Mary L. Stoeckle (Thesis Director/Committee Member), Jane C. Swart (Dean, Collge of Nursing and Health), Elizabeth J. Lipp (Committee Member), Andrew Hawk (Committee Member)
Master of Science (MS)
Definitive airway management is one of the most important aspects of the care of ill or injured patients with a decrease in the level of consciousness. The effect of poor airway management can lead to aspiration, hypoxia, suffocation and death. Definitive airway management is the gold standard of care in patients with a Glasgow Coma Scale (GCS) of less than or equal to eight. Since average flight times to arrive at the patients "bedside" (hospital or accident scene location) are thirty minutes to two hours, the care that the patient receives prior to arrival of the flight crew is vital to improving patient outcomes. The incidence of definitive airway management prior to arrival of a rotary airmedical service with The Glasgow Coma Scale as an indicator is not known. The purpose of the investigation which used a descriptive -correlational design was to examine the incidence of definitive airway management prior to arrival of a rotary airmedical service with The Glasgow Coma Scale as an indicator. Roy's Adaptation Model of Nursing was used to guide the investigation. A retrospective chart review of 2, 938 flight requests was performed at a Midwestern rotary airmedical service of flight requests during the period of April 18, 1995 to May 19, 1996. A sample size of 453 patients met the inclusion criteria giving the sample a power of at least 90%. Analysis of the data was performed by using frequencies, percentages and logistic regression to answer the research questions. The sample size of n = 453 had a "yes" answer or presence of definitive airway management with a GCS score of less than or equal to eight in n =326 (71.96%) patients. The majority of patients n =207 (45.7%) had a GCS score of 3. The patients in the sample n =453 had a high presence of cardiac mechanical activity n =422 (93.2%) upon arrival of the airmedical crew. A pvalue of .05 was used to include variables in the logistic regression mode~. Type of patient (medical versus trauma) was dropped from the model because it was not significant with a p-value of . 5888. For every one year increase in patient age in the sample size of n = 326 patients, the odds of the presence of definitive airway management increased by 1 018 (increase of about 2%). Four regions of the Midwestern airmedical service area were examined and compared. Region three was compared to region one with region one having a 1.91 times greater likelihood of patients having definitive airway management in place prior to arrival of the airmedical service. Analysis of where the patient was received (hospital versus prehospital) indicated that if a patient was located in the hospital setting prior to arrival of a rotary airmedical crew the odds of the presence of definitive airway management was 6.94 times 91eater than a prehospital location. Each prehospital region was defined by level of prehospital provider (basic versus advanced provider). Finally, a GCS score range of three to eight and the presence of definitive airway management were examined and found that for each one-unit decrease in GCS score the odds of the presence of airway management increased by 1.51 times. A relationship between the presence of airway management increasing with patient age was significant and has been found in previous investigations possibly due to the difficult nature of the pediatric airway. This finding may indicate a need for aggressive pediatric airway management education. Geographic location (hospital versus prehospital) and the presence of definitive airway management was found to have a higher odds ratio in the hospital setting which correlates with the level of skills and airway adjuncts of the physician hospital provider versus prehospital provider. Examination of prehospital providers skills and the use of chemical adjuncts in the prehospital setting shou1d be analyzed to facilitate airway management.
Department or Program
College of Nursing and Health
Year Degree Awarded