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363 ArmyFlight Medics in Iraq and Afghanistan: A Survey
Research Forum Abstracts
362
Emergency Medical Technicians in Accra, Ghana: A Basic Trauma Knowledge Assessment
Mould-Millman CN, Lynch C, Sasser S, Isakov A/Emory University, Atlanta, GA
Study Objective: To date there has been no baseline knowledge assessment amongst the emergency medical technicians of the Ghana Ambulance Service. The Ghana Ambulance Service emergency medical technician training academy has graduated 4 classes, of over 200 emergency medical technicians, in either 3-, 6-, 9- or 12-month courses. The emergency medical technicians receive biannual supplementary refresher courses. Our objective is to perform a baseline trauma knowledge assessment of the Ghana Ambulance Service emergency medical technicians who currently work in the capital city of Accra. Methods: Emergency medical technicians-basics of the Ghana Ambulance Service employed in the Accra metropolitan area for at least 6 months were enrolled in the study. A validated trauma questionnaire, based on essential knowledge and skills adapted from the World Health Organization’s (WHO) Out-of-hospital Trauma Care Systems, was verbally administrated by a single investigator. The questionnaire tested the participant’s ability to identify critical injuries: airway, breathing, circulation, neurologic disability (ABCD) and perform trauma interventions. A background educational history for each participant was also collected. Descriptive statistics, including Pearson’s chi-squared and Fischer’s exact test, were used to compare participants’ answers. Questionnaire responses were grouped for comparison by emergency medical technicians class length and refresher courses in the last 6, 12 and 24 months. Results: Of the total 44 Ghana Ambulance Service emergency medical technicians in Accra, 41 completed the questionnaire with a response rate of 93%. Most emergency medical technicians were male (88%) averaging 34 years of age (⫾ SD 5.2), 6.4 years of total medical experience and 5.7 years of Ghana Ambulance Service experience. 88% of emergency medical technicians demonstrated insufficient knowledge in ABCD that could prove lethal for trauma patients. 97% of emergency medical technicians cited at least 1 sign of airway obstruction, but an inability to speak was mentioned in only 17% of respondents. In managing an obstructed airway, only 15% of emergency medical technicians recalled all 3 basic rescue maneuvers (head tilt, chin lift and jaw thrust). 97% of emergency medical technicians were able to mention at least 1 finding indicative of severe blood loss. However, only 1 emergency medical technician was able to state that hypotension and tachycardia were both findings in severe blood loss. In managing severe blood loss, 85% of respondents would apply direct pressure, 7% would elevate a bleeding limb and 51% stated they would give intravenous fluids, which was more likely with participation in a refresher course in the past 24 months (p⫽.04). Most (95%) of emergency medical technicians recognized trauma as an indication for spinal precautions. 71% described appropriate technique for spine immobilization. For each domain tested, there was no difference in knowledge between the emergency medical technician classes. Conclusion: The majority of Ghana Ambulance Service emergency medical technicians displayed inadequate basic trauma knowledge assessed against WHO essential criteria. Most deficits pertained to key physiologic concepts, such as recognizing inability to speak as a sign of airway obstruction, or hypotension and tachycardia as findings in severe blood loss. Almost all emergency medical technicians’ have mastered appropriate spinal precautions for transport. No difference in overall knowledge was found between emergency medical technicians class lengths. Rapid knowledge decay after training academy graduation with bi-annual emergency medical technicians refresher training courses might account for the relatively equal distribution of knowledge across all graduates. We recommend the Ghana Ambulance Service focus their continuing medical educational curriculum around frequent refresher courses on basic physiology in emergency trauma care.
363
ArmyFlight Medics in Iraq and Afghanistan: A Survey
Bier S, Hermstad E, Trollman C, Holt M/Memorial Hermann The Woodlands Hospital, The Woodlands, TX; William Beaumont Army Medical Center, El Paso, TX; 159th Combat Aviation Brigade, Fort Campbell, TX; Sam Houston State University, The Woodlands, TX
Study Objectives: In recent years, the adequate level of training and appropriate amount of continuing education for Army flight medics has been a highly contested topic. In this study we sought to obtain a cross section of the education, experience level, and amount of time spent by deployed flight medics on patient care during and in between deployments. We also sought the opinions of these medical providers
S300 Annals of Emergency Medicine
regarding topics including training standards, transport staffing, and medical oversight. Methods: This was a prospective, qualitative survey study administered to Army flight medics deployed or recently deployed. Subjects participated in a 31-question survey which was administered electronically through surveymonkey.com. The first section of the survey collected demographic information. The second was meant to assess opinions related to training, oversight, and ability to complete their mission. Responses were rated on a 5-point modified Likert scale according to their agreement or disagreement. Results: Of the 53 Army flight medics who participated, 57% stated that between deployments they spend less than 10 hours per month on patient care and 28% reported getting no exposure to patients at all while in garrison. Furthermore, 30% had not seen a patient for greater than 6 months prior to deployment. A majority (85%) felt that training to the civilian paramedic level was optimal for their mission. Regarding their time between deployments, 77% disagreed with the statement they spent enough time on patient care and 96% agreed they would benefit from medical rotations. Almost half agreed that they had been in situations while deployed in which they felt unprepared medically. Conclusions: These results indicate that Army flight medics feel their training and patient contact is too limited prior to and in between deployments to meet mission requirements. As a preponderance of medics felt they should be trained to the paramedic level and most surveyed were willing to extend their Army commitment in exchange for this training, this might be an avenue worth exploring. These findings support a need for the reassessment of initial and ongoing standards as well as the amount of hands-on patient care Army flight medics receive.
364
Evaluating Out-of-Hospital Communication At A Level 1 Urban Trauma Center: Perceptions and Reality
McCay BD, Rodas EB, Parra MW, Catino JD, El Sanadi N/Nova Southeastern University, Fort Lauderdale- Davie, FL; Broward General Medical Center, Fort Lauderdale, FL
Study Objectives: The primary objective is to improve communication between out-of-hospital emergency medical services and hospital staff. Secondary objectives include identifying which information is often omitted and surveying emergency medical services and hospital staff to determine their respective perceptions of communication. Methods: A 3-phase study was performed. In phase 1, a prospective 1-month cohort of consecutive trauma alerts at our urban Level 1 Trauma Center was observed. We prospectively collected handwritten reports taken by hospital staff from out-of-hospital radio communication. It was predetermined that thirteen basic data points were to be included for a complete report. Data collected included: emergency medical services provider/unit, trauma identifier, age, sex, mechanism of injury, injuries and/or complaints, blood pressure, pulse, respiratory rate, oxygen saturation, Glasgow Coma Scale, treatments provided in the field and estimated time of arrival. Data sheets were analyzed for completeness. In phase-2, surveys of emergency department nurses, emergency medical services paramedics and trauma surgeons were conducted to obtain perceptions of problems and suggestions. After analyzing the data and surveys, a new protocol was established and emergency medical services and hospital staff were taught the new protocol. This protocol is based on the MIVT (mechanism of injury, injuries, vital signs, and treatment) and the hospital staff was given 1 data collection sheet to replace the multiple types of sheets previously used. Phase-3 consisted of another 1-month cohort, similar to phase-1. These data were analyzed and compared to phase-1. Results: In phase-1, a 32-day period, a total of 168 consecutive trauma alerts were observed. Data were collected by different hospital personnel including; trauma nurses, charge nurses, emergency department technicians, and unit secretaries. The mean percentage of the 13 basic data points was 65.6% (95% CI 63% to 68.2%) and the range was from 23% to 92%. In phase-2, the emergency medical services survey results indicated that 92% of paramedics thought that out-of-hospital communication and information conveyed was adequate and 62% said they followed a specific protocol for trauma. Of the trauma nurses surveyed, 14% felt that out-ofhospital communication and information provided was adequate. The trauma surgeon survey results indicated that 29% of trauma surgeons thought that out-ofhospital communication and information conveyed was adequate and 86% thought that receiving out-of-hospital information made a difference in patient care. The most commonly cited problem with communication was radio transmission/equipment (40% of paramedics and 79% of nurses). Phase 3 was a 35-day period with 175 trauma alerts. Data were collected by trauma nurses and charge nurses. The mean percentage of the 13 basic data points was 72.6% (95% CI 69.1% to 76.1%) and the
Volume , . : October
362
Emergency Medical Technicians in Accra, Ghana: A Basic Trauma Knowledge Assessment
Mould-Millman CN, Lynch C, Sasser S, Isakov A/Emory University, Atlanta, GA
Study Objective: To date there has been no baseline knowledge assessment amongst the emergency medical technicians of the Ghana Ambulance Service. The Ghana Ambulance Service emergency medical technician training academy has graduated 4 classes, of over 200 emergency medical technicians, in either 3-, 6-, 9- or 12-month courses. The emergency medical technicians receive biannual supplementary refresher courses. Our objective is to perform a baseline trauma knowledge assessment of the Ghana Ambulance Service emergency medical technicians who currently work in the capital city of Accra. Methods: Emergency medical technicians-basics of the Ghana Ambulance Service employed in the Accra metropolitan area for at least 6 months were enrolled in the study. A validated trauma questionnaire, based on essential knowledge and skills adapted from the World Health Organization’s (WHO) Out-of-hospital Trauma Care Systems, was verbally administrated by a single investigator. The questionnaire tested the participant’s ability to identify critical injuries: airway, breathing, circulation, neurologic disability (ABCD) and perform trauma interventions. A background educational history for each participant was also collected. Descriptive statistics, including Pearson’s chi-squared and Fischer’s exact test, were used to compare participants’ answers. Questionnaire responses were grouped for comparison by emergency medical technicians class length and refresher courses in the last 6, 12 and 24 months. Results: Of the total 44 Ghana Ambulance Service emergency medical technicians in Accra, 41 completed the questionnaire with a response rate of 93%. Most emergency medical technicians were male (88%) averaging 34 years of age (⫾ SD 5.2), 6.4 years of total medical experience and 5.7 years of Ghana Ambulance Service experience. 88% of emergency medical technicians demonstrated insufficient knowledge in ABCD that could prove lethal for trauma patients. 97% of emergency medical technicians cited at least 1 sign of airway obstruction, but an inability to speak was mentioned in only 17% of respondents. In managing an obstructed airway, only 15% of emergency medical technicians recalled all 3 basic rescue maneuvers (head tilt, chin lift and jaw thrust). 97% of emergency medical technicians were able to mention at least 1 finding indicative of severe blood loss. However, only 1 emergency medical technician was able to state that hypotension and tachycardia were both findings in severe blood loss. In managing severe blood loss, 85% of respondents would apply direct pressure, 7% would elevate a bleeding limb and 51% stated they would give intravenous fluids, which was more likely with participation in a refresher course in the past 24 months (p⫽.04). Most (95%) of emergency medical technicians recognized trauma as an indication for spinal precautions. 71% described appropriate technique for spine immobilization. For each domain tested, there was no difference in knowledge between the emergency medical technician classes. Conclusion: The majority of Ghana Ambulance Service emergency medical technicians displayed inadequate basic trauma knowledge assessed against WHO essential criteria. Most deficits pertained to key physiologic concepts, such as recognizing inability to speak as a sign of airway obstruction, or hypotension and tachycardia as findings in severe blood loss. Almost all emergency medical technicians’ have mastered appropriate spinal precautions for transport. No difference in overall knowledge was found between emergency medical technicians class lengths. Rapid knowledge decay after training academy graduation with bi-annual emergency medical technicians refresher training courses might account for the relatively equal distribution of knowledge across all graduates. We recommend the Ghana Ambulance Service focus their continuing medical educational curriculum around frequent refresher courses on basic physiology in emergency trauma care.
363
ArmyFlight Medics in Iraq and Afghanistan: A Survey
Bier S, Hermstad E, Trollman C, Holt M/Memorial Hermann The Woodlands Hospital, The Woodlands, TX; William Beaumont Army Medical Center, El Paso, TX; 159th Combat Aviation Brigade, Fort Campbell, TX; Sam Houston State University, The Woodlands, TX
Study Objectives: In recent years, the adequate level of training and appropriate amount of continuing education for Army flight medics has been a highly contested topic. In this study we sought to obtain a cross section of the education, experience level, and amount of time spent by deployed flight medics on patient care during and in between deployments. We also sought the opinions of these medical providers
S300 Annals of Emergency Medicine
regarding topics including training standards, transport staffing, and medical oversight. Methods: This was a prospective, qualitative survey study administered to Army flight medics deployed or recently deployed. Subjects participated in a 31-question survey which was administered electronically through surveymonkey.com. The first section of the survey collected demographic information. The second was meant to assess opinions related to training, oversight, and ability to complete their mission. Responses were rated on a 5-point modified Likert scale according to their agreement or disagreement. Results: Of the 53 Army flight medics who participated, 57% stated that between deployments they spend less than 10 hours per month on patient care and 28% reported getting no exposure to patients at all while in garrison. Furthermore, 30% had not seen a patient for greater than 6 months prior to deployment. A majority (85%) felt that training to the civilian paramedic level was optimal for their mission. Regarding their time between deployments, 77% disagreed with the statement they spent enough time on patient care and 96% agreed they would benefit from medical rotations. Almost half agreed that they had been in situations while deployed in which they felt unprepared medically. Conclusions: These results indicate that Army flight medics feel their training and patient contact is too limited prior to and in between deployments to meet mission requirements. As a preponderance of medics felt they should be trained to the paramedic level and most surveyed were willing to extend their Army commitment in exchange for this training, this might be an avenue worth exploring. These findings support a need for the reassessment of initial and ongoing standards as well as the amount of hands-on patient care Army flight medics receive.
364
Evaluating Out-of-Hospital Communication At A Level 1 Urban Trauma Center: Perceptions and Reality
McCay BD, Rodas EB, Parra MW, Catino JD, El Sanadi N/Nova Southeastern University, Fort Lauderdale- Davie, FL; Broward General Medical Center, Fort Lauderdale, FL
Study Objectives: The primary objective is to improve communication between out-of-hospital emergency medical services and hospital staff. Secondary objectives include identifying which information is often omitted and surveying emergency medical services and hospital staff to determine their respective perceptions of communication. Methods: A 3-phase study was performed. In phase 1, a prospective 1-month cohort of consecutive trauma alerts at our urban Level 1 Trauma Center was observed. We prospectively collected handwritten reports taken by hospital staff from out-of-hospital radio communication. It was predetermined that thirteen basic data points were to be included for a complete report. Data collected included: emergency medical services provider/unit, trauma identifier, age, sex, mechanism of injury, injuries and/or complaints, blood pressure, pulse, respiratory rate, oxygen saturation, Glasgow Coma Scale, treatments provided in the field and estimated time of arrival. Data sheets were analyzed for completeness. In phase-2, surveys of emergency department nurses, emergency medical services paramedics and trauma surgeons were conducted to obtain perceptions of problems and suggestions. After analyzing the data and surveys, a new protocol was established and emergency medical services and hospital staff were taught the new protocol. This protocol is based on the MIVT (mechanism of injury, injuries, vital signs, and treatment) and the hospital staff was given 1 data collection sheet to replace the multiple types of sheets previously used. Phase-3 consisted of another 1-month cohort, similar to phase-1. These data were analyzed and compared to phase-1. Results: In phase-1, a 32-day period, a total of 168 consecutive trauma alerts were observed. Data were collected by different hospital personnel including; trauma nurses, charge nurses, emergency department technicians, and unit secretaries. The mean percentage of the 13 basic data points was 65.6% (95% CI 63% to 68.2%) and the range was from 23% to 92%. In phase-2, the emergency medical services survey results indicated that 92% of paramedics thought that out-of-hospital communication and information conveyed was adequate and 62% said they followed a specific protocol for trauma. Of the trauma nurses surveyed, 14% felt that out-ofhospital communication and information provided was adequate. The trauma surgeon survey results indicated that 29% of trauma surgeons thought that out-ofhospital communication and information conveyed was adequate and 86% thought that receiving out-of-hospital information made a difference in patient care. The most commonly cited problem with communication was radio transmission/equipment (40% of paramedics and 79% of nurses). Phase 3 was a 35-day period with 175 trauma alerts. Data were collected by trauma nurses and charge nurses. The mean percentage of the 13 basic data points was 72.6% (95% CI 69.1% to 76.1%) and the
Volume , . : October