Paramedics can apply and read Mantoux tuberculosis tests

Selected paramedics (26) received 2 h of training in the application and interpretation of Mantoux skin tests by a specially trained registered nurse. Instruction included a lecture, a video tape, and practice skin test administration on "induration arms." All students successfully completed written and skills tests. During a follow-up period, registered nurses directly observed skin test application and interpretation by the paramedics when applying the skin test to other departmental fire fighters and compared these to set criteria. Interpretation of skin test results included appropriate referral for positive results. Paramedics administered 319 skin tests during subsequent follow-up and 305/319 (96%) were monitored by a registered nurse. All administration criteria were performed as indicated 100% of the time except for the criterion requiring a 5-10 mm wheal. The application was appropriately repeated in each case. In one application, a paramedic began to use the same needle and syringe to draw up additional solution, but was immediately corrected. Among 227 cases of test interpretation by paramedics, paramedics were monitored by a registered nurse in 169 interpretations (74%). All monitoring criteria were performed as indicated 100% of the time. Nurses concurred with each monitored measurement. Induration results were 0 mm, 216 tests; 1-9 mm, 9 tests; > or =10 mm, 2 tests. Appropriate follow-up was provided to the two individuals with > or =10 mm induration. The results indicate that paramedics can successfully apply and accurately interpret Mantoux skin tests on public safety employees, although the number of positive tests was low, reducing the reliability of the findings.