Page 85 - Journal of Special Operations Medicine - Summer 2016

2016 Special Operations Medical and
Scientific Assembly Abstracts

TOP PODIUM PRESENTATION Background: Patients commonly present to emergency
rooms and primary care clinics with cellulitic skin in-
Expanding Military Trauma Research in Law Enforce- fections with or without abscess formation. In military
ment and Responder Populations operational units, non-physician medical personnel pro-
Carolyn Elizabeth Cuevas, MS, NRP, Senior Lecturer, vide most primary care and initial emergency medical
College of Health Affairs, University of Texas Rio care. The objective of this study was to determine if,
Grande Valley, Brownsville, TX after minimal training, Army physician assistants (PAs)
and medics could use portable ultrasound (US) machines
Recent battlefield trauma research has resulted in sig- to detect superficial soft-tissue abscesses.
nificant translational improvements for survivability;
however, they are slow to garner widespread accep- Methods: This was a single-blinded, randomized, pro-
tance and implementation. The lack of not only com- spective, observational study conducted over the course
parable but also understandably relevant studies that of 2 days at a military installation. Active duty military
translate to civilian populations has fueled resistance to PAs and medics with little or no US experience were re-
implementation of proven military trauma survivability cruited to participate in the study. They received a short
recommendations. block of training on abscess detection, using both clinical
exam skills (inspection/palpation) and US exam. The par-
Employing proven battlefield trauma severity and surviv- ticipants were then asked to provide a yes/no answer as to
ability assessment methodologies, this review of officer abscess presence in a chicken-tissue model. Results were
mortality deepens the understanding of law enforcement analyzed to assess participants’ ability to detect an ab-
duty mortality through identification of causes, inci- scess, compare the accuracy of their clinical exams with
dence of specific trauma, and determination of possible their US exams, and assess how often US results changed
survivability with the aim to reduce future mortality. treatment plans initially based on clinical exam findings.

Using well-established military and trauma mortality Results: 22 participants performed a total of 220 clinical
classification methodologies, this approach identifies exams and 220 US scans on 10 chicken-tissue abscess
factors influencing survivability, allowing for improved models. Clinical exam for abscess yielded a sensitivity of
planning, training, and field operations. Law enforce- 73.5% (95% confidence interval [CI], 65.3%–80.3%)
ment officer duty fatalities often occur in situations and a specificity of 77.2% (95% CI, 67.4%–84.9%),
where either the location or environment hinders im- while US exam yielded a sensitivity of 99.2% (95%
mediate access to a definitive trauma facility. Similari- CI, 95.4%–99.9%) and a specificity of 95.5% (95%
ties to battlefield trauma will be examined in this study CI, 88.5%–98.6%) for abscess detection. Clinical exam
to better understand the circumstances of potentially yielded a diagnostic accuracy of 75.0% (95% CI, 68.9%–
survivable death in law enforcement populations and 80.35) while US exam yielded a diagnostic accuracy of
tactical situations. Utilizing approaches from military 97.7% (95% CI, 94.6%–99.2%), a difference in accu-
prevention and control for civilian populations with sig- racy of 27.7% favoring US (p < .01). Ultrasound changed
nificant risk of survivable polytrauma, the identification the diagnosis in 56 of 220 cases (25.4% of all cases; p =
of factors influencing survivability aims to increase ac- 0.02). Of these 56 cases, US led to the correct diagnosis
ceptance and adaptation of established military trauma 53 out of 56 times (94.6%).
survivability practices.

PODIUM PRESENTATIONS
TOP POSTER PRESENTATION
Prehospital Analgesia Administration and Adherence
Ultrasound Detection of Soft Tissue Abscesses Per- to TCCC Guidelines: The Prehospital Trauma Registry
formed by Non-physician US Army Medical Providers Experience in Afghanistan
Naïve to Diagnostic Sonography CPT Steven G. Schauer, DO (USAISR); Cord W. Cun-
CPT Michael LaDuke, PA-C, EMPA DSc Candidate, ningham, MD, MPH, FACEP, LTC, MC, FS, DMO, 1st
US Army-Baylor University EMPA Program, Madigan Air Cav Brigade/TMC-12, Battlefield Prehospital and
Army Medical Center, JBLM, WA Disaster Medicine

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