Page 58 - Journal of Special Operations Medicine - Summer 2014

METHODS Each participant’s time in seconds, traction in pounds,
and confidence responses were recorded. Times of stu-
Participants dents failing to apply a splint completely or generating
zero traction were not used in analyses so that failures
Twenty-one Army Health Care Specialists (Military by subjects who quit the application procedure could
Occupational Specialty 68W), 29 Aerospace Medical not benefit a device’s average times. Times on each de-
Technicians (Air Force Specialty Code 4N), one Navy vice were compared using a one-way ANOVA with 158
Hospital Corpsman (HM rating), and six Coast Guard degrees of freedom (df) within groups and 3 df between
emergency medical technicians (Health Services Techni- groups. Two-tailed Student’s t-tests were used to deter-
cian and Aviation Survival Technician ratings) partici- mine the magnitude of differences between each device
pated in the surveys and data collection during January group as well.
2014. One Coast Guard and four Army Servicemembers
participated in the initial survey but did not complete The post-skills survey contained statements with cor-
the study due to conflicts with mission requirements. responding 5-point bipolar Likert scoring scales (1 =
Thus, 57 total subjects participated in some part of the “strongly disagree,” 3 = “neutral,” 5 = “strongly agree”)
study with 53 completing both surveys and testing on to measure student confidence and preference to per-
all four devices.
form traction splinting. A space for free responses was
provided for each splint. No attempts were made to in-
Procedure fluence these responses and all instructors were blinded
to any responses until after conclusion of the course
Brief standardization training on traction splinting was and analyses. Comparisons of mean values between
delivered via PowerPoint slides using the instructions for corresponding questions from the four sections of the
use provided by the manufacturer. This was followed by post-skills survey were performed using matched-pairs
a demonstration of the correct application of each splint Student’s t-tests given 52 df.
on a commercially available femoral traction training
manikin (Simulaids, Saugerties, NY) by a member of the RESULTS
research team. Every participant applied each splint in
random order to the manikin with an assumed weight The 57 Armed Forces medical personnel who partici-
of 150 lb. Timed testing for each splint was graded as pated averaged just less than 8 years of service, 5.3 years
pass/fail with regard to proper application based on the of medical experience, and 7 months of deployment ex-
manufacturer’s instructions for use and the ability to perience. The average participant also had treated two
create measurable traction. Participants were timed with battlefield casualties. Approximately one in five (20%)
a digital stopwatch starting with the instruction “Go” had used their medical training on battlefield casual-
and ending when the participant indicated that he was ties, and one in 11 (9%) had treated a casualty with a
finished. A quantitative measure of traction applied was femoral fracture on the battlefield. One in six (16.7%)
indicated by the manikin’s digital display. This display had used a traction splint on a live patient, while one in
was not visible to the participant, but participants could 20 (5%) had used a traction splint on a combat casu-
note lengthening of the shortened limb and improve- alty. One in five (20%) had treated a femoral fracture
ment of deformity if the correct traction was applied. in some setting. Subjects had previously trained on trac-
The participants were given the quick-reference instruc- tion splints an average of approximately 6 times. Sub-
tions included with each splint if needed during testing. jective and demographic data from the initial survey are
summarized in Table 2.
This study was reviewed by the University of South
Florida Division of Research Integrity & Compliance Aggregated results of the initial survey showed that
and was determined to be exempt quality improvement participants self-reported the most training experience
research that did not meet the definition of human sub- with the RS and the most patient experience with the
jects research. KTD. The most commonly selected splint reported as
the “most effective” treatment for a suspected femo-
ral fracture was the CT-6. Participants were also most
Data and Analyses
confident in their ability to apply the CT-6. The CT-6
Fifty-three participants completed two surveys and a was selected as best designed for dismounted carry and
single timed trial with each traction splint. An initial most appropriate overall for battlefield use on the initial
survey was conducted after the standardized presenta- survey.
tion but before hands-on skills practice. A second survey
was conducted after students had received instruction Of all the splints tested, the average application time
and placed all devices on the manikin without assistance for the STS was the fastest (242.1 seconds), followed by
in timed trials. the KTD (265.9 seconds), the CT-6 (314.6 seconds), and

48 Journal of Special Operations Medicine Volume 14, Edition 2/Summer 2014