
3 | Rural, urban, split | Nominal | 1 = Urban 2 = Rural 3 = Split | Urban area defined as: "De facto population living in areas classified as urban according to the criteria used by each area or country. Data refer to 1 July of the year indicated and are presented in thousands". Rural area defined as: "De facto population living in areas classified as rural. Data refer to 1 July of the year indicated and are presented in thousands". |
4 | Usual tiered response | Free text | Free text | Describe briefly |
5 | Time intervals collected | Free text | Free text | Describe briefly |
6 | Service mission types | Free text | Free text | Describe briefly; e.g., mainly trauma or mixed patient population |
7 | Times available | Free text | Free text | Describe briefly |
8 | Established airway management protocols | Free text | Free text | Describe briefly |
9 | Airway management techniques available | Free text | Free text | Describe briefly |
10 | Describe type of training in airway management | Free text | Free text | Describe briefly |
11 | Type of tracheal tube confirmation technique | Nominal | 1 = Auscultation 2 = Colorimetry 3 = Capnometry 4 = Capnography 5 = none | |
12 | Type of available ventilator | Free text | Free text | Describe briefly |