The Efficiency of Bag-Valve Mask Ventilations by Medical First Responders and Basic Emergency Medical Technicians
Total Page：16
File Type：pdf, Size：1020Kb
California State University, San Bernardino CSUSB ScholarWorks Theses Digitization Project John M. Pfau Library 2003 The efficiency of bag-valve mask ventilations by medical first responders and basic emergency medical technicians John Vincent Commander Follow this and additional works at: https://scholarworks.lib.csusb.edu/etd-project Part of the Vocational Education Commons Recommended Citation Commander, John Vincent, "The efficiency of bag-valve mask ventilations by medical first responders and basic emergency medical technicians" (2003). Theses Digitization Project. 2310. https://scholarworks.lib.csusb.edu/etd-project/2310 This Project is brought to you for free and open access by the John M. Pfau Library at CSUSB ScholarWorks. It has been accepted for inclusion in Theses Digitization Project by an authorized administrator of CSUSB ScholarWorks. For more information, please contact [email protected]. THE EFFICIENCY OF BAG-VALVE MASK VENTILATIONS BY MEDICAL FIRST RESPONDERS AND BASIC EMERGENCY MEDICAL TECHNICIANS A Project Presented to the Faculty of California State University, San Bernardino In Partial Fulfillment of the Requirements for the Degree Master of Arts in Education: Career and Technical Education by John Vincent Commander September 2003 THE EFFICIENCY OF BAG-VALVE MASK VENTILATIONS BY MEDICAL FIRST RESPONDERS AND BASIC EMERGENCY MEDICAL TECHNICIANS A Project Presented to the Faculty of California State University, San Bernardino by John Vincent Commander September 2003 Approved by: © 2003 John Vincent Commander ABSTRACT• Bag-valve mask (BVM) ventilation maintains a patient's oxygenation and ventilation until a more definitive artificial airway can be established. In the prehospital setting of a traffic collision-or • medical aid scene this is performed by an Emergency Medical Technician or medical first responder. Few studies have looked at the effectiveness of Bag-valve mask (BVM) or the complication rate of ventilating an unprotected airway. The purpose and goal of this study was to educate both medical first responders and basic emergency medical technician's through positive attribution feedback loop; the important objectives of bag-valve mask (BVM) ventilation: (1) manual airway protection; and (2) adequate tidal volume. iii ACKNOWLEDGMENTS I would like to thank the following individuals who have contributed greatly to the success of this Project: Professor Joseph A. Scarcella, Ph.D. for his dedication to the students of the Career and Technical Education Department at California State University, San Bernardino. Dr. Scarella spent more numerous hours than any other person I know of reading theses, responding to questions, answering emails and phone calls, updating various Internet sites and providing valuable guidance and encouragement. As my advisor he has played an active role in both my research, the expansion of my knowledge, and my overall education but most of all helping me to get back on track and remain "focused" in my research. He has been a true mentor during my long trek to achieve the Masters Degree; for this, I am deeply grateful and appreciative. Special thanks to Professor Ronald K. Pendleton, Ph.D, from the Vocational Education Department at California State University, San Bernardino for his guidance in the early years of my formal education has proven to be invaluable to me. His many enlightening conversations and advice are appreciated far more that he will perhaps ever know. iv To Timothy Thelander, whom I owe my deepest and profound heart felt gratitude, for getting me through the paper chase, computer quagmires and keeping me on track and knowing what was best for me in order to be successful in completion of this project. v DEDICATION This project is dedicated to Daved van Stralen M.D., Pediatric Intensivist, at Loma Linda University Medical Center and Children's Hospital and Medical Director for the San Bernardino County Fire Department. He is a visionary in pre-hospital and pediatric care management in southern California, an internationally known leader in pre-hospital emergency medicine and pediatric care; a man whose academic accomplishments are surpassed only by his leadership, kindness and compassion, and most of all a good friend. Since 1995 he has been an exemplary role model providing others and me with encouragement, motivation, inspiration, and insight all for the benefit of humankind. I can only hope that this research project on the efficiency of bag-valve mask ventilation's by medical first responders and basic emergency medical technicians will complement the years and timeless hours Dr. van Stralen has dedicated to prehospital care in the Inland Empire area. To my Late loving mother, Jesusita S. Commander for without her love and continued support this mile stone in my life could never have been achieved. TABLE OF CONTENTS ABSTRACT................................................ iii ACKNOWLEDGMENTS ........................................ iv LIST OF FIGURES......................................... viii CHAPTER ONE: BACKGROUND Introduction ...................................... 1 Context of the Problem ............................ 1 Purpose of the Project........................... 4 Significance of the Project ...................... 5 Assumptions ....................................... 5 Limitations and Delimitations . ............... 6 Limitations .................................. 6 Delimitations ................................ 6 Definition of Terms ............................... 7 Organization of the Thesis....................... 15 CHAPTER TWO: REVIEW OF THE LITERATURE Introduction.............. 17 National Standard Curriculum ..................... 17 California Standard Curriculum ................... 21 Emergency Medical Service Training Manuscript Review......... 21 Contemporaneous Literature Review ............... 23 Summary........................... 39 CHAPTER THREE: METHODOLOGY ■ Introduction ...................................... 42 vi Population Served.................... 42 Existing System ............................. 43 Proposed System ............................. 45 Summary............................................ 51 CHAPTER FOUR: CONCLUSIONS AND RECOMMENDATIONS Introduction ...................................... 53 Conclusions...................... 53 Recommendations ................................... 55 Summary............................................ 56 APPENDIX A: DEPARTMENT OF TRANSPORTATION FIRST RESPONDER CURRICULUM MODULE - 2 (RESPIRATORY) ............................. 57 APPENDIX B: DEPARTMENT OF TRANSPORTATION EMERGENCY MEDICAL TECHNICIAN - BASIC MODULE - 2 (RESPIRATORY) ............................. 71 APPENDIX C: CALIFORNIA CODE OF REGULATIONS, TITLE 22. DIVISION 9 CHAPTER 1.5 STANDARDS FOR PUBLIC SAFETY PERSONNEL SECTIONS 100018 AND 100019 ......................... 86 APPENDIX D: CALIFORNIA.CODE OF REGULATIONS, TITLE 22. DIVISION 9 CHAPTER 2. EMERGENCY MEDICAL TECHNICIAN SECTIONS 100063 AND 100075 ..................................... 89 APPENDIX E: BAG VALVE MASK VENTILATION SURVEY ........ 92 APPENDIX F: BAG VALVE MASK DATA COLLECTION CARD ..... 95 APPENDIX G: BAG VALVE MASK DATA COLLECTION CARD (VENTILATION) ............................. 97 APPENDIX H: BAG VALVE MASK VENTILATION PATIENT DATA....................................... 99 REFERENCES.............................................. 101 vii LIST OF FIGURES Figure 1. Bag-Valve Mask.............................. 8 Figure 2. Esophageal Tracheal Combitube .............. 10 Figure 3 . Head Tilt Chin Lift Maneuver............... 11 Figure 4. Jaw-Thrust Maneuver ......................... 11 Figure 5. Laryngoscope ................................ 12 Figure 6. Nasopharyngeal Airways ..................... 13 Figure 7. Oropharyngeal Airways ...................... 13 viii CHAPTER ONE BACKGROUND Introduction The contents of Chapter One presents an overview of the project. The contexts of the problem are discussed followed by the purpose, significance of the project, and assumptions. Next, the limitations and delimitations that apply to the project are reviewed. Finally, definitions of terms are presented. Context of the Problem The primary goal of Emergency Medical Service (EMS) is the reduction of potentially preventable death and disability. This is achieved through early reversal of tissue hypoxia. The quickest and easiest way to disrupt oxygen-reaching tissues is through the loss of the airway. This is the basis for intervention of the familiar mnemonic called Airway, Breathing, Circulation, (ABC's). It is also the reason airway and breathing come first. The quickest and easiest way to reverse tissue hypoxia is through manual control of the airway with bag-valve-mask ventilation. Loss of airway is thus a major and preventable contribution to highway death or Medical emergency. 1 Emergency Medical Services Systems (EMSS) label manual control of the airway and bag-valve-mask ventilation as Basic Life Support (BLS). The unintended consequence of this is the consideration by Emergency Medical Service (EMS) caregivers that manual airway control and bag-mask ventilation is simple and easy. It then becomes a task for the medical first responder or Emergency Medical Technician (EMT) with the least experience. This commonly leads to inadequate airway control, which allows ventilated air to enter the stomach and displace gastric contents into the esophagus. The gastric contents, or emesis, obstructs the airway and aspire into the lungs. This is a problem has been observed