Prehospital Battlefield Casualty Intervention Decision Cognitive Study

Area of Science:

• Emergency Medicine
• Surgical Procedures
• Military Health

Background:

• Airway compromise is a leading cause of preventable battlefield death.
• Surgical cricothyroidotomy (SC) is a critical intervention recommended by Tactical Combat Casualty Care (TCCC) guidelines when basic airway maneuvers fail.
• Understanding prehospital providers' decision-making for airway interventions is crucial for improving outcomes.

Purpose of the Study:

• To analyze the decision-making process of prehospital emergency providers regarding airway interventions.
• To determine the association between Tactical Combat Casualty Care (TCCC) certification and the choice of surgical cricothyroidotomy (SC).

Main Methods:

• A descriptive analysis was conducted using a scenario-based survey with video clips of explosive injury events.
• 254 prehospital providers (176 civilian, 78 military) responded to the survey.
• Multivariable logistic regression models were used to assess the impact of training factors on intervention choice.

Main Results:

• Military providers were significantly more likely to be TCCC-certified (OR: 13.1).
• Surgical cricothyroidotomy (SC) was the most frequently chosen intervention (29.92% and 22.10%).
• TCCC-certified providers were more likely to choose SC (OR: 2.3 after controlling for factors).

Conclusions:

• Military providers demonstrate a higher propensity for TCCC certification.
• TCCC certification is associated with an increased likelihood of selecting SC for early prehospital emergency airway management.
• This highlights the importance of TCCC training in guiding critical airway intervention decisions on the battlefield.