First Medical Center, General Hospital of the PLA, Beijing, 100853, China.
Department of Emergency Nursing, School of Nursing, Naval Medical University, Shanghai, 200433, China.
Mil Med Res. 2019 Dec 13;6(1):39. doi: 10.1186/s40779-019-0230-9.
Snakebites can lead to lifelong consequences and is one of the main causes of death among military troops worldwide. However, few Chinese military medics know the proper first aid procedures for snakebites. Therefore, this study aimed to explore the impact of the Standard Operation Procedure (SOP) and checklist on Chinese military medics' ability to manage snakebite first aid.
This study was a prospective single-blind randomized controlled trial conducted in a military medical university of China from May to June 2017. A questionnaire-based survey was performed to collect the participants' socio-demographic profiles before the baseline measurement. During the baseline measurement, participants were requested to provide corresponding first aid that was responsive to the simulative situation portrayed by the SPs (standardized patients) and the evaluators then scored their performances according to a checklist for snakebite first aid scoring table. After the baseline measurement, they were randomly assigned to one of three intervention groups after stratification according to their baseline performance scores: group A received a self-learning course with textbooks (n = 27), group B received a self-learning training on the SOP and checklist (n = 27) and group C was engaged in an interactive discussion panel regarding the SOP and checklist (n = 26). After the interventions, participants received outcome measurements about snakebite first aid key points capability from the same evaluator and SP for each group to avoid observational error. The reviewers were blinded about the grouping in the trial.
The baseline measurement yielded no significant difference (H = 1.647, P = 0.439) among the three groups. The post-intervention scores were higher than the pre-intervention scores for all three (A, B and C) groups (P = 0.008, P < 0.001 and P < 0.001, respectively). There was significant difference of the post-intervention scores among the three groups (F = 8.841, P < 0.001). Both post-intervention scores of group B and group C were higher than that of group A (P < 0.001 and P = 0.001, respectively), but no difference was found between group B and C (P = 0.695). The acceptance questionnaire score of SOP and checklist was mostly very satisfied, as the final scores of group B and group C were 4.62 ± 0.61 and 4.82 ± 0.45, respectively.
In this study, the implementation of an SOP and checklist for snakebite first aid was shown to update and improve first aid treatment concepts in military medics. These intervention methods played an important role in improving the medics' cognition and understanding of snakebite first aid. Therefore, this finding suggests that SOP and checklist training should be further implemented in Chinese troops for snakebite care.
蛇咬伤可导致终身后果，是全球军队中死亡的主要原因之一。然而，中国军队医务人员中很少有人了解蛇咬伤的正确急救程序。因此，本研究旨在探讨标准操作程序（SOP）和检查表对中国军队医务人员管理蛇咬伤急救的影响。
本研究是 2017 年 5 月至 6 月在中国某军医大学进行的前瞻性单盲随机对照试验。在基线测量前进行了一项基于问卷的调查，以收集参与者的社会人口统计学特征。在基线测量期间，要求参与者根据标准患者（SP）和评估者描绘的模拟情况提供相应的急救，并根据蛇咬伤急救评分表的检查表对其表现进行评分。基线测量后，根据基线表现评分对他们进行分层，然后将他们随机分配到三个干预组之一：组 A 接受了带教科书的自学课程（n=27），组 B 接受了 SOP 和检查表的自学培训（n=27），组 C 则参与了关于 SOP 和检查表的互动讨论小组（n=26）。干预后，每个组的同一评估者和 SP 对参与者进行了蛇咬伤急救要点能力的结果测量，以避免观察误差。评审员对试验中的分组情况不知情。
三组之间的基线测量无显著差异（H=1.647，P=0.439）。所有三组（A、B 和 C）的干预后得分均高于干预前得分（P=0.008、P<0.001 和 P<0.001）。三组之间的干预后得分存在显著差异（F=8.841，P<0.001）。组 B 和组 C 的干预后得分均高于组 A（P<0.001 和 P=0.001），但组 B 和 C 之间没有差异（P=0.695）。SOP 和检查表的接受问卷评分大多非常满意，因为组 B 和组 C 的最终评分分别为 4.62±0.61 和 4.82±0.45。
本研究表明，实施蛇咬伤急救 SOP 和检查表更新并改善了军队医务人员的急救治疗观念。这些干预方法在提高医务人员对蛇咬伤急救的认知和理解方面发挥了重要作用。因此，这一发现表明，SOP 和检查表培训应在中国军队中进一步实施，以进行蛇咬伤护理。
