A cross sectional study on the acceptance of pre-hospital continuous positive airway pressure ventilation among ambulance paramedic in an urban emergency medical service system in a developing country

Abstract

Objectives: To assess the acceptance among the developing country urban paramedics towards pre-hospital continuous positive airway pressure (CPAP) ventilation.

Methods: A cross-sectional prospective study was conducted among the ambulance paramedics working at the pre-hospital care unit of the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia from March 2012 to August 2012 on ambulance paramedics. Questionnaires were used to assess their experience, knowledge, and perception, while their competencies were assessed using an Objective Structured Clinical Examination by 2 independent-calibrated raters on the use of the Boussignac CPAP system.

Results: Twenty-six ambulance paramedics qualified for this study with an average work experience of 5.59+/-3.53 years. A total of 76.9% had no formal training for CPAP during their study years. Knowledge of CPAP apparatus-arrangement sequence scored as 88.5% correct, while 96.2% scored `Good` to `Very-good` in the ability to diagnose conditions that warrant its use. A total of 76.9% were confident to monitor patients on CPAP, and 61.5% in applying the device. However, only 53.8% were confident to start the CPAP, and 38.5% to troubleshoot if any problem arose. For perceptions, 96.2% felt it was easy to learn CPAP, while 88.5% felt that paramedics could use it without supervision, and 80.8% felt that it should not be confined to the Emergency Department setting. A total of 96.1% were competent in CPAP application.

Conclusion: Developing country urban ambulance paramedics possessed adequate knowledge, positive attitudes, and demonstrated good CPAP application skills. However, lack of confidence towards decision to initiate and troubleshoot of potential complications were the main obstacles hindering its use.