Page 80 - Journal of Special Operations Medicine - Winter 2015

study. A waiver of consent was obtained, since the sur- 1 year or less experience as a staff EP. The mean to-
veys were anonymous, and the procedural volume data tal deployment time was 10.9 months, with 11 (23%)
were obtained in a deidentified manner. A letter of ap- reporting zero months deployed. Table 1 outlines the
proval was obtained from SRMC Command because demographics of those surveyed; Table 2 outlines the
this study was considered to be of Command interest. A responses elicited; and Table 3 outlines the reported vol-
physician contact list was provided by the leadership of ume of each procedure by facility.
the individual departments included in the survey popu-
lation: Brooke Army Medical Center, which was later Table 1 Demographics of the Active-Duty EPs Surveyed
changed to the San Antonio Military Medical Center
(SAMMC) as part of the Base Realignment and Clo- Age, y 37.1 (range 29–51)
sure Act; Winn Army Community Hospital, Fort Stew- Male 91%
art, Georgia; Blanchfield Army Community Hospital, Years out of residency* 4.7 (range 1–21)
Fort Campbell, Kentucky; Reynolds Army Community
Hospital, Fort Sill, Oklahoma; Martin Army Medical Number of months deployed 10.9 (range 0–31)
Center, Fort Benning, Georgia; and Bayne-Jones Army *Physicians recently out of training were classified as 1 year or less.
Community Hospital, Fort Polk, Louisiana. US Army
EPs who were assigned to the emergency departments Table 2 Reported Number of Annual Procedures That EPs
Indicated Were Necessary to Remain Deployment-Ready
(EDs) at participating locations and who had completed
an EM residency (62A) were sent an e-mail invitation IQR
to participate in the anonymous, online survey. The Procedure Mean Median (25–75%)
survey was available over a 6-month period from Jan- Tube thoracostomy 5.9 5 3–8
uary through June 2014. A reminder e-mail was sent Endotracheal intubation 11.4 10 5–13.5
part way through the study, with the goal to increase Cricothyrotomy 4.2 4 2–5
response rates.
Lumbar puncture 5.2 4 2–6
Physicians who agreed to participate were e-mailed a Central line 10.0 10 5–12
link to complete a survey via a fillable form on Google FAST 21.3 12 5.5–24
Docs. The data were collected in a deidentified manner. Dislocations/reductions 10.6 6 4.5–12
Demographic data were collected (e.g., age, sex, years
in training). EPs were asked to estimate the volume of Splints 10.5 10 4–12
the following procedures they would need on an annual Procedural sedations 11.7 10 4.5–12
basis to maintain their skills at a deployment-ready sta- IQR, interquartile range.
tus in case they were deployed to combat areas with
no consulting services available: tube thoracostomy, Discussion
endotracheal intubation, cricothyrotomy, lumbar punc-
ture, central venous line, FAST examinations, disloca- In our study we found that significant variance exists
tions/reductions, orthopedic splints, and procedural in the perceived annual volume of procedures neces-
sedations. sary to maintain procedural skills competency, and
most EPs felt underprepared. These findings highlight
The data obtained from the physicians’ surveys were several important factors to consider regarding training
then compared with the available institutional proce- and maintenance of skills competency for EPs. Signifi-
dure volume data for the procedures surveyed (i.e., the cant variance exists in the perceived volume of annual
number of specific procedures performed at each par- procedures necessary to maintain procedural skills com-
ticipating ED). Procedure volume data were obtained petency. While not presented specifically in this report,
for 2013 by searching for applicable Current Procedural some of the variance appears to be associated with years
Terminology codes from the EDs. The in-garrison vol- in practice, with junior physicians stating larger volumes
ume data were then compared with the volume of pro- are necessary than did more seasoned providers. How-
cedures the EPs reported they would need to maintain ever, the number of years of experience that delineates
their skills at a deployment-ready status. junior from senior physicians is unclear, making statis-
tical calculations challenging. The military physician
force is unique in that more than half of the surveyed
Results
physicians had 3 years or less experience after residency.
Of 47 invited EPs, 35 (74%) participated in the survey. This differs from the civilian EP work force, given the
The mean age of participants was 37.1 years, and the nature of military activities. In addition, patient acuity
majority were men (91%). The mean time out of res- at military MTFs where these physicians practiced was
idency training was 4.7 years, with 10 (21%) having generally low. Physicians tend to join at a younger age,

68 Journal of Special Operations Medicine Volume 15, Edition 4/Winter 2015