Earticle

Purpose: This study aimed to compare the effects of rescue ventilation maneuvers on the quality of two-rescuer cardiopulmonary resuscitation (CPR). Methods: We implemented mouth to mouth (MMV), mouth to pocket mask (MPV) and bag-valve mask ventilation (BMV) maneuvers. Each team of two-nurses was randomized to perform three consecutive sessions of two-rescuer CPR by using three artificial ventilation maneuvers. Results: The subjects were 26 teams of nurses (female: 96.2%, male: 3.8%, age: 26.6 years). Failed ventilation was more frequent in BMV (2.23±2.21, p ＜.001) than MMV (0.31±0.74) and MPV (0.38±0.64). BMV had more compressions per minute (93.7±5.7) than MMV (87.0±7.2, p = .001) and shorter total compression pause time (46.1±5.8sec) and compression pause fraction (23.3±2.2%) than MMV (54.8±10.3sec, p = .001, 25.5±3.5%, p = .001, respectively) and MPV (53.1±7.1sec, p = .006 and 25.8±2.6%, p = .006, respectively). Conclusion: In our simulation study, BMV reduced the compression pause time and increased the number of compressions per minute, thus indicating CPR provided to patients was effective. However, considering the high rate of ventilation failure, we recommend periodic training.

Purpose: To determine factors of kindergarten teachers’willingness to perform cardiopulmonary resuscitation (CPR) and to suggest education methods toward CPR. Methods: We interviewed 92 kindergarten teachers trained to administer CPR. Among them, 74 answered the questions regarding CPR experience, barriers, and willingness. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CIs) for the association of willingness factors to cognition, performance, and attitude toward CPR. Results: Of the participants, 73 (98.7%) were female, 32 (43.0%) were in their twenties (mean age: 33.9 years), 31 (41.9%) graduated college, 47 (63.5%) had ＜10 years of tenure, and 65 (87.8%) and 62 (83.8%) indicated willingness to perform CPR to family members and kindergarteners, respectively. Barrier factors included fear of performing CPR incorrectly (46.8%) and injuring the victim (25.6%). Willingness factors included understanding brain death (37.7%) and performing CPR correctly (26.1%). Willingness predictors included attitude toward family members (OR: 4.54, 95% CI: 1.19 –17.39, p = .027) and kindergarteners (OR: 3.07, 95% CI: 1.15-8.22, p = .025), and cognition to kindergarteners (OR: 0.36, 95% CI: 0.13-0.99, p = .050). Conclusion: The kindergarten teachers were more willing to perform CPR to family members and kindergarteners than to others in an attitude-dependent manner.

Purpose: The purpose of this study was to improve airway management ability by comparing the speed, angle of the neck, and confidence and ease of supraglottic airway laryngopharyngeal tube (SALT) and endotracheal intubation via direct laryngoscopy. Methods: The subjects of this experimental research study with a randomized crossover design were 44 emergency medicine technician - paramedics working in the fire department of 'J' - do. SPSS version 19.0 was used in the statistical analysis. Results: Speed and angle of the neck (p ＜.001), as well as confidence and ease (p ＜.001), showed significant differences between endotracheal intubation with a SALT and endotracheal intubation via direct laryngoscopy. Conclusion: If endotracheal intubation via direct laryngoscopy is difficult to use or in trauma patients, using a SALT is safe and enables fast intubation. Moreover, in order to improve the efficiency of advanced airway management, the application of SALT should be introduced in the domestic scene.

Purpose: The purpose of the study was to identify differences in paramedic image and its determinants between paramedic and non-paramedic students. Methods: From September 18 to 26, 2013, data were collected from 146 universities students by using a self-reported questionnaire. Results: The mean paramedic image score was 4.22 for paramedic students and 3.89 for non-paramedic students. The paramedic students had a more positive paramedic image than the non-paramedic students. Among three subcategories of paramedic image, professional image was selected as the most positive factor. The determinants of paramedic image differed between the paramedic and non-paramedic students. The mean subjective determinants score showed higher than those of any other determinants for both student groups. Conclusion: The findings of this study showed that practical strategies are needed to promote a positive paramedic image among non-paramedic students.

Purpose: This study aimed to identify the effects of job insecurity and job engagement on turnover intention of paramedics who work in emergency medical institutions. Methods: From October 14 to 28, 2014, data were collected by structured questionnaires from 171 paramedics who were working in emergency medical institutions. The data were analyzed by using SPSS/WIN 21.0. Results: Of the 171 subjects, 57.3% were temporary employees, of whom 87.5% were working in regional emergency medical centers. The mean scores were 3.19 for job insecurity, 4.58 for job engagement, and 3.28 for turnover intention. The correlation between the variables showed that the higher the job insecurity of the participants, the higher their turnover intention (r = .397, p ＜.001). Moreover, the higher their job engagement, the lower their turnover intention (r = -.354, p ＜.001). The variable that most significantly affected turnover intention was job insecurity. The coefficient of determination (R2) of job insecurity and job engagement was 24.3%. Conclusion: A law should be enacted to involve paramedics as required personnel for emergency medical institutions in order to enhance the quality of emergency medical services and provide prompt and professional emergency medical services to emergency patients.

Purpose: This study aimed to investigate paramedic students’ awareness and attitude toward a do not resuscitate (DNR) order and death. Methods: This research was conducted among 421 students from the Department of Emergency Medical Technology in a 4-year college located in the Chungcheong and Daejeon districts, from May 14 to 22, 2014. Data were analyzed by using IBM SPSS 21.0. Results: The mean level of attitude toward death was 2.17. The paramedic students with clinical experience showed a positive attitude toward death, of whom 72.0% answered that a DNR order is necessary. The mean level of attitude toward DNR was 2.88. The paramedic students with clinical experience showed a positive attitude toward a DNR order. They indicated that sanctity of life should be respected rather than extending ineffective treatment and that patients’ decisions on DNR should be respected. The students who had more knowledge about DNR and felt the necessity of DNR had a positive attitude about death and DNR. Conclusion: Paramedic students need systematic education for proper recognition and values establishment about death and DNR.

Purpose: Although appointed as a national competency standards (NCS) based reserves department, the department of emergency medical technology, an NCS-based emergency department, is mainly focused on subject deduction for a NCS-based curriculum. Methods: Job models were formed and verified by combining the competency unit of NCS and the duty of Developing a curriculum (DACUM) based on the development procedure indicated in the guidelines for a NCS-based curriculum. The mapping method of the subject was performed by deducting necessary competency units (duty) and competency unit elements (task) by connecting with the composition items of NCS and DACUM. Results: Job models combined with job analysis for the NCS and DACUM were reduced to 13 competency units (duty) and 79 competency unit elements (task). A modified method such as the 1:N method was mainly applied as a subject-matching method with consideration of the competency level and size of the competency unit. Conclusion: It would be a desirable direction to develop a NCS-based curriculum in the center of the practice subject in consideration of the size of the competency unit and competency level of the competency unit element. The existing curriculum should be promoted as a field-oriented curriculum at the complementary level.

Purpose: This study aimed to provide basic data for clinical training program development by analyzing the operating conditions and satisfaction in a clinical training program for 119 emergency medical technicians (EMTs) in South Korea. Methods: Data from 84 EMTs were collected on June 19, 2014. We administered a 64-item questionnaire about operating conditions and satisfaction in the clinical training program, and analyzed data (SPSS v 21.0). Results: The degree of performance in the field, importance of the item in the field, and level of difficulty were 3.36, 4.23, and 3.21, respectively. In the number of times that an item was directly performed according to the subjects’general characteristics a statistically difference in sex (p = .000), duty (p =.021), and total working time of trainees (p = .002). The subjects’total satisfaction score was 3.77. The difference in satisfaction according to the subjects’characteristics was a statistically significant in terms of sex (p = .016) and clinical training area (p = .005). Conclusion: A more efficient training system for hospital clinical training courses should be developed. The operation condition analyzed in this research may contribute to the improvement of the performance of EMTs.