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A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department

  • Steven G. Schauer (a1) (a2), Cord W. Cunningham (a3) (a4), Andrew D. Fisher (a5) and Robert A. DeLorenzo (a6)
Abstract
Abstract Introduction

Select units in the military have improved combat medic training by integrating their functions into routine clinical care activities with measurable improvements in battlefield care. This level of integration is currently limited to special operations units. It is unknown if regular Army units and combat medics can emulate these successes. The goal of this project was to determine whether US Army combat medics can be integrated into routine emergency department (ED) clinical care, specifically medication administration.

Project Design

This was a quality assurance project that monitored training of combat medics to administer parenteral medications and to ensure patient safety. Combat medics were provided training that included direct supervision during medication administration. Once proficiency was demonstrated, combat medics would prepare the medications under direct supervision, followed by indirect supervision during administration. As part of the quality assurance and safety processes, combat medics were required to document all medication administrations, supervising provider, and unexpected adverse events. Additional quality assurance follow-up occurred via complete chart review by the project lead.

Data

During the project period, the combat medics administered the following medications: ketamine (n=13), morphine (n=8), ketorolac (n=7), fentanyl (n=5), ondansetron (n=4), and other (n=6). No adverse events or patient safety events were reported by the combat medics or discovered during the quality assurance process.

Conclusions

In this limited case series, combat medics safely administered parenteral medications under indirect provider supervision. Future research is needed to further develop this training model for both the military and civilian setting.

Schauer SG , Cunningham C W, Fisher AD , DeLorenzo RA . A Pilot Project Demonstrating that Combat Medics Can Safely Administer Parenteral Medications in the Emergency Department. Prehosp Disaster Med. 2017;32(6):679681.

Copyright
Corresponding author
Correspondence: Steven G. Schauer, DO, RDMS 3698 Chambers Pass Road Fort Sam Houston, Texas 78234 USA E-mail: steven.g.schauer.mil@mail.mil
Footnotes
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Conflicts of interest/disclaimer: Opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the US Department of the Air Force, the US Department of the Army, or the US Department of Defense. The authors have no conflicts of interest to declare.

Footnotes
References
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1. Butler FK, Kotwal RS, Buckenmaier CC 3rd, et al. A triple-option analgesia plan for Tactical Combat Casualty Care: TCCC guidelines change 13-04. J Spec Oper Med. 2014;14(1):13-25.
2. Committee on Combat Casualty Care. Tactical Combat Casualty Care Guidelines for Medical Personnel. 2015. http://www.specialoperationsmedicine.org/documents/TCCC/04%20CoTCCC%20Meeting%20Minutes/CoTCCC%20Meeting%20Minutes%201402%20Final.pdf. Accessed November 29, 2015.
3. Cunningham CW. Only break glass in case of war? J Spec Oper Med. 2015;15(1):90-92.
4. Cunningham CW. A study of healthcare career progression: policy paper on producing battlefield medical specialist in conflict and peacetime. The University of Texas School of Public Health, 2015. http://digitalcommons.library.tmc.edu/dissertations/AAI1597641/. Accessed November 29, 2015.
5. De Lorenzo RA. How shall we train? Mil Med. 2005;170(10):824-830.
6. Derlet RW, Richards JR. Emergency department overcrowding in Florida, New York, and Texas. South Med J. 2002;95(8):846-849.
7. 84R8933 SLC-D. http://www.legis.state.tx.us/tlodocs/84R/billtext/html/HB02020I.htm. Accessed July 19, 2017.
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Prehospital and Disaster Medicine
  • ISSN: 1049-023X
  • EISSN: 1945-1938
  • URL: /core/journals/prehospital-and-disaster-medicine
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