Page 66 - JSOM Fall 2019

Airway Management for Army Reserve Combat Medics

An Interdisciplinary Workshop

Bradley Miller, DNP, CRNA, NREMT-P, ANC*;
Chad Kinder, MSN, RN, CNOR, CRNFA, ANC; Rachel Smith-Steinert, DNP, MSN, CRNA

ABSTRACT
Background: An Army Reserve Combat Medic’s training is Introduction
focused on knowledge attainment, skill development, and
building experience and training to prepare them to perform An Army Reserve combat medic’s training is focused on knowl-
in austere conditions with limited resources like on the battle- edge attainment, skill development, and building experience
field. Unfortunately, the exposure to skills they may be respon- and training to prepare them to perform in austere conditions
sible for performing is limited. Research shows that greater with limited resources like on the battlefield. Unfortunately,
than 90% of battlefield deaths occur in the prehospital setting, these providers often have a low exposure to skills for which
24% of which are potentially survivable. Literature demon- they may be responsible for performing in an emergency. This
strates that 91% of these deaths are related to hemorrhage; lack of opportunity to perform skills is associated with airway
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the remaining are related to other causes, including airway failure, complications, and adverse events. It is established in
compromise. The skill and decision-making of this population the literature that these providers generally possess a lack of
are prime targets to optimize outcomes in the battlefield set- experience and opportunity to perform the necessary skills in
ting. Methods: Army Reserve combat medics were selected to scenarios outside the training environment and possess an in- 2
voluntarily participate in an educational intervention provided complete set of tools required to achieve optimal outcomes.
by anesthesia providers focusing on airway management. Par- Many Army Reserve medics hold civilian jobs. Thus, if skills
ticipants completed a preintervention assessment to evaluate are developed, they atrophy during the times of nondeploy-
baseline knowledge levels as well as comfort with airway ment. Continuous training, beyond basic training, is necessary
skills. Medics then participated in a simulated difficult airway for this population of providers to sustain skill proficiency.
scenario. Next, airway management was reviewed, and nav-
igation of the difficult airway algorithm was discussed. The The lack of opportunity to perform and practice skills, such as
presentation was followed by simulations at four hands-on those needed to identify and manage a patient with a compro-
stations, which focused on fundamental airway concepts such mised airway or inadequate ventilation, is illustrated by Wang
as bag-mask ventilation and placement of oral airways, tra- and colleagues to be associated with failure, complication,
cheal intubation, placement of supraglottic airways, and crico- and adverse events. This is generalizable to the populations
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thyrotomy. Pre/post knowledge assessments and performance of Army Reserve medics. This population of providers have
evaluation tools were used to measure the effectiveness of a wide spectrum of skill and experience levels regarding safe
the intervention. Results: Statistically significant results were and effective out of hospital airway management. Despite this
found in self-reported confidence levels with airway skills generally low exposure to skill and decision-making in airway
(z = –2.803, p = .005), algorithm progression (z = –2.807, management outside the training environment, it has been
p = .005), and predicting difficulty with airway interventions found that the overall rate of correct placement of advanced
based on the patient’s features (z = –2.809, p = .005). Estab- airways placed under combat conditions by prehospital mili-
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lishment of ventilation was completed faster after the inter- tary providers is comparable to that of civilian paramedics.
vention. More coherent and effective airway management was It reasonable to extrapolate this concept of skill exposure to
noted, new knowledge was gained, and implications from psy- soldier medics in the Army Reserves with careful consideration
chological research applied. Conclusion: Supplementing the that airway management for a trauma patient under combat
training of Army Reserve Combat Medics with the utilization conditions is potentially very different from that of non-trau-
of anesthesia providers is an effective platform. This exercise matic causes of respiratory compromise or failure, which is far
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imparted confidence in this population of military providers. more commonplace in the civilian setting.
This is critical for decision-making capabilities, performance, 5
and the prevention of potentially survivable mortality on the Eastridge et al found that during recent conflicts in Iraq and
battlefield. Afghanistan “to impact the outcome of combat casualties with
potentially survivable injuries, strategies must be developed to
mitigate hemorrhage on the battlefield, optimize airway man-
Keywords: airway; mortality; military; nurse anesthetist; agement, and decrease the time from point of injury to surgical
education
treatment.” Our work was focused exclusively on improving
airway management provided by Army Reserve medics, with

*Correspondence to Bradley Miller, 3110 Vine St, Cincinnati, OH 45221 or Bmmiller15171@gmail.com
LT Miller, USAR, CPT Kinder, USAR, and Dr Smith-Steinert are affiliated with the University of Cincinnati College of Nursing, Nurse Anesthe-
sia Program, Cincinnati, OH.

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