D Hale1, K Sipprell. 1. Regions Hospital Emergency Department, St. Paul, Minnesota 55047, USA.
Abstract
INTRODUCTION: In certain emergency medical services (EMS) systems, emergency medical technicians-paramedics (EMT-Ps) repair lacerations in the field. This practice is supported by studies showing equivalence between nonphysicians and physicians regarding infection rates and cosmetic outcomes. OBJECTIVE: To evaluate the ability of emergency medical technicians-basic (EMT-Bs) to identify wounds repairable in the field or requiring tetanus prophylaxis. METHODS: This was a prospective, double-blind convenience sample study at an urban teaching hospital. Eleven EMT-B volunteers, trained by a one-hour lecture and bedside teaching, evaluated lacerations for prehospital repair by answering three questions: Could this wound be repaired in the field, and if no, why not? If on an adult forearm, could this wound be repaired in the field, and if no, why not? Does this patient need tetanus prophylaxis, and if no, why not? A blinded principal investigator also answered these questions, and a person uninvolved in the study correlated results. Statistical evaluation was performed using kappa statistics. RESULTS: The EMT-Bs identified 17 of 17 potentially repairable wounds and 163 of 163 wounds excluded from prehospital repair. Placing the wound on the forearm, the EMT-Bs identified 82 of 87 potentially repairable wounds and 93 of 93 wounds excluded from prehospital repair (sensitivity 94%, specificity 100%, positive predictive value 100%, negative predictive value 95%, kappa 0.97). For five of five wounds, physicians disagreed with the EMT-Bs and thought the wound repairable prehospital. The EMT-Bs and physicians agreed on individual wound exclusion criteria in 207 of 239 (86.6%) instances. Finally, the EMT-Bs identified 108 of 108 patients requiring tetanus prophylaxis. CONCLUSIONS: Basic EMTs can accurately identify wounds eligible for prehospital repair and/or requiring tetanus prophylaxis.
INTRODUCTION: In certain emergency medical services (EMS) systems, emergency medical technicians-paramedics (EMT-Ps) repair lacerations in the field. This practice is supported by studies showing equivalence between nonphysicians and physicians regarding infection rates and cosmetic outcomes. OBJECTIVE: To evaluate the ability of emergency medical technicians-basic (EMT-Bs) to identify wounds repairable in the field or requiring tetanus prophylaxis. METHODS: This was a prospective, double-blind convenience sample study at an urban teaching hospital. Eleven EMT-B volunteers, trained by a one-hour lecture and bedside teaching, evaluated lacerations for prehospital repair by answering three questions: Could this wound be repaired in the field, and if no, why not? If on an adult forearm, could this wound be repaired in the field, and if no, why not? Does this patient need tetanus prophylaxis, and if no, why not? A blinded principal investigator also answered these questions, and a person uninvolved in the study correlated results. Statistical evaluation was performed using kappa statistics. RESULTS: The EMT-Bs identified 17 of 17 potentially repairable wounds and 163 of 163 wounds excluded from prehospital repair. Placing the wound on the forearm, the EMT-Bs identified 82 of 87 potentially repairable wounds and 93 of 93 wounds excluded from prehospital repair (sensitivity 94%, specificity 100%, positive predictive value 100%, negative predictive value 95%, kappa 0.97). For five of five wounds, physicians disagreed with the EMT-Bs and thought the wound repairable prehospital. The EMT-Bs and physicians agreed on individual wound exclusion criteria in 207 of 239 (86.6%) instances. Finally, the EMT-Bs identified 108 of 108 patients requiring tetanus prophylaxis. CONCLUSIONS: Basic EMTs can accurately identify wounds eligible for prehospital repair and/or requiring tetanus prophylaxis.
Authors: Suzanne Mason; Emma Knowles; Brigitte Colwell; Simon Dixon; Jim Wardrope; Robert Gorringe; Helen Snooks; Julie Perrin; Jon Nicholl Journal: BMJ Date: 2007-10-04