Abstract
BACKGROUND: The importance of establishing the airway and providing ven-tilation during resuscitation is well recognized; however, the effectiveness of de-mand-valve ventilation has not been fully addressed. METHODS & MATERI-ALS: We examined the differences in respiratory frequency (f), tidal volume (VT), and minute ventilation (VE) achieved by 15 emergency medical technicians (EMT) in a paramedic training course (EMT-4) and 16 second-year respiratory care stu-dents (RC) when ventilating a mannequin by three different methods: Laerdal pocket mask, a mask designed for mouth-to-mask ventilation (Method I), demand valve with one hand (Method II), and demand valve with two hands (Method III). RESULTS: The RC f was much higher for all three methods compared to the EMT-4. The EMT-4 demonstrated larger VT for each method compared to the RC. The RC only achieved acceptable VT with Method III. The EMT-4 and RC demonstrated statistically significant differences in VE between each method. How-ever, the clinical importance of these differences for EMT-4 is negligible. Although the mean values indicated achievement of minimum VTs by the EMT-4 with the pocket mask, 40% were unable to do so at 1 minute and 60% at 5 minutes. A great difference was seen in VE produced by RC with Method I at both 1 and 5 minutes vs Methods II and III. CONCLUSIONS: EMT-4 appear to have superior ventila-tion skills compared to RC. Superior performance skills may be related to (1) dif-ferent instructional methodologies, (2) effects of various amounts of experience in ventilating actual victims, and (3) greater familiarity of EMTs with the demand valve. As a consequence of this study, we are re-evaluating the instructional meth-odology used in our programs; we encourage other programs to do the same. We reommend that EMS providers and hospitals consider changing to an acceptable alternate mask in light of these and previous data.
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