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2017

Performance of Norwegian Civilian EMTs and Army Medics in Penetrating Trauma: A Controlled Simulation-Based Assessment

Author

Sigurd Wisborg Blix, EMT

Associate authors: Jørgen Melau, CRNA/EMT, Inger Lund-Kordahl, MD

Introduction—Penetrating trauma and blast injuries kill rapidly. Patients with potentially survivable penetrating injuries most commonly die from extremity exsanguination or open/tension pneumothorax. Thorough and efficient examination and aggressive hemorrhage control is important to save lives. The aim of this study was to compare bleeding examination and control between Norwegian civilian EMTs and army medics.

Methods—Power calculations revealed a necessary sample size of at least 28. We included 60 volunteering certified EMTs and army medics. First, the participants examined a patient with five bleeding wounds. Second, the participants were presented a civilian mass-casualty event on video and a patient with a penetrating injury on a pork side fixated to the right thigh with an ongoing artificial arterial bleeding. Mann-Whitney U tests were used for nonparametric data, chi square tests for categorical data and logistic regression for relationships between continuous variables and outcome.

Results—The analysis shows 23/32 (72%) EMTs and 30/30 (100%) army medics found four or five of the five bleeding spots on the patient (p=0.002). The EMTs used significantly shorter time on trauma examination, average 17 secs. vs. 46 secs. (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 used average 39 secs. and army medics 21 secs. to hemostasis (p<0.001). Total average time spent on the packing was 18 secs. vs. 43 secs. respectively (p<0.001). Increasing time spent on the procedure showed significantly better chance of an approved procedure, OR 1.4 (95% CI: 1.1–1.7). Decreasing time to hemostasis was significantly associated to approved packing procedure, OR 0.82 (95% CI: 0.78–0.91).

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. Based on this study, wound packing training needs to be incorporated into initial and ongoing civilian EMT training.

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