Association between case volume and hesitation to perform supraglottic airway insertion among emergency medical services personnel

Objective: Advanced prehospital procedures performed by emergency medical services (EMS) clinicians are important for the care of emergency patients.Although procedural confidence is essential in urgent situations, its determinants remain unclear.This study examined whether individual case volume among EMS clinicians was associated with hesitation to perform supraglottic airway (SGA) insertion.Methods: A nationwide cross-sectional survey of South Korean EMS personnel was conducted in August 2024.The questionnaire assessed demographic and occupational characteristics, procedural confidence, and unmet needs for specialized training.The primary outcome was self-reported hesitation to perform SGA insertion.Individual case volume was categorized as low-to-moderate (1-4 cases per 24 hours), high (5-8 cases), or very high (≥9 cases).Multivariable logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals.Results: Of 14,212 eligible EMS clinicians, 1,910 personnel voluntarily completed the survey, and 1,765 qualified participants were included in the final analysis.Overall, 26.9% of participants reported hesitation to perform SGA insertion.Hesitation was not significantly associated with individual case volume; compared with the low-to-moderate group, the adjusted odds ratios were 0.95 (95% confidence interval, 0.72-1.25)for the high-volume group and 0.88 (95% confidence interval, 0.68-1.13)for the very high-volume group.Conclusion: Individual case volume was not associated with hesitation to perform SGA insertion.These findings suggest that confidence in advanced procedures may not be determined by field exposure alone.