Krieger Joshua A, Radloff Steven A, White Nathan J, Schauer Steven G
Department of Emergency Medicine, Evans Army Community Hospital, Ft. Carson, CO.
Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA.
Med J (Ft Sam Houst Tex). 2023 Jan-Mar(Per 23-1/2/3):57-63.
Introduction: Military Role 1 practitioners have difficulty maintaining skill competency by working solely in military medical treatment facilities. Recognizing this, the Army Medical Department has renewed focus on physician specialty-specific Individual Critical Task Lists (ICTL) and is increasing the number of military-civilian partnerships, wherein small military treatment teams work full-time in civilian trauma centers. Yet, data to validate this approach is lacking. We hypothesize military Role 1 practitioners working full-time at a civilian Level 1 trauma center would attain similar resuscitation-specific procedural frequency to providers deployed to an active combat zone, and use the emergency medicine (EM) ICTL to compare select procedural frequency between a cohort of trauma patients from a civilian Level 1 trauma center and a cohort of combat casualties from the Department of Defense Trauma Registry (DODTR).
We compared a selected subset of critically-injured, military-aged (18-35 years) trauma patients who were seen in a Level I Trauma Center emergency department (ED) between January 1, 2016 and December 31, 2017 and dispositioned directly either to the operating room, intensive care unit, or morgue to a selected cohort from the Department of Defense Trauma Registry (DODTR) who were seen in EDs in Iraq and Afghanistan between January 2007 and August 2016 using descriptive statistics. The primary outcome was the frequency of ICTL procedures performed, and the secondary outcome was injury severity.
We identified 843 civilian patients meeting inclusion criteria, of 1,719 military-aged patients captured by the trauma registry during the study. The selected cohort from the DODTR included 27,359 patients. Demographics were similar between the 2 groups, except the DODTR cohort included significantly more patients with blast trauma (55% versus 0.4%). We found similar ICTL procedural frequency (1 procedure for every 1.84 patients in the civilian cohort compared to one procedure/1.52 patients in the military cohort).
Role-1 ICTL trauma procedures were performed at similar frequencies between civilian patients seen at a Level 1 trauma center and combat casualties. With proper practice implementation, the opportunity exists for Role 1 practitioners to maintain their trauma resuscitation skills at civilian trauma centers.
引言：军事角色1的从业者仅在军事医疗设施工作时，难以维持技能水平。认识到这一点后，陆军医疗部门重新将重点放在了针对医生专业的个人关键任务清单（ICTL）上，并增加了军民合作关系的数量，即小型军事治疗团队在民用创伤中心全职工作。然而，缺乏验证这种方法的数据。我们假设在民用一级创伤中心全职工作的军事角色1从业者，其特定复苏程序的执行频率将与部署到活跃战区的医疗人员相似，并使用急诊医学（EM）的ICTL来比较来自民用一级创伤中心的一组创伤患者与国防部创伤登记处（DODTR）的一组战斗伤亡人员之间的特定程序频率。
我们比较了2016年1月1日至2017年12月31日期间在一级创伤中心急诊科（ED）就诊且直接被送往手术室、重症监护病房或停尸房的选定子集的重伤、适龄军人（18 - 35岁）创伤患者，与2007年1月至2016年8月期间在伊拉克和阿富汗的急诊科就诊的国防部创伤登记处（DODTR）选定队列，采用描述性统计方法。主要结果是ICTL程序的执行频率，次要结果是损伤严重程度。
在研究期间创伤登记处记录的1719名适龄军人患者中，我们确定了843名符合纳入标准的 civilian患者。来自DODTR的选定队列包括27359名患者。两组的人口统计学特征相似，但DODTR队列中爆炸伤患者明显更多（55%对0.4%）。我们发现ICTL程序频率相似（民用队列中每1.84名患者进行1次程序，而军事队列中为每1.52名患者进行1次程序）。
在一级创伤中心就诊的 civilian患者与战斗伤亡人员之间，角色1的ICTL创伤程序执行频率相似。通过适当的实践实施，角色1的从业者有机会在民用创伤中心维持其创伤复苏技能。
