title: Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.
abstract: BACKGROUND
  Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to keep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient to keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting.
  
  
  METHODS
  EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready.
  
  
  RESULTS
  The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center.
  
  
  CONCLUSIONS
  This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Schauer
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Varney
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Cox
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004635:Emergency Medicine / Q000592:standards* / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000628:therapy; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000592:standards*; D020377:Self Efficacy; D013129:Spinal Puncture / Q000706:statistics & numerical data; D013165:Splints / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013907:Thoracostomy / Q000706:statistics & numerical data; D014139:Tracheostomy / Q000706:statistics & numerical data; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives