Performance of Norwegian civilian EMTs and army medics in penetrating trauma: a controlled simulation‐based assessment

• Published in: Acta anaesthesiologica Scandinavica Vol. 61; no. 7; pp. 848 - 853
• Main Authors: Blix, S. W., Melau, J., Lund‐Kordahl, I.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-08-2017; Wiley; John Wiley and Sons Inc
• Subjects: Army; Bleeding; Clinical Competence - statistics & numerical data; Clinical medical disciplines: 750; Emergency medical services; Emergency Medical Technicians - statistics & numerical data; Emergency Medicine; Emergency services; Gauze; Hemorrhage; Hemostasis; Hemostatics; Humans; Injuries; Klinisk medisinske fag: 750; Medical disciplines: 700; Medisinske Fag: 700; Military Personnel - statistics & numerical data; Norway; Original; Packing; Patient Simulation; Pork; Prospective Studies; Simulation; Technicians; Thigh; Training; Trauma; VDP; Wounds; Wounds, Penetrating - therapy
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.12910

Background
Penetrating trauma kills rapidly. Thorough and efficient examination and aggressive hemorrhage control is important to save lives. The aim of this study was to assess the skills of civilian Emergency Medical Technicians (EMTs) in bleeding examination and control compared to Army Medics. Our hypothesis was that civilian pre‐hospital systems perform at a lower level compared to an expert group, and did not have sufficient focus on education and training in examination and treatment of penetrating injuries.
Material and methods
We included 60 volunteer Certified EMTs and Army Medics. First, the participants examined a wounded patient. Second, the participants were presented a patient with a penetrating injury on a pork side fixated to the thigh with an artificial arterial bleeding.
Results
The EMTs took significantly shorter time examining, median 1 min 5 s vs. 3 min 58 s (P < 0.001). 5/30 (17%) of EMTs and 28/30 (93%) of army medics did an approved gauze wound packing of the penetrating injury (P < 0.001). EMTs took (median) 18 s and army medics 8 s to hemostasis regardless of approved packing or not (P < 0.001). Time spent on the packing was (median) 1 min 50 s vs. 5 min 47 s respectively (P < 0.001). Increasing time spent on the procedure showed significantly better chance of a successful procedure.
Conclusion
The EMTs had lower accuracy in examination but used significantly shorter time than the Army Medics. The treatment part of the study showed poor EMT performance compared to the Army Medics. This study indicates that more wound packing training needs to be incorporated into initial and ongoing civilian EMT training.