The accuracy of manual blood pressures obtained by paramedic students in a quiet simulated and roadside environment
PDF

Keywords

Emergency Medical Services
emergency medical technicians
Blood Pressure Determination

How to Cite

1.
Ramothwala LM, Stassen W, Stein C. The accuracy of manual blood pressures obtained by paramedic students in a quiet simulated and roadside environment. Australasian Journal of Paramedicine [Internet]. 2015Nov.1 [cited 2021Nov.28];12(5). Available from: https://ajp.paramedics.org/index.php/ajp/article/view/243

Abstract

Introduction.

It is well-recognised that ambient noise impacts on the accuracy of auscultation. Often, paramedics are required to manually obtain blood pressures on the side of the road where ambient traffic noise might impact on its accuracy. This study aimed to determine the level of agreement between manual blood pressure results obtained in a quiet and simulated roadside environment.

Methods.

An experimental prospective study in the repeated measures design was utilised to determine whether emergency care students could accurately determine the manual blood pressure in a quiet and simulated roadside environment. A roadside environment was simulated by looping road traffic noise at constant volume. A cross-over control was employed. The accuracy of the blood pressure recorded in the quiet environment was contrasted to that obtained in the simulated roadside environment using the Bland-Altman plot.

Results.

The data of 60 students (120 measurements) were analysed. The mean bias (95% CI; standard error) for the Systolic Blood Pressures (SBPs) was -1.28 (-2.83;-2.64; 5.99) while the mean bias for the Diastolic Blood Pressures (DBPs) was -1.2 (-3.12; 0.71; 7.39). The 95% limits of agreement are -13.02 to 10.46 and -15.68 to 13.28 for the SBPs and DBPs respectively.

Conclusions.

This experimental study found that emergency care students are able to accurately obtain a manual blood pressure in a simulated roadside environment. However, a clinically significant discrepancy of 20-28mmHg in SBP or DBP might still be appreciable in some cases. Further, more robust studies in a variety of different prehospital settings are recommended to corroborate these findings.

https://doi.org/10.33151/ajp.12.5.243
PDF

References

Lalezarzadeh F, Wisniewski P, Huynh K, Loza M, Gnanadev D. Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality. Am Surg 2009;75(10):1009–14.

Søreidea E, Deakin CD. Pre-hospital fluid therapy in the critically injured patient - a clinical update. Injury 2005;36:1001–10.

Brain Trauma Foundation. Guidelines for prehospital management of traumatic brain injury, 2nd edn. Prehosp Emerg Care 2007;12(1):S1–52.

Prasad NH, Brown LH, Ausband SC, Cooper-Spruill O, Carroll RG, Whitley TW. Prehospital blood pressures: inaccuracies caused by ambulance noise? Am J Emerg Med 1994;12(6):617–20.

Pickering TG, Hall JE, Appel LJ, et al. Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Circulation 2005;111:697–716.

Lightfoot JT, Tuller B, Williams DF. Ambient noise interferes with auscultatory blood pressure measurement during exercise. Med Sci Sports Exerc 1996;28(4):502–8.

Zun L, Downey L. The effect of noise in the emergency department. Acad Emerg Med 2005;12(7):663–6.

Skirton H, Chamberlain W, Lawson C, Ryan H, Young E. A systematic review of variability and reliability of manual and automated blood pressure readings. J Clin Nurs 2011;20(5-6):602–14.

Traffic Sound Effects. [Online].; 2011 [cited 2013 May 2. Available at: www.pachd.com/traffic-ambience.html

Coppola S, Froio S, Chiumello D. Fluid resuscitation in trauma patients: what should we know? Curr Opin Crit Care 2014;30(4):444–50.

Evans JD. Straightforward statistics for the behavioural sciences Pacific Grove: Brooks/Cole Pub. Co.; 1996.