Conventional versus task-based package organization for out-of-hospital emergency kits: an emergency medical services simulation study

Background: Emergency Medical Service crews are equipped with comprehensive emergency kits for routine care and to provide life-saving interventions in severely ill patients. While guidelines on contents and packing strategies of emergency kits for specific tasks and specialized situations exist, data for the design of out-of-hospital emergency kits in a general urban population is lacking. It may be possible to transfer the promising results of modern in-hospital packing strategies such as task-based package organization (TPO) to an Emergency Medical Service setting.

Methods: Four types of emergency kit were used in this study: two novel backpack emergency kits were acquired for this study (one packed using a TPO approach (PAX bags) and the other a traditional non-TPO approach (inter-rescue)); the existing emergency kit; and a TPO-repack of the existing kit. We recruited 80 paramedics who each performed four different tasks in a simulated setting: preparation for endotracheal intubation; preparing an intravenous access and a crystalloid infusion; preparing intraosseous access with medication; and preparing for a forearm splint. Questionnaires were completed before starting, after each task, and at the end of each study session.

Results: There was no overall difference for the primary outcome of task completion between the novel TPO and novel non-TPO kit (p = 0.11). However, for selected tasks (forearm splint) completion time was significantly different between these kits. Overall, participants performed fastest when using the existing emergency kit. Participants frequently omitted items required for critical procedures, regardless of kit type.

Conclusion: TPO has been previously investigated in an in-hospital setting using participants with low exposure to medical emergencies, and with promising results. In our prehospital simulation setting with paramedics, equipment retrieval was neither faster nor more complete compared to non-TPO kits.