Science&Society

NEW APPROACHES IN HEALTH EDUCATION FOR ALTERNATIVE

AIRWAY MANAGEMENT

Prof. Dr. Elena Taina Avramescu1, Lect. Arslan Say2, Lect. Aslı Aydogan2,
Assoc.Prof.Dr. Arif Ayar2, Assoc.Prof.Dr. Dr.Katalin Papp3
1
University of Craiova, Craiova
2
University of Amasya, Turkey
3
University of Debrecen, Hungary

ABSTRACT
The present paper presents new approaches in paramedics education in the framework
of an Erasmus + project entitled “Use of Extraglottic and Glottic Alternative Airways
Methods in Alternative Airway Management”. The project is based on collaboration
between hospitals and Higher Education Institutes from Turkey, Hungary and Romania
and aims to develop, test and adapt a continuous vocational educational medical
programme, developed on an exhaustive needs analysis and focusing on a transnational
approach for airway management. Airway management is the provision of air to, and
oxygenation of the patient (who cannot perform the respiratory function due to
obstruction of breathing, respiratory arrest) with equipment placed in the respiratory
tract, such as in the mouth, or in the trachea. A transnational research showed that at this
moment there are national differences in training of paramedics, the methods and
equipment used. In addition, knowledge and skill deficiencies arise in graduates due to
the lack of curriculum for the use of alternative airway methods in paramedic and
emergency medical technician training. In order to develop knowledge and skills for the
use of these methods, and to raise awareness, this subject, which is lacking in paramedic
training, is planned to be overcome as a result of collective information sharing with
transnational countries. The innovative information that emerges as a result of this
sharing will be placed in the paramedic education curriculum to provide graduated
students with more effective and quality service. In addition, with the awareness of the
new information on airway management from different countries, it will be supported to
use these equipments in the ambulances in Turkey and to use them effectively by the
health personnel. The awareness created through this quality and effective service will
prevent unwanted damage and deaths due to the lack of knowledge, skills and
equipment related to the alternative airway method.
Keywords: health education, alternative airway management, open education.

INTRODUCTION
Every day all over the world people of all ages suffer acute illnesses or injuries that
need intensive care. The emergency care systems serve as the first point of contact
within the health system and the emergency care providers represent the frontline that
manage children and adults with medical, surgical and obstetric emergencies. In this
context the role and importance of emergency medical services and emergency medical
transportation services is beyond further argumentations and enabling countries to
5th International Multidisciplinary Scientific Conferences on Social Sciences & Arts SGEM 2018

provide emergency care for their populations is placed on the top of the international
community’s priority list.
Responding to an emergency requires a complex team including medical doctors of
different specialties, nurses, paramedics and other medical staff that act on an integrated
approach focused on early recognition of the addressed pathology and early
management including resuscitation and first aid. For this reason, providing emergency
care must involve not only building on appropriate health systems but also providing
advanced staff training.
The model of emergency medical services (EMS), the training and qualification levels
for emergency medical staff vary widely across Europe. There is no perfect model and it
is normal that each country will organise its own EMS model based on economic
resources, community needs and medical practices, and having in this way its own
'approach' to how EMS should be provided, and by whom [1], but in the same time as
an overall approach all this models must rely on the same principles and abilities of the
appropriate staff.
In 2008, the WHO elaborated a report regarding the organization of ambulance services
and the training of their staff all over Europe [2]. Their results, as well as the results of
another European study, the EED (European Emergency Data) project, identified some
important differences in Europe, which could have important consequences for patient
safety [3] [4].
Chenaitia et al (2011) identifies two predominant models for the emergency medical
services across Europe: the Anglo-American model which uses mainly paramedics in
prehospital settings and the Franco-German model which uses mainly physicians for the
same settings [5]. Their research findings showed that there are great similarities
regarding the dispatch center, the methods and the response time for most of the
European countries, meanwhile the biggest differences are related to the personnel and
their training, although they all have to perform the same emergency procedures and
manage similar types of patients. In this context, European harmonisation in emergency
staff training is a great ”must”, even if it can seem difficult to attain.
EU Commission Communicate on Rethinking Education (2012) underlines that
vocational education must be able to react to the demand for advanced vocational skills
[6]. The emergency medical care sector is a great professional and educational challenge
and imposes a constant and permanent need in education of doctors and the whole
emergency medical teams [7].
The present paper presents new approaches in paramedics education in the framework
of an Erasmus + project entitled “Use of Extraglottic and Glottic Alternative Airways
Methods in Alternative Airway Management”. The project is based on collaboration
between hospitals and Higher Education Institutes from Turkey, Hungary and Romania
and aims to develop, test and adapt a continuous educational medical program, based on
an exhaustive needs analysis and focusing on a transnational approach for airway
management.
METHODS
Airway management is the provision of air to, and oxygenation of the patient (who
cannot perform the respiratory function due to obstruction of breathing, respiratory
 Science&Society

arrest) with equipment placed in the respiratory tract, such as in the mouth, or in the
trachea.
Although the countries participating in this project use various alternative equipment for
airway management, in Turkey, one method (endotracheal intubation) is frequently used
and alternative methods are not used especially before the hospital. The project is
carried out transnational aiming to close this gap, to create a curriculum and publication
about these innovative methods in the partner countries, to raise awareness in the
necessary institutions in our country, to make use of these methods in our country and to
avoid unnecessary deaths.
Within the scope of this project, our target groups are academic staff who provide
training in the first and emergency aid program, paramedics (first and emergency help
technician), students who are trained in the first and emergency program and
paramedics (first and emergency help technicians) working in pre-hospital settings and
hospitals and other health care employees.
In order to achieve this goal, the partnership carried on a transnational research in order
to identify the national differences in training of paramedics, the methods and
equipment used. In addition, knowledge and skill deficiencies arise in graduates due to
the lack of curriculum for the use of alternative airway methods in paramedic and
emergency medical technician training.
The general needs of the hospitals and ambulance transportation in terms of dotation,
the methods and the response time for different medical emergencies, as well as training
specific approaches for paramedics were identified. The partnership worked together
for collection and analysis of such data, resulting in a feasibility study aiming to
develop common references for vocational training in paramedics education.
All the results for participant countries were gathered by a fieldwork survey and
documentary research and from visits of the academic staff in emergency medical units
in Turkey, Romania and Hungary.
The documentary research summarized all the information gathered from Universities
institutional websites, Ministry of Education and Research, professional networks and
associations, professional organization active in medical field in all participants’
countries.
Based on the results of this research academic staff from all countries joint their efforts
to work out the most up-to-date and most relevant information on the methods used in
alternative methods used in airway management, and to develop a curriculum as a result
of these efforts.

RESULTS
As our project is work in progress we delivered our first output in the form of a
transnational report aiming to identify the similarities and the differences in paramedic
education. In order to attain this goal, analysis of learners’ actual knowledge and of
knowledge needs for identifying the current performances and gaps was carried on in
Romania, Hungary and Turkey.
5th International Multidisciplinary Scientific Conferences on Social Sciences & Arts SGEM 2018

Our transnational research showed that at this moment there are national differences in
the training of paramedics, the methods and equipment used. In addition, knowledge
and skill deficiencies arise in graduates due to the lack of curriculum for the use of
alternative airway methods in paramedic and emergency medical technician training.
The last part of the report tries to identify the best ways for introducing the best
procedures for Alternative Airway Management into the work environment by
presenting the state of art of emergency medical education and the national rules in
accreditation/certification of paramedic competencies.
According to our research the available levels of care in prehospital settings are similar
in all the three participants countries and include three main categories: basic life
support (BLS), advanced life support (ALS) and critical care transport (CCT). These
types of emergency care are assured by various traditional healthcare professionals:
ambulance driver, ambulance care assistants (emergency medical technician, emergency
medical dispatcher), paramedics, registered nurses and ambulance physicians.
The EU single market regulated profession database shows all countries in which this
profession is regulated, with the name of the profession as used in the country. By
clicking on the name details of the regulated profession with the competent authorities
and points of contact can be accessed (fig.1.).

Fig. 1. The EU single market regulated profession database

It can be seen that Romania and Turkey are not yet included in the list and updating the
records can be one of major impact of the project as our reports will be sent to the
Ministry of Health in participant countries.
 Science&Society

Regarding our research on paramedics education and tasks the information can be
summarized as follows:
In Romania the emergency care is organized at the national level gathering different
institutions into an integrated approach, under the coordination of the Ministry of
Health, the Ministry of Internal Affairs, local authorities and the Special
Telecommunication Service. All these institutions use the single European emergency
call number (112).
According to the type of emergency, emergency calls are transferred to the appropriate
emergency agencies that may include: ambulance, Mobile Emergency Service for
Resuscitation and Extrication (SMURD), General Inspectorate for Emergency
Situations, Police or Romanian Gendarmerie.
SMURD is a complementary service, dealing with the most acute emergency cases, in
cooperation with the regular Ambulance Service (Serviciul de Ambulanţă). In most of
the cities the system is ambulance based, while in six cities (Târgu
Mureș, Bucharest, Iaşi, Arad, Craiova and Constanţa) EMS is provided also by HEMS
(helicopter emergency medical system).
Emergency responses are provided according to the color code:
• red code refers to major life-threatening emergencies and in order to assure EMS
highly equipped ambulances, with intensive care equipment and a qualified medical
doctor are provided
• yellow code refers to emergencies with life-threatening potential and for this
code an ambulance with equipment for emergency interventions, including a
defibrillator with a qualified medical doctor or just a nurse is provided
• green code refers to non-emergency cases, in which situation ambulances with
first aid equipment and medical or nursing staff depending on the case are sent
The Emergency Medical Technician (EMT) and paramedics are the primary care
providers in the pre-hospital setting for basic life support in various life-threatening
situations. The EMT is responsible for driving the ambulance; works under the direction
of a Paramedic and assume a support role, while the paramedic is responsible for pre-
hospital medical procedures for basic and advanced life support (basic patient
assessment, airway management, use of the automatic defibrillator, cardiac monitoring
and administration of basic medications).
EMT and Paramedic education in Romania is coordinated by SMURD. Nurses,
regardless of their specialization, can work at SMURD service if they attend
paramedical courses at the Emergency Situations Inspectorates. The level of
qualification is paramedical course and the official length of programme is 4 weeks.
In Hungary the level of qualification for paramedics is BSc/ University Faculty of
Health, with an official length of programme of 8 semesters, each of them consists of 14
weeks term time and 6 weeks exam period. The total number of study hours is 4370,
including theory and practice, with a rate of theoretical and practical hours during the
training being of 40 and 60 %, respectively. Access requirements include secondary
school leaving certificate, entrance examination.,
5th International Multidisciplinary Scientific Conferences on Social Sciences & Arts SGEM 2018

The staff members of the department take part in teaching the theory and practice of
subjects in connection with Oxiology and Rescue technique in the Bachelor programme.
In these lessons students get to know and learn medical interventions professionally and
safely in emergency patient care circumstances, as well as they become skilled in using
the applied rescue techniques, appliances and instruments.
The aim of the education is to train paramedics (ambulance officers/EMT) in order to be
able to carry out certain medical intervention in a professional and safe way, to perform
rescuing tasks they were trained for on the scene of mass casualty accidents, epidemic
and catastrophe and to use their skills in a professional way in all the cases when
emergency care is needed either on the spot or in health institutions especially in the
emergency department.
In Turkey the level of qualification for paramedic/ first and emergency aid technician is
health services vocational school in university. Paramedic program is not a bachelor
program. The official length of programme of 4 semesters, each of them consists of 14
weeks term time and 30-day vocational intership. The total number of study hours is
1430, including theory and practice, with a rate of theoretical and practical hours during
the training being of 59 and 41 %, respectively. Hours of theoretical and practical
lessons may show a substantial difference between the universities. In the program
mainly lectures; anatomy, physiology, resuscitation, emergency patient care, emergency
aid and rescue work, emergency medical services, pharmacology, body building,
trauma.
The fundamental aim of the paramedic education is to cater for the increasing demand
for the qualified first and emergency aid workforce delivering services in cases
requiring emergency intervention to patients or the injured within the operations of the
first and emergency aid units of various health institutions. Program graduates may
pursue employment opportunities as technicians at the emergency units of the state and
private hospitals and ambulance services.

Country Educational Study Theoretical Practical Level Prerequisites

training hours study study Competencies
(weeks) hours (%) hours
(%) LLL
Romania 4 120 30 70 Emergency
Medical
Technician
Turkey 56 1430 51 40 Paramedic
Hungary 112 4370 40 60 Paramedic
 Science&Society

CONCLUSIONS
Depending on country, area within country, or clinical need, emergency medical
services may be provided by one or more different types of organization. This variation
may lead to large differences in levels of care and expected scope of practice.
In all participant countries paramedics must have a higher level of medical training and
are usually able to perform a wide range of emergency care skills as intravenous
cannulation, administration of drugs to relieve pain, cardiac monitoring, more advanced
airway procedures, continuous positive airway pressure, perform endotracheal
intubation and tracheal intubation or a cricothyrotomy.
With regard to long-term and Europe-wide influence, it is certain that those who belong
to the paramedical profession in today's competitive professional conditions need new
skills, innovation and innovative European citizenship. Among the traditional learning
tools that are applied, the right people to the right profession are found with
specialization studies in their branches and different alternatives can be offered to the
people in the long run. Training of a generation of conscious professionals in Europe by
the inclusion of this study in educational policies will be the most positive impact of our
project.
The innovative information that emerges as a result of this sharing will be placed in the
paramedic education curriculum to provide graduated students with more effective and
quality service. In addition, with the awareness of the new information on airway
management from different countries, it will be supported to use these equipment’s in
the ambulances in Turkey and to use them effectively by the health personnel. The
awareness created through this quality and effective service will prevent unwanted
damage and deaths due to the lack of knowledge, skills and equipment related to the
alternative airway method.
5th International Multidisciplinary Scientific Conferences on Social Sciences & Arts SGEM 2018

In this context, the expected impacts of the project will be as follows:

1. The comprehension of the use of alternative methods of airway management by our
school students / participants, the ability to recognize potential health risks in airway
management, developing skills in this field
2. Through a publication prepared in transnational cooperation the effect that the
members of the professions with different ethnic backgrounds and languages can work
with each other will be the greatest impact of our project in human sense.
3. The awareness created through this quality and effective service will prevent
unwanted damage and deaths due to the lack of knowledge, skills and equipment related
to the alternative airway method.

ACKNOWLEDGEMENTS
The present research was carried on in the framework of project 2017-1-TR01-KA202-
046653 entitled” Use of Extraglottic and Glottic Alternative Airways Methods in
Alternative Airway Management”.
The project is financed by European Commission under the Erasmus + programme,
KA2.
This document reflects only the author's view and that the National Agencies and the
Commission are not responsible for any use that may be made of the information it
contains.

REFERENCES
[1] Maarten N.B., Veenvliet K.C, Plass A.M., Ambulance care in Europe Organization
and practices of ambulance services in 14 European countries, 2015, pp 20-22;
[2] World Health Organization (WHO). Emergency Medical Service Systems in the
European Union. Copenhagen: World Health Organization, 2008, pp 16-39
[3] Krafft T., García-Castrillo Riesgo L., Edwards S., Fischer M., Overton J.,
Robertson-Steel I., König A., European Emergency Data Project: EMS data-based
Health Surveillance System. European Journal of Public Health 2003; vol 13, issue s3,
pp 85-90
[4] Fischer M., Kamp J., García-Castrillo Riesgo L., Robertson-Steel I., Overton J.,
Ziemann A., Krafft T., Comparing emergency medical service systems – A project of the
European Emergency Data (EED) Project, Resuscitation, 2011; volume 82, issue 3, pp
285-293.
[5] Chenaitia H., Massa H., Cyril N., Fournier M., Verges M., Emeric S., Guibert S.,
Michelet P., Paramedics in prehospital emergency medical systems across Europe,
International Paramedic Practice, 2011, vol. 1, issue 1, pp 33–39
[6] Communication From The Commission To The European Parliament, The Council,
The European Economic And Social Committee And The Committee Of The Regions,
”Rethinking Education:Investing in skills for better socio-economic outcome”s, EUR-
 Science&Society

Lex - 52012DC0669, available at http://eur-lex.europa.eu/legal-content/en/TXT/?

uri=CELEX:52012DC0669
[7] Nikic-Sovilj L., The place, role and importance of emergency medical are in the
Serbian Healt care system, Lijec Vjesn, 2009; vol.131, suppl 4, pp 70-72