Page 93 - Journal of Special Operations Medicine - Summer 2017

Table 1 Population Factors of Surveyed Medics as chest-tube feedback, jugular intravenous (IV) access
Survey Item Average Response insertion, wound closure, hemorrhagic wound packing,
Treated live casualties at point 77% answered yes and bilateral chest-tube insertion sites.
of injury? Given the high degree of homogeneity between these
Rank/grade E7—Sergeant First Class / groups and correlation of their ratings on greater than
Chief Petty Officer 90% of variables, the groups were combined for addi-
Length of SOF Medic career ~ 6 years tional analysis. As detailed in Methods, a standardized
thus far comparison variable was generated for each of the three
Number of times you have 2 categories having a value equivalent to the summed
completed SOCMSSC training mean of all the Likert-scaled item scores within the cat-
Number of times you have 1 egory. This process produced a comparison variable of
completed MPT “average importance” with respect to all others within
Total combat OIF deployments 0.99 its category of general characteristics, procedures, or in-
Total combat OEF deployments 1.73 juries, with values of 4.05, 4.37, and 4.48, respectively,
each out of a possible maximum of 5. Evaluation against
Casualty Care (TCCC) curriculum (i.e., extremity tour- this mean comparison variable allowed for identifica-
niquet procedure, hemorrhage wound packing pro- tion of manikin HPS factors, which were subjectively
cedure, chest wound seal procedure, bilateral needle rated significantly above or below average importance.
decompression procedure, tourniquet application re-
sponse, bilateral needle decompression sites response, The means and p values for survey items and manikin
and packable wounds), basic life support (i.e., palpable features rated as significantly different from their cat-
pulses, air moves through HPS airway, rise and fall of egory’s comparison variable are reported in Table 3,
chest, and bag-valve mask response), and realism (i.e., which describes positively rated general features; Table
realistic wounds, changeable wounds, realistic feed- 4, which lists negatively scored general features; and
back, changeable vital signs, realistic anatomy around Table 5, which lists data specific to procedures and inju-
cricothyrotomy site, and realistic anatomy around chest ries. Many manikin features did not demonstrate mean-
tube site). ingful differences in rating from the mean comparison
variable of the same category and these are summarized
In general, USASOC (Army) and USSOCOM (Navy/Air in Table 6. Of note, skin color as a feature was identified
Force) personnel had a high level of agreement in their as an outlier with a z-score of 3.2 and a mean rating of
opinions on features and procedures; there was signifi- 1.95 out of a possible 5 (i.e., low importance). The only
cant disagreement in only 10 of the 102 variables (Table injury that was replicated by manikin HPS devices and
2). In general, when significant differences were identi- rated significantly different from the group was a de-
fied, USSOCOM personnel had more interest in features gloved extremity, which was an outlier with a z-score of
relevant to definitive care or transport procedures, such 2.1 and a rating of 3.67 out of 5 (i.e., fair importance).

Table 2 Features Displaying Significant Disagreement Between Surveyed Populations
Mean by USASOC Mean by USSOCOM
Rated Feature Personnel (Out of 5) Personnel (Out of 5) p-Value
Wound closure ability with sutures or staples 3.70 4.20 <.01
Humidified air creates misting in endotracheal tubes 3.66 4.08 <.01
Realistic joint range of motion 3.95 4.29 <.01
Chest tube sites bilaterally functional 4.32 4.58 .019
Peripheral IV site external jugular 4.20 4.48 .019
Hemorrhage wound cavity reacts to and capable 4.64 4.82 .023
of packing
Non-propriety connections 4.13 3.77 .025

Blood pressure responsiveness 4.29 4.52 .048
Chest tube insertion site feedback (air flutter or 4.05 4.33 .048
blood return)
Uses organic medical diagnostic devices 4.25 4.48 .049
(BP, Etco , Spo , ECG)
2 2

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