Table 1 The definitions of the possible states of the risk influencing factors (RIF).
RIF | Possible states of RIFs | ||
|---|---|---|---|
| Â | Poor | Average | Good |
Culture and Attitudes | - Does not adhere to current recommendations or guidelines for advanced pre-hospital airway management. - Ignores good practice - Relies only on own opinion of what is best practice - Thinks that own skills are sufficient and that there is no need for practice outside clinical practice - Not aware of or neglects use of protocol - Overly confident in own ability to handle complications - Does not believe that serious complications will occur - Performs procedure for the benefit of the procedure, not to improve patient condition - Does not believe in protocols - No formal training of new providers - Performed by an unsupervised, inexperienced provider - Does not recognise experience and practise of other related services - Do not acquire new knowledge on a regular basis - No culture for feedback from receiving hospital | - Between good and poor | - Adheres to current recommendations and guidelines for advanced pre-hospital airway management, uses them in daily practice. - Has back-up from experienced provider - Positive attitude towards use of protocol to improve procedure safety - Prioritises patient safety - Formal training program for new providers - Takes preventive measures to avoid complications - Learns from own experience and complications â—¦ Individual â—¦ Department - Open learning environment - Novice operators under direct supervision from experienced operator - Interacts with other services to improve quality - Has "system" of acquiring feedback from receiving hospitals |
Providers experience and knowledge | - Not competent in advanced airway management - Unfamiliar with difficult airway algorithm - Has no strategy for checking the patency of the airway after the procedure - Is not up to date on current recommendations and guidelines for advanced pre-hospital airway management - No defined relevant role model for own activity - Focus on own standing and career rather than patient outcome - Random assistant during airway procedures | - Competent in advanced airway management - Knows difficult airway algorithm - Checks patency of the airway at regular intervals - Has limited knowledge of current recommendations and guidelines for advanced pre-hospital airway management - Has trained assistant (that is integrated in the crew) for airway procedures, but makes irregular use of assistance | - Competent in advanced airway management - Competent in difficult airway management - Familiar with local back-up airway equipment - Familiar with potential airway complications in the pre-hospital setting and the handling of these - Monitors the patency of the airway after the procedure - Knows the current recommendations and guidelines for advanced pre-hospital airway management, especially the use of tracheal intubation. - Uses trained assistant (that is integrated in the crew) during airway procedures |
System | - System has no policy on hiring providers experienced in pre-hospital medicine - Most providers are inexperienced in pre-hospital medicine or are in-training - There is no system for training or retraining the providers in advanced airway management - No system for quality assurance - No formal R&D activities - Techniques and equipment used for advanced airway management is not up to date with current standards | - System hires mostly providers experienced in pre-hospital medicine or specialists within their field - The providers are trained in some of the skills and procedures related to advanced airway management at regular interval or all procedures at irregular intervals | - System hires only providers experienced in pre-hospital medicine and specialists within their field - All providers are trained and retrained regularly in all skills and procedures related to advanced airway management, including rescue techniques - Techniques and equipment used in advanced airway management are up to date with current standards - Service registers activity data from advanced airway management and uses data for quality improvement and research |
Protocol compliance | - No protocol available or available protocol is not followed - Protocol do not match provider competence | - Protocol available, but does not give a clear framework for the procedure (see "good") - Partially follows protocol | - Protocol for advanced pre-hospital airway management exists. - Protocol defines framework for the procedure - Protocol defines measures to improve quality and safety of procedure - Protocol defines team roles - Protocol is followed in all cases - Protocol is regularly updated to comply with current knowledge |