title: Optimal training for emergency needle thoracostomy placement by prehospital personnel: didactic teaching versus a cadaver-based training program.
abstract: BACKGROUND
  Tension pneumothorax can rapidly progress to cardiac arrest and death if not promptly recognized and appropriately treated. We sought to evaluate the effectiveness of traditional didactic slide-based lectures (SBLs) as compared with fresh tissue cadaver-based training (CBT) for placement of needle thoracostomy (NT).
  
  
  METHODS
  Forty randomly selected US Navy corpsmen were recruited to participate from incoming classes of the Navy Trauma Training Center at the LAC + USC Medical Center and were then randomized to one of two NT teaching methods. The following outcomes were compared between the two study arms: (1) time required to perform the procedure, (2) correct placement of the needle, and (3) magnitude of deviation from the correct position.
  
  
  RESULTS
  During the study period, a total of 40 corpsmen were enrolled, 20 randomized to SBL and 20 to CBT arms. When outcomes were analyzed, time required to NT placement was not different between the two arms. Examination of the location of needle placement revealed marked differences between the two study groups. Only a minority of the SBL group (35%) placed the NT correctly in the second intercostal space. In comparison, the majority of corpsmen assigned to the CBT group demonstrated accurate placement in the second intercostal space (75%).
  
  
  CONCLUSIONS
  In a CBT module, US Navy corpsmen were better trained to place NT accurately than their traditional didactic SBL counterparts. Further studies are indicated to identify the optimal components of effective simulation training for NT and other emergent interventions.
authors.affiliation: From the Navy Trauma Training Center (D.G., P.H.), LAC + USC Medical Center; and Division of Acute Care Surgery (K.I., E.K., D.S., M.S., D.D.), Department of Surgery, Keck School of Medicine of USC, Los Angeles, California; and Department of Surgery (M.M.), Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grabo
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Peter
authors.initials: P
authors.lastname: Hammer
authors.forename: Efstathios
authors.initials: E
authors.lastname: Karamanos
authors.forename: Dimitra
authors.initials: D
authors.lastname: Skiada
authors.forename: Matthew
authors.initials: M
authors.lastname: Martin
authors.forename: Maura
authors.initials: M
authors.lastname: Sullivan
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D002102:Cadaver; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000379:methods; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D008297:Male; D008887:Military Medicine / Q000193:education; D011030:Pneumothorax / Q000628:therapy; D013663:Teaching / Q000379:methods; D013907:Thoracostomy / Q000193:education*; D055815:Young Adult