title: Evaluation of Contingency Telemedical Support to Improve Casualty Care at a Simulated Military Intermediate Resuscitation Facility: The EM-ANGEL Study.
abstract: OBJECTIVE
  We sought to determine whether Contingency Telemedical Support (CTS) improves the success rate and efficiency of primary care providers performing critical actions during simulated combat trauma resuscitation. Critical actions included advanced airway, chest decompression, extremity hemorrhage control, hypothermia prevention, antibiotics and analgesics, and hypotensive resuscitation, among others.
  
  
  BACKGROUND
  Recent studies report improved survival associated with skilled triage and treatment in the out-of-hospital/preoperative phase of combat casualty care. Historically, ground combat units are assigned primary care physicians and physician assistants as medical staff, due to resource limitations. Although they are recognized as optimal resuscitators, demand for military trauma surgeons and emergency physicians exceeds supply and is unlikely to improve in the near term.
  
  
  METHODS
  A prospective trial of telemedical mentoring during a casualty resuscitation encounter was studied using a high-fidelity patient simulator (HFPS). Subjects were randomized and formed into experimental (CTS) or control teams. CTS team leaders were equipped with a headset/microphone interface and telementored by a combat-experienced emergency physician or trauma surgeon. A standardized, scripted clinical scenario and HFPS were used with 14 critical actions. At completion, subjects were surveyed. Statistical approach included contingency table analysis, two-tailed t-test, and correlation coefficient. This study was reviewed and approved by our institutional review board (IRB).
  
  
  RESULTS
  Eighteen CTS teams and 16 control teams were studied. By intention-to-treat ITT analysis, 89% of CTS teams versus 56% of controls completed all life-threatening inventions (LSIs) (p<.01); 78% versus 19% completed all critical actions (p<.01); and 89% versus 56% established advanced airways within 8 minutes (p<.06). Average time to completion in minutes (95% confidence interval [CI] 95) was 12 minutes (10?14) for CTS versus 18 (16?20) for controls, with 75% of control teams not completing all critical actions.
  
  
  CONCLUSIONS
  In this model, real-time telementoring of simulated trauma resuscitation was feasible and improved accuracy and efficiency of non?emergency-trained resuscitators. Clinical validation and replicated study of these findings for guiding remote damage control resuscitation are warranted.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Gerhardt
authors.forename: Jonathon
authors.initials: J
authors.lastname: Berry
authors.forename: Robert L
authors.initials: RL
authors.lastname: Mabry
authors.forename: Lawrence
authors.initials: L
authors.lastname: Flournoy
authors.forename: Robert G
authors.initials: RG
authors.lastname: Arnold
authors.forename: Christopher
authors.initials: C
authors.lastname: Hults
authors.forename: John B
authors.initials: JB
authors.lastname: Robinson
authors.forename: Robert A
authors.initials: RA
authors.lastname: Thaxton
authors.forename: Ramon
authors.initials: R
authors.lastname: Cestero
authors.forename: Jason D
authors.initials: JD
authors.lastname: Heiner
authors.forename: Alexandra R
authors.initials: AR
authors.lastname: Koller
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Cox
authors.forename: Jay N
authors.initials: JN
authors.lastname: Patterson
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dalton
authors.forename: Anne L
authors.initials: AL
authors.lastname: McKeague
authors.forename: Gary
authors.initials: G
authors.lastname: Gilbert
authors.forename: Carl
authors.initials: C
authors.lastname: Manemeit
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Adams
mesh_terms: D006801:Humans; D058749:Military Facilities; D008889:Military Personnel; D016544:Patient Simulation; D011787:Quality of Health Care; D012151:Resuscitation / Q000379:methods* / Q000592:standards; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors; D014857:Warfare; D014947:Wounds and Injuries / Q000628:therapy*