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

Abstract

BackgroundPenetrating 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 methodsWe 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.ResultsThe 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.ConclusionThe 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.

Norwegian Emergency Medicine Systems’ Training and Equipment for Penetrating Injuries: A National Survey-Based Study

“…The national core curriculum states that EMTs should be able to identify and treat life-threatening injuries in general, but skills in hemorrhage control are shown to be highly variable in a study from 1 Norwegian Health Region. 3,10 If it is not within the scope of the PLIVO program to teach these skills, another program should be made. A US survey revealed that the slow incorporation of military medical techniques in civilian prehospital practice is caused by concerns of safety and effectiveness, expenses, and lack of training.…”

“…In the current curriculum for the EMT training, examination and treatment of penetrating wounds is not specified, and we found it lacking in a previous study. 3 All EMS regions in Norway were invited to participate in an electronic survey concerning practical medical training within PLIVO scenario training as well as specific training in hemorrhage control and penetrating injuries. Demographic data such as geographic region, level of education, experience, age, and job description, were also registered to allow to adjust for confounders in the final data analysis.…”

Framework for the evaluation of military health systems

“…Though similar to paramedics or clinical officers, their training and employment may not align with civilian categories of healthcare providers. 23 The second is the employment status of the personnel. Military systems may include active-duty service-members, reservists or civilian personnel, with implications for their availability to work on overseas operations or domestically.…”