Stage de préparation OPEX ?: Insuffisant !

Quantifying Clinical Opportunities at the Navy Trauma Training Center

Schmied Blackman V et Al. Mil Med. 2021 Jan 25;186(Suppl 1):40-48.

 

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Ce document doit interpeller sur la pratique de formation des personnels appelés à mettre en oeuvre les gestes du sauvetage au combat. Les différents stages suivis n'assurent à l'évidence pas une pratique gestuelle mais plutôt son observation, ce qui n'est pas du tout la même chose. Par ailleurs ces stages ne permettent pas la confrontation à des traumas ouverts. En outre la nature de l'activité en Service d'Urgence ne correspond pas à une technicité suffisante. L'immersion en bloc opératoire le permet plus même si les opportunités de pratiques gestuelles semblent moindre. Un bon compromis pourrait être l'immersion en salle de surveillance postinterventionnelle.

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Introduction: 

Military-Civilian partnerships (MCPs), such as the Navy Trauma Training Center, are an essential tool for training military trauma care providers. Despite Congressional and military leadership support, sparse data exist to quantify participants' clinical opportunities in MCPs. These preliminary data from an ongoing Navy Trauma Training Center outcomes study quantify clinical experiences and compare skill observation to skill performance.

Materials and methods: 

Participants completed clinical logs after each patient encounter to quantify both patients and procedures they were involved with during clinical rotations; they self-reported demographic data. Data analyses included descriptive statistics and chi-square statistics to compare skills observed to skills performed between the first and second half of the 21-day course.

Results: 

A sample of 47 Navy personnel (30 corpsmen, 10 nurses, 3 physician assistants, 4 physicians) completed 551 clinical logs. Most logs (453/551) reflected experiences in the emergency department, where corpsmen and nurses each spent 102.0 hours, and physician assistants and physicians each spent 105.4 hours. Logs completed per participant ranged from 1 to 31, (mean = 8). No professional group was more likely than others to complete the clinical logs. Completion rates varied by cohort, both overall and by clinical role. Of emergency department logs, 39% reflected highest acuity patients, compared with 21% of intensive care unit logs, and 61% of operating room logs. Penetrating trauma was reported on 16.5% of logs. Primary and secondary trauma assessments were the most commonly reported clinical opportunities, followed by obtaining intravenous access and administration of analgesic medications. With few exceptions, logs reflected skill observation versus skill performance, a ratio that did not change over time.

Conclusion: 

Prospective real-time data of actual clinical activity is a crucial measure of the success of MCPs. These preliminary data provide a beginning perspective on how these experiences contribute to maintaining a skilled military medical force.