Army flight medic performance of paramedic level procedures: indicated vs. performed

Area of Science:

• Emergency Medicine
• Aeromedical Transport
• Military Health Systems

Background:

• Significant disparities exist in education, experience, and staffing for civilian versus Army aeromedical transports (AMT).
• Current Army flight medic training may not align with the medical needs of patients during AMT missions.

Purpose of the Study:

• To assess if medical skills beyond standard Army flight medic training are indicated and performed during Army AMT missions.
• To compare the performance rates of indicated interventions by basic Emergency Medical Technician (EMT-B) and paramedic (EMT-P) flight medics.

Main Methods:

• Retrospective review of 406 Army AMT patient charts from Iraq (EMT-B staffed) and Afghanistan (EMT-P staffed) between July 2008 and June 2009.
• Independent chart review by two Emergency Medicine board-certified Army flight surgeons to identify indicated interventions.

Main Results:

• Of 984 indicated interventions, 36% were paramedic (EMT-P) level. 17% of indicated interventions were not performed.
• Basic EMT-Bs failed to perform indicated procedures 35% of the time, compared to 3% for EMT-Ps (p < 0.001).
• Basic EMT-Bs missed 76% of indicated paramedic-level procedures, versus less than 1% for EMT-Ps (p < 0.001).

Conclusions:

• Army AMT missions frequently require medical interventions exceeding standard flight medic training.
• Paramedic-trained flight medics significantly outperform basic EMTs in performing advanced interventions.
• The Army should consider adopting civilian AMT standards for flight medic training and practice.