L'hôpital de proximité: Insuffisant ?

Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study

Schauer SG et Al. J Spec Oper Med. 2015 Winter;15(4):67-70

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Lire également cet éditorial qui pointe l'insuffisance de l'exercice en hôpital de proximité avec le rôle important que peut jouer la simulation. Les auteurs proposent un  maintien longitudinal des compétences avec des minima en termes de pratiques gestuelles avant projection. 

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BACKGROUND:

Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to okeep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient t keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting.

METHODS:

EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready.

RESULTS:

The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center.

CONCLUSIONS:

This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume.