Page 65 - JSOM Fall 2020

by users expressly for that purpose, the USAISR regulatory FIGURE 1 Flow diagram of the review process.
office determined our project met the requirements for perfor-
mance improvement and did not require institutional review
board oversight (USAISR project H-18-037). Initial search = 611 nonduplicate
entries from all databases combined
Data Acquisition
We searched the Center for Army Lessons Learned (CALL, Primary reviewers assessed for
https://call2.army.mil), the Army Medical Department Les- relevance (SGS, JFN, MDA)
sons Learned (AMEDDLL, https://secure-ll.amedd.army.mil) removing nonrelevant entries
(e.g., no airway issue noted,
and the Joint Lessons Information System (JLLIS, https://www books, guidelines, etc.)
.jllis.mil/apps) for all entries since 2001.“Lessons learned”
data bases are set up by commercial, government, and military
organizations to capture, store, and share all knowledge. Relevant entries = 74
12
Typically, end-users (in the case of the military, soldiers and
other servicemembers in the field) are encouraged to provide Overall review team
input and feedback on positive and negative “lessons learned” (SGS, JFN, MDA, KT, JKM,
during their field experiences. Organizational policies and DMB, TEB, RAD) categorized
command guidance encourage this feedback. Anonymous re- and extracted select, highly
relevant comments
ports are possible to encourage frank reporting. Details of the
lessons learned databases are described elsewhere. 13
AARs categorized
Equipment/malfunctions = 37
The databases were searched using the following terms: airway, Training/education = 28
airway device, bougie, breathing, cricothyrotomy, cricothyroi- Other = 9
dotomy, endotracheal, GlideScope, hypoxia, hypoxic, intu-
bation KingLT, laryngeal mask airway, LMA, laryngoscopy,
laryngoscope, nasopharyngeal airway, NPA, oral pharyngeal
airway, oropharyngeal airway, OPA, stylet, supraglottic, and TABLE 1 Training-Related Comments
video laryngoscope. We downloaded AAR files that met one
or more search terms. Predeployment and Proficiency Training
All medics are required to have 90 days of medical proficiency train-
ing (in a continuous block) every year. In our division, that require-
Review Process ment has been reduced to 45 days. None of the medics ever get the
The primary review team (SGS, JFN, MDA) reviewed all 45 days; most never get any. This is unacceptable for the education
nonduplicate entries that were available for relevance. Upon of our frontline responders and unfair to those Soldiers whom they
removal of nonrelevant views (protocols, tactics, guidelines, are supposed to treat. We are the world’s premier fighting force and
etc.), the overall expert panel (SGS, JFN, MDA, KT, JKM, yet our medics finish AIT with only basic emergency medical tech-
nician (EMT) skills, which MUST be continually refined and built
DMB, TEB, RAD) then reviewed and categorized. We then upon to ensure that they mature. This can only happen through a
selected relevant reviews for analysis. Given the diverse na- focused, dedicated, and regimented medical proficiency training
ture of the sources, the nonstandard format for users to report program that ALL medics must go through every year. There is no
information, and the variable degree of detail in each report, established or enforced division/posttraining plan to accomplish this
mission and therefore it is left to the unit to complete. This must be
we applied unstructured qualitative methods to analyze the tracked at the division level and be a key component of USR [unit
reports. We created a post hoc categorization scheme using status reporting], such as Ranger and AASLT [air assault] training
three broad areas related to equipment, training, and other. statistics.
Data are reported in descriptive format and supplemented Medics believe that their base training (EMT, BTLS [Basic Trauma
by selected quotes lifted from the sources to illustrate key Life Support], Trauma-AIMS [Airway management, intravenous
themes. therapy, medication, shock management]) is adequate but not on-
going training (medical proficiency training) and specific training in
combat casualty care (how the medic should approach care in com-
Results bat rather than what is taught in civilian equivalent course). Specifi-
cally, medics need further training in airway management including
Our initial database search yielded 611 nonduplicate entries. surgical and treatment of pneumothorax. All medics should contin-
After initial review, we removed irrelevant entries, which left ue to be EMT-Basic, and transition to EMT-Intermediate beginning
at E-4 with completion by E-6.
70 deployment-based lessons learned and 4 training-based les- Prior to deployment and LD [line of departure] the emphasis was on
sons learned for review. The team of subject matter experts vehicles and MES [medical equipment sets] being set for the pending
then reviewed the 74 lessons learned. We categorized 37 AARs combat operation. There was little time for medical training; once a
(50%) as equipment challenges/malfunctions, 28 (38%) as training schedule was published, the next day it was thrown out due
training/education challenges, and 9 (12%) as other (Figure to taskings and details.
1). The overwhelming majority of specific, addressable feed- ATLS [Advanced Trauma Life Support] procedures are required on
back was interpreted by the SME team as shortages related to several patients. I have performed endotracheal intubation, surgical
cricothyroidotomy, tube thoracostomy, needle chest decompression,
training—noting that 68W (previously 91W) airway-specific and venous cut-down. I could have benefited from more experience
training was insufficient (Table 1). Several lessons learned spe- prior to deployment.
cifically stated that units were not making medic training a Flight medics should be maintained in the career field as long as they
priority and that units should consider sending their medics desire to do so by stabilizing assignments and allowing for promo-
to civilian training centers. Equipment shortages were noted tion through E-7 as a flight paramedic because of the cost of training
mostly specific to certain mission types (e.g., pediatric casual- and perishable skills.
ties; Table 2). (continues)

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