Page 62 - Journal of Special Operations Medicine - Spring 2014

would permit detection of a difference of 40% between 98% of the predefined critical actions (14 per case)
experimental and control teams completing all critical ac- were completed by CTS teams versus 71% of controls
tions within 20 minutes. This study was reviewed and ap- (p < .01); 89% of CTS teams versus 56% of controls
proved by the Institutional Human Subjects Committee established advanced airways within 8 minutes, which
of Brooke Army Medical Center and by the U.S. Army closely approximated significance (p < .06). Average
Clinical Investigation Regulatory Office. time to completion in minutes (95% CI) for CTS teams
was 12 (10–14) versus 18 (16–20) for controls (p < .01).
After excluding the two cases with HFPS failures, 100%
Results
of CTS teams versus 56% of controls completed all LSI
As defined a priori, we conducted interim analyses after (p < .01), while 86% of CTS teams and 19% of control
the first simulator iteration (nine experimental teams and teams completed all critical actions (p < .01) Analysis of
nine control teams accumulated), and after the second (18 interrater agreement was performed by calculating the
experimental teams and 16 control teams accumulated). coefficient of correlation for total time elapsed. In this
Because the results of the second interim analysis dem- case (r = 0.998, p < .01).
2
onstrated substantial and clinically significant differences
in our respective outcome measurements, we elected to
suspend additional experiments and report our results. Discussion
Contingency Telemedical Support holds promise as a
There were two episodes of HFPS manikin failure, both viable solution for providing and projecting emergency
occurring in experimental cases. One instance involved medical and trauma resuscitation expertise into the
failure to produce the requisite airway obstruction; out-of-hospital environment. In this investigation, we
the second involved failure to produce signs of tension demonstrated substantial and significant improvements
pneumothorax. in participants’ performance rates for LSIs, their com-
pletion of all critical actions, and in the total time-to-
Detailed results are depicted in Table 1. Eighteen CTS completion of the simulated resuscitation encounters
teams and 16 control teams were studied. CTS teams among experimental teams employing CTS. We also
were led by the following provider types: physicians in demonstrated the utility of a portable, field-maintainable,
11 instances, RNs or ANPs in six instances, and a den- and adaptable telemedical suite as a potential solution
tist in one instance. Control teams were led by 13 physi- for the crucial telecommunications link that would en-
cians, one RN, and one dentist (χ = 2.06, p < .36). able CTS in both conflict settings and in domestic sys-
2
tems of emergency care.
Table 1 Results of Trial of CTS*.
In performing this study, we have not sought so much to
CTS Control
Group Group Significance report a stunning new discovery; rather, we think of our
results more in terms of being “a blinding flash of the
No. of teams 18 16
obvious.” Intuitively, we recognize the inherent value of
Team leader clinical mentorship and a sizeable proportion of health
MD/DO 11 13 professional training reflects what others might call a
RN 5 2 master/apprentice model. Our results provide quantita-
tive evidence to support the CTS concept as a means to
ANP 1 0
connect mentors and protégés providing the critical, ini-
DDS 1 1 tial battlefield care to the wounded. In many cases, these
All LSIs complete 89% 50% <.03 novice providers may otherwise have considered them-
All critical actions 98% 71% <.01 selves underprepared to meet that clinical challenge.
complete
In addition to the promise of performance improvement
Airway secure <8 min 89% 56% <.06
among formative trauma resuscitation teams, we were
Time to case 12 18* <.01 pleased to observe that both the DREAMS technology
™
complete (min)
as well as the telepresence of the CTS consultant was
Notes: *In the event that a case was not completed by 20 min, we widely embraced by our experimental subjects. One re-
assigned a 20-min time for analysis purposes. All CTS cases were com-
plete by 20 min. Eight control cases were not completed. curring observation sums up this point succinctly: when
asked whether subjects would use the CTS solution were
All critical actions were performed by resuscitation team it to be available on their next deployment, a recurring
members (Table 1). By ITT analysis, 89% of experimental reply was, “You mean this isn’t already going to be there
teams versus 56% of controls completed all LSI (p < .01); when we get to our units?”

54 Journal of Special Operations Medicine Volume 14, Edition 1/Spring 2014