Feasibility of Continuous Positive Airway Pressure by Primary Care Paramedics

Prehospital Emergency Care, Vol. 16, No. 4, Pages 535-540

Continuous positive airway pressure (CPAP) has been used effectively in the prehospital environment for a wide range of respiratory emergencies but the authors felt that the feasibility of CPAP when used by basic life support level care providers (denoted as primary care paramedics – PCPs) in comparison with advanced care paramedics (ACPs) has not been established.

An observational study of 302 consecutive cases of CPAP use over one year beginning June 25, 2009 was studied. Compliant use was defined as 100% adherence to the provincial CPAP medical directive, including specifics of patient presentation, vital signs, and appropriate documentation by the paramedic, as well as proper use, titration, and discontinuation of CPAP equipment according to protocol.

Using the criteria set out for compliant CPAP use, the highest level of compliance among the ACPs and the PCPs was 98.6% and 98.9%, respectively, for documenting indication for CPAP use. The lowest level of compliance among the ACPs was 84.4% for titration of CPAP during treatment, and the lowest level of compliance among the PCPs was 90% for adherence to criteria for CPAP application according to patients’ vital signs. Overall, the criteria for compliant use of CPAP were met for 76.8% (232/302) of the call reports examined. The rate of compliant use of CPAP was 75.9% for ACP calls and 78.9% for PCP calls.

This study found no significant difference in the compliant use of prehospital CPAP between paramedics trained to the PCP level and those trained to the ACP level. This study suggests that CPAP use by basic life support level paramedics/ care providers may be feasible.

http://informahealthcare.com/doi/abs/10.3109/10903127.2012.689930