Do mannequin chests provide an accurate representation of a human chest for simulated decompression of tension pneumothoraxes?

BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationally sound and realistic mannequins.The objective of this study is to identify if the chest wall thickness(CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest.METHODS:This is a two-part study.A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins.The literature search was conducted using the Cochrane Central Register of Controlled Trials,MEDLINE,CINAHL,and EMBASE databases from their beginning until the end of May 2012.Key words included chest wall thickness,tension pneumothorax,pneumothorax,thoracostomy,needle thoracostomy,decompression,and needle test.Studies were included if they reported chest wall thickness.RESULTS:For the literature review,4 461 articles were located with 9 meeting the inclusion criteria.Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line.The Laerdal? manikin in the area of the second intercostal space mid clavicular line,right side of the chest was 1.1 cm thick with the left 1.5 cm.The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm.CONCLUSION:Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.

Undergraduate paramedic students cannot do drug calculations

Previous investigation of drug calculation skills of qualified paramedics has highlighted poor mathematical ability with no published studies having been undertaken on undergraduate paramedics. There are three major error classifications. Conceptual errors involve an inability to formulate an equation from information given, arithmetical errors involve an inability to operate a given equation, and finally computation errors are simple errors of addition, subtraction, division and multiplication. The objective of this study was to determine if undergraduate paramedics at a large Australia university could accurately perform common drug calculations and basic mathematical equations normally required in the workplace. A cross-sectional study methodology using a paper-based questionnaire was administered to undergraduate paramedic students to collect demographical data, student attitudes regarding their drug calculation performance, and answers to a series of basic mathematical and drug calculation questions. Ethics approval was granted. The mean score of correct answers was 39.5% with one student scoring 100%, 3.3% of students （n=3） scoring greater than 90%, and 63% （n=58） scoring 50% or less, despite 62% （n=57） of the students stating they ＇did not have any drug calculations issues＇. On average those who completed a minimum of year 12 Specialist Maths achieved scores over 50%. Conceptual errors made up 48.5%, arithmetical 31.1 % and computational 17.4%. This study suggests undergraduate paramedics have deficiencies in performing accurate calculations, with conceptual errors indicating a fundamental lack of mathematical understanding. The results suggest an unacceptable level of mathematical competence to practice safely in the unpredictable prehospital environment.

Drug calculation ability of qualified paramedics:A pilot study

BACKGROUND: The inability of paramedics to perform accurate calculations may result in a compromise of patient safety which may result from under or over dosing of drugs, incorrect joules for defibrillation, or a major adverse event such as death. The objective of this study was to identify the drug calculation and mathematical ability of qualified operational paramedics.METHODS: The study used a cross-sectional design with a paper-based calculation questionnaire. Twenty paramedics enrolled in an intensive care paramedic course were eligible to participate in the study. The questionnaire consisted of demographic, drug calculation(seven questions), and mathematical(five) questions. Students were given no notice of the impending study and use of a calculator was not permitted.RESULTS: All eligible students participated in the study. The average time employed as a paramedic was 7.25 years, SD 2.5 years, range four years to twelve years. Four(20%) students got all 12 questions correct, and five(41.6%) got 50% or less. The average score was 8.6(71.7%) correct, SD 2.8 correct, range 3 to 12 correct questions. There were eight(40%) conceptual errors, 12(60%) arithmetical errors, and five(25%) computational errors.CONCLUSION: The results from this study supports similar international studies where paramedic's ability to undertake mathematical and drug calculations without a calculator varies, with some results highlighting the paramedics mathematical skills as a potential risk to patient safety. These results highlight the need for regular continuing mathematical and drug calculation practice and education to ensure a lower error rate.