Page 42 - JSOM Fall 2023

were insufficient. If several tests were carried out, the p-value cosal Atomization Device (Teleflex, https://www.teleflex.com/
was adjusted using the Bonferroni correction. usa/en/product-areas/anesthesia/atomization/mad-nasal-device/
index.html). Physicians were most familiar with the bioavail-
Authorization ability of IN sufentanil (n = 135; 67.2%), and the least with
Study approval was obtained from the French Military Health ketamine (n = 31; 15.4%) and fentanyl (n = 30; 14.9%). Only
Service (project validation no. 2019PHJ20). 33 (16.5%) scored a grade ≥3, including four (2%) with a
grade of 5. Knowledge of INA was greater in practitioners who
graduated <5 years (p < .018) prior the study period, had fol-
Results
lowed additional training in emergency medicine (p < .001), or
Of the 259 responders (33% response rate), 141 were males worked shifts on a regular basis (p < .001). However, there was
and 118 were females. The average age was 36.2 years. The no significant association between the number of shifts and the
majority (n = 170; 65.6%) of respondents had been practic- level of knowledge as opposed to the number of deployments
ing medicine for less than 10 years; 162 (62.5%) had addi- (p < .01). Finally, those assigned to highly operational units
tional training in emergency medicine; and 151 (58.3%) were were more familiar with INA (p < .01) (Table 2).
working emergency medicine shifts on a regular basis. Army,
Air Force, and Gendarmerie physicians accounted for 41.3% TABLE 2 Knowledge About Intranasal Route Among the 259
(n = 107), 12.7 % (n = 33), and 12.7 % (n = 33) of the sample, Responding Physicians
respectively (Table 1). Aware Not aware Total
Variable (%)* (%)* (%)* p-value
TABLE 1 Demographics of the 259 Responding Physicians Years of practice
Variables Total (%) <5 years 75 12 87
(29) (4.6) (33.6)
Gender .0184
126
46
172
Male 141 (54.4) >5 years (48.6) (17.8) (66.4)
Female 118 (45.6) Additional training in emergency medicine
Years of practice No 59 38 97
<5 years 87 (33.6) (22.8) (14.7) (37.5)
>5 years 172 (66.4) Yes 142 20 162 <.001
Additional training in emergency medicine (54.8) (7.7) (62.5)
Yes 162 (62.5) Emergency medicine shifts on a regular basis
No 97 (37.5) No 68 40 108
Emergency medicine shifts on a regular basis (26.2) (15.4) (41.6) <.001
18
151
133
Emergency department (ED) 70 (27) Yes (51.3) (6.9) (58.2)
Prehospital care (PH) 20 (7.7) If yes, how often?
ED and PH 61 (23.6) 0–4/month 110 17 127
None 108 (41.7) (42.5) (6.5) (49) NS
Number of deployments lasting >2 months >5/month 23 1 24
1–5 224 (86.5) (8.9) (0.4) (9.3)
>5 35 (13.5) Number of deployments**
Unit 1–5 times 168 56 224
(64.9) (21.6) (86.5)
Army* 107 (41.3) >5 times 33 2 35 <.01
Air Force 33 (12.7) (12.7) (0.8) (13.5)
Gendarmerie** 33 (12.7) Units
Military Fire and Rescue*** 24 (9.3) Highly operational*** 87 6 93
Command center/Logistics/Administration 23 (8.9) (33.6) (2.3) (35.9) <.001
Navy**** 19 (7.3) Regular 114 52 166
Emergency department physicians 12 (4.7) (44) (20.1) (64.1)
Special Forces 8 (3.1) *With respect to the 259 responding physicians
*Including Paratroopers, mountain troops, French Foreign Legion **>2-month duration
***Including: Special Forces, paratroopers, Air Force air ambulance,
**French military law enforcement Air Force heliborne search and rescue, Navy medical bay, mountain
***Paris and Marseille fire brigades and Civil Security troops, Paris and Marseille Fire Brigades, and Civil Security.
****Including Navy medical bay and Navy base infirmary
Our sample was not significantly different from the global In actual practice, out of the 256 physicians who fully replied,
French military population (p = .085). Regarding INA, 201 phy- 47 physicians (18.3%) had performed INA in trauma patients,
sicians (77.6%) reported being familiar with it from scientific mainly in France (n = 45; 71.3%) during prehospital care
publications, including civilian (n = 71; 29.1%) and military (n (n = 33; 52.4%) and deployments (n = 18; 28.6%). The most
= 45; 18.4%), or through conference lectures (n = 48; 19.7%) frequently used medications were ketamine (n = 32; 57.1%)
or discussions with colleagues (n = 41; 16.8%). Among these whether in monotherapy (n = 21; 37.5%) or combined with
201 physicians who answered the five additional MCQs, 91 midazolam (n = 11; 19.6%); sufentanil (n = 18; 32.1%); mid-
(45.3%) knew the IN route onset of action (1–15 minutes), but azolam in monotherapy (n = 4; 7.2%); and fentanyl (n = 2;
only 58 (28.8%) were aware of the MAD Nasal Intranasal Mu- 3.6%). Ten physicians (31.2%) reported psychodysleptic side

40 | JSOM Volume 22, Edition 3 / Fall 2023