• Brandon M Carius, Michael D April, and Steve G Schauer.
• Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio, TX.
• Mil Med. 2020 Aug 14; 185 (7-8): e977-e981.

IntroductionConsistent procedural volume is important for emergency physicians (EPs) to maintain opportunities for critical lifesaving skills. While non-EP literature demonstrates improved patient outcomes with higher volumes, few studies examine the optimal number of repetitions needed to maintain procedural competency in EP populations. The largely young, healthy active duty population that constitutes the majority of patients in military treatment facilities (MTFs) decreases the likelihood to utilize emergent procedures. Despite this likelihood, EPs are expected to maintain proficiency and readiness to perform critical procedures in deployed settings.Materials And MethodsA retrospective analysis of de-identified data obtained through the Military Health System Mart was performed for procedural codes involving surgical airway, central venous access, and intubation. Data were sought for 2014-2016 calendar years from seven Army hospitals under the Southwest Region Medical Command. Procedural numbers were obtained for both overall volume and those performed per 1,000 encounters. Additionally, we analyzed for volume differences with the highest volume MTF (Brooke Army Medical Center [BAMC]) removed from the data set.ResultsA total of 1,450 procedures were performed among the MTFs analyzed, including 973 intubations, 473 central venous catheter placements, and 4 surgical airways. MTFs averaged 69.5 intubations and 38.8 venous catheters placed each year, but decreased to 28.1 intubations and 13.0 venous catheters placed annually when BAMC was removed from the data set (a 59.6 and 61.6% decrease, respectively). Monthly averages of 40.5 intubations and 19.7 central venous catheterizations per month among all included MTFs decreased to 14.0 and 6.5 when BAMC was removed. All surgical airways were performed at BAMC. Procedural frequency per 1,000 encounters was highest at BAMC, although ordinal differences were noted in the remaining six MTFs compared with overall procedural volumes.ConclusionsThis retrospective analysis demonstrates a significant variation in procedural volumes across MTFs, illustrating disproportionate opportunities for procedural skill maintenance among Army EPs. Low procedural volume threatens the maintenance of critical EP skills. These numbers could also suggest low skills for other providers (such as physician assistants), further illustrating decreased skill readiness throughout the force. Further research is needed to examine procedural volumes per individual EP, as well as those performed by other providers to evaluate for overall procedural readiness across the military force.Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.

8 keywords...

hide…