Page 62 - 2022 Spring JSOM

TABLE 1 Pre- and Posttesting Confidence in Obtaining Intravenous
IV IO
Lighting Pre Post p Value Pre Post p Value
‡
†
†
HL 4.3 (0.2) 4.6 (0.2) 0.14 4.4 (0.2) 4.8 (0.2) 0.04
†
NVG 3.0** (0.2) 2.6 (0.2) 0.053 3.7** (0.2) 4.0 (0.2) 0.52
NVG+A 2.3 (0.3) 2.9 (0.2) 0.049 2.9 (0.3) 4.2 (0.2) 0.003
† p < .001 vs NVG, NVG+A.
**p < .01 vs NVG-A.
‡ p < .001 vs NVG, p < .02 vs NVG+A.
HL = tactical headlamp; IV, intravenous; IO, intraosseous; NVG, night vision goggle; NVG+A, night vision goggle with focusing adaptor;
NVG-A.
low-light setting. For those who selected one combination was roughly one-third lower than that of the tactical head-
only, the most common combinations were the headlamp lamp but roughly one-third higher than that of NVG. NVG+A
with an IO procedure (39%) and NVG with an IO procedure completion times were marginally slower than those of NVG
(26%). However, 5 of 23 participants (22%) selected more for IO access but marginally faster for IV access. NVG+A was
than one combination. Including these multiple combination rated marginally less difficult than NVG for IV and IO pro-
selections, the most frequent combinations were a headlamp cedures, and confidence ratings were somewhat higher than
with an IO procedure (12/23; 48%) and NVG with an IO pro- those for NVG at posttesting for both IV and IO procedures.
cedure (9/23; 39%). NVG+A with an IO procedure was in- These results may have been driven, at least in part, by lack
cluded by 13% (3/23) of participants, and NVG+A with an IV of user familiarity with NVG+A because few had prior expe-
procedure was included by 9% (2/23) of participants. Overall, rience with focusing adaptors. This speculation is supported
57% (13/23) included the headlamp in their preferred com- by participant feedback and by the statistically significant
binations, while 39% (9/23) included NVG, and 17% (4/23) increases in pre–post changes in user confidence for both IV
included NVG+A. and IO procedures. Overall, 13% of participants indicated
that they would use the focusing adaptors eagerly in an oper-
ational setting, whereas 30% indicated that they would do so
Discussion
reluctantly.
Performing medical tasks can be challenging in low-light
conditions. Rapidly acquiring IV or IO access is vital toward Participant feedback regarding the focusing adaptors varied.
preserving the life of the hemorrhaging warfighter. Standard Some participants liked the increased near-field focus, while
tactical lighting (i.e., a tactical headlamp) may be effective in others had difficulty focusing the devices. Perceived bright-
aiding IV or IO access, but standard tactical lighting does not ness also varied, with some reporting improved brightness
confer light discipline, thereby risking unnecessary exposure to and others reporting a darkened view. Two participants were
the enemy. NVGs confer light discipline but are not designed concerned with the lack of integration into the NVGs and
for close-in work, such as obtaining IV or IO access. Focus- feared that the adaptors would get lost. Three indicated that
ing adaptors may fill this need, but the efficacy of focusing the adaptors would be valuable only if supplemented with
adaptors compared to NVGs and tactical headlamp lighting in an infrared light source. One participant revealed that “the
the speed and success of obtaining IV and IO access was un- NVG+A allows you to focus on multiple depths at the same
clear. This study makes a novel contribution to the literature time which is crucial for IVs. I could see flash much better
by testing focusing adaptors for IV and IO access using US SO, with the adaptors.” Another stated that the NVG+A “made
SARC, and FMST professionals. it easier to see close up during the procedure.” However, still
another commented that NVG+A was “another piece of gear
The tactical green-light headlamp performed best in the pres- to adjust.” Others reflected that they needed more repetitions
ent study, demonstrating the fastest completion times, highest with the focusing adaptors before reaching strong conclusions
rates of success, and highest participant confidence in obtain- regarding the utility of the NVG+A.
ing IV and IO access, and was the most common user prefer-
ence. These findings support the use of the tactical headlamp Implications
for IV and IO access when light discipline is not of significant Present findings regarding speed, success, confidence, ease of
importance but not when light discipline is critical. use, and user preference suggest that a tactical headlamp may
be superior to NVG or NVG+A for starting IVs and IOs in
NVG results were mixed, with 100% success in obtaining low-light conditions. On the posttest exit survey, some com-
IO access but the least success in obtaining IV access. Fur- mented that they preferred the tactical headlamp but were
ther, NVG was marginally faster than NVG+A in IO appli- concerned about light discipline and being seen by the enemy.
cation time, but marginally slower in IV application time These findings imply that a tactical headlamp may be the su-
and somewhat worse in perceived difficulty in performing IV perior choice for IV and IO access when light discipline is not
and IO procedures. Confidence results were also mixed for paramount. However, NVG or NVG+A might be the only via-
both IV and IO access, with NVG rated significantly higher ble alternatives to tactical lighting when light discipline is vital
than NVG+A at pretest but somewhat lower than NVG+A at or when the provider does not have access to a tactical light at
posttest. Roughly 4 of every 10 participants preferred a com- the time that the IV or IO access is needed.
bination that included NVG.
NVG+A should not be used for medical procedures, such as
NVG+A results were also mixed. IO application success was IV or IO procedures, without appropriate training and prac-
identical to that of the tactical headlamp. The IV success rate tice. This implication is based on both the observation that

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