Page 71 - JSOM Fall 2019

FIGURE 5 Dunning-Kruger effect. 10 FIGURE 6 Project flowchart.

of complication, there is great potential to decrease incidence
of preventable death from failure to ventilate and morbidity
from airway injury.

Human Factors
The medics performed poorly on airway algorithm progression social desirability bias. The group comparison was also biased
during the initial difficult airway scenario. It is hypothesized by the composition of the group. Differences within the group
that human factors brought on by stress of the high-fidelity of participants exist: age, gender, culture, military experience,
simulation interfered with decision-making capabilities. The airway experience, presence or absence of a healthcare career.
balance between stress and anxiety levels is profound and a Threats to external validity are minimal because all army
significant factor affecting performance. McLernon et al medics must meet similar standards for army medic training.
11
suggests that skills and higher order knowledge that is borne Therefore, this sample, although small, can be considered rep-
of deliberate practice in moderately stressful scenarios is an resentative of cohorts across geographic areas.
effective way to impart high performance in real situations.
11
Providing repeated exposures and opportunities to stress-
ful scenarios increases skill and can not only lead to higher Conclusion
quality performance, but can also increase self-esteem, confi- Anesthesia providers are subject matter experts in the field of
dence, motivation, and participant satisfaction and can lead to airway management. Having these practitioners impart basic
more positive interactions, fewer mistakes, and better patient airway knowledge to improve the training of combat medics
outcomes. 12 and improve skills is effective. The expansion of this interpro-
fessional airway workshop could improve participant satisfac-
Quality Improvement tion and the quality of care that is delivered (Figure 6). This
The performance evaluation tool is difficult to enact in real exercise imparted not only improved airway knowledge and
time with respect to capturing data accurately. Moving for- skill attainment but also confidence in this population of mil-
ward, video recording will be used to collect data during simu- itary providers. This confidence is critical for decision-making
lations, coupled with multiple rounds of practice enacting the capabilities, performance, and the prevention of potentially
performance evaluation tool to increase operator effectiveness survivable mortality on the battlefield.
and accuracy. Also, using a timer that reports time in seconds
will allow an ease of measuring and recording time rather than Acknowledgments
calculating minutes to seconds in order to have continuous The authors wish to acknowledge the assistance of committee
data for analysis. member Matt Yockey, MSN, CRNA.
Force Multiplier Disclosure
As Kotwal et al. illustrated, training of the entire force is as- The authors have indicated they have no financial relation-
sociated with a significant decrease in mortality and an elimi- ships relevant to this article to disclose.
nation of preventable deaths. By more experienced providers
9
empowering less experienced medics with knowledge, skill, Author Contributions
and confidence on an ongoing basis, they act as force multipli- BM, RSS, and MY conceived the study concept. BM and MY
ers by disseminating airway management training to even less designed and built the workshop. RSS advised on the doctoral
experienced personnel, ultimately yielding a more thoroughly of nursing practice fundamentals and contributed to writing
trained and prepared unit. and editing the manuscript. BM and MY coordinated and
collected the data. CK recruited participants and coordinated
Threats to internal validity include the use of survey data the military training schedule. BM and RS analyzed data and
where there is inherent danger in the author inserting infor- developed the manuscript. All authors approved the final
mation bias and the participants demonstrating recall bias or manuscript.

Airway Management for Army Reserve CMs | 69