What is needed to increase the professional competencies of the military emergency medical technicians of the Republic of Korea Air Force?

Recently, a draftee’s shooting spree in the inter-Korean border town of Goseong, Gangwon-do resulted in killing five and injuring seven soldiers. The 119 state emergency agency and military were criticized for flawed communication, causing delay in dispatching an emergency helicopter to the frontline unit where the shooting took place [1]. The autopsy results showed that some of the victims died from heavy blood loss rather than directly from their wounds [2]. At this point, several questions are raised. Are military emergency medical technicians well trained? Do they have enough experience? What kind of education is needed to perform their role? What do they need to increase their professional competencies? The aim of this study is to determine what is needed to increase the professional competencies of the Republic of Korea Air Force (ROKAF) emergency medical technicians (EMTs).

During three weeks in June 2014, all 78 ROKAF medical technicians were contacted by email. Questionnaire item topics are presented in Table 1. Items can be grouped as follows. Items 1 to 3 address educational activities to colleagues; items 4 and 5 cover patient management experience; items 6 to 11 review educational needs; and items 12 and 13 address professional competence. Not all questions were answered by every respondent; therefore, answers are described by number and percentage of responses to specific questions. The replies were collected and analyzed. Out of total 78 subjects, 67 (86.0%) responded. Results were as follows. (1) Educational activity to teach other soldiers about cardiopulmonary resuscitation (2013): Among the 62 respondents, 40 (64.5%) taught cardiopulmonary resuscitation to other soldiers at least once, while 22 (35.5%) had not. Number of sessions varied (once to 80 times); 16 (40%) of them were five or fewer. Most of them (36, 90%) were 20 or fewer. (2) Educational activity to teach other soldiers about trauma management (TM; 2013): Among the 64 respondents, 37 EMTs (57.8%) taught TM to other soldiers at least once, while 27 (42.2%) had not. Number of sessions varied (once to over 30 times); 27 (73.0%) of them were within five sessions. (3) Experience of cardiac arrest patient management during the last 12 months: Among the 67 respondents, only three EMTs (4.5%) experienced cardiac arrest patient management during the last 12 months. The remainder (64, 95.5%) had not. Two of them had one opportunity each; one had two opportunities. (4) Experience of fracture patient management during last 12 months: Among the 67 respondents, only nine EMTs (13.4%) experienced fracture patient management during the last 12 months. The remainder (58, 86.6%) had not. Two of them had one opportunity each, four had two opportunities, two had three opportunities, and one had five opportunities. (5) Experience of trauma patient management during the last 12 months: Among the 67 respondents, only 10 EMTs (14.9%) experienced trauma patient management during the last 12 months. The remainder (57, 85.1%) had not. Six of them had one opportunity each, three had two opportunities, and one had three opportunities. (6) Attendance at conferences (2013): Among the 67 respondents, only four EMTs (6.0%) attended conferences for emergency medicine in 2013. The remainder (63, 94.0%) had not. Three of them attended once each; one had attended six times. (7) Inclination to attend emergency medical technique conferences: Among the 67 respondents, 58 EMTs (86.6%) were inclined to attend EMT conferences, while the remainder (9, 13.4%) did not. (8) Inclination to attend military emergency medical technique training courses: Among the 67 respondents, 49 EMTs (73.1%) intended to attend military EMT training courses, while the remainder (18, 26.9%) did not. (9) Dispatch to 119 Rescue Center for field experience: Among the 67 respondents, 53 EMTs (79.1%) wanted to gain field experience through 119 Rescue Center dispatch, while the remainder (14, 20.9%) did not. (10) Desirable duration of dispatch to 119 Rescue Center: Among the 50 respondents, 40 EMTs (80.0%) thought the desirable duration of dispatch to 119 Rescue Center would be under two weeks. Ten preferred longer periods (20.0%). (11) Inclination to have experience in 119 Rescue Center after hours: Among the 67 respondents, 24 EMTs (35.8%) were willing to gain field experience in 119 Rescue Center after hours (after 5 pm or weekends), while the remainder (43, 64.2%) did not. (12) What is needed for the role performance of military emergency medical technicians? Among the 67 respondents, 29 EMTs (43.3%) answered dispatch to 119 Rescue Center was necessary for the role performance of EMTs. Fixing the duty assignment as an EMT (27, 40.3%) followed. (13) What is needed for the capacity building of ROKAF EMTs? Among the 67 respondents, 50 EMTs (74.6%) answered dispatch to 119 Rescue Center was necessary to increase their professional competencies. Dispatch to emergency centers of civilian hospitals followed (13, 19.4%).

Table 1.

Thirteen questionnaire items dispatched via email to ROKAF emergency medical technicians surveyed in June 2014

Number	Questionnaire items
1	Educational activity to teach other soldiers about cardiopulmonary resuscitation (2013)
2	Educational activity to teach other soldiers about trauma management (2013)
3	Experience of cardiac arrest patient management during the last 12 months
4	Experience of fracture patient management during the last 12 months
5	Experience of trauma patient management during the last 12 months
6	Attendance at conferences (2013)
7	Inclination to attend emergency medical technique conferences
8	Inclination to attend military emergency medical technique training courses
9	Dispatch to 119 Rescue Center for field experience
10	Desirable duration of dispatch to 119 Rescue Center
11	Inclination to gain experience at 119 Rescue Center after hours
12	What is needed for the role performance of military emergency medical technicians?
13	What is needed for the capacity building of military emergency medical technicians?

In the Korean Armed Forces, several studies have been conducted on the efficient use of military EMTs [3]. Kim and Jang [4] said that the EMTs’ perceived job satisfaction was low (35.8%) and only 9.5% respondents answered that they knew their role and duty well. Park et al. [5] analyzed the structured questionnaire collected from military EMTs of Korean Army units and insisted it was urgent to provide medical equipment and supply them to guarantee emergency relief work.

Recently, the Royal Centre for Defence Medicine in the United Kingdom quantified doctors’ contributions to the Medical Emergency Response Team-Enhanced. Surprisingly, the median time from take-off to arrival was 44 minutes. A doctor flew on the helicopter in 88% of missions. A doctor’s presence was not clinically beneficial in 77% of missions [6]. Comparing the mean arrival time of the United Kingdom team (44 minutes) and the South Korean team to the shooting rampage in the 22nd Division (over 3 hours), the Korean Armed Forces should improve delivery systems and attend to the education of the military EMTs. The Swedish Armed Forces examined how medics perceived their learning outcomes following military pre-hospital training and found that they learned medical care through interaction, action, and reflection. Interaction during the education period is important for learning. Action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. Reflection, learning to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful [7]. Like the Swedish Armed Forces, military EMTs in Korea could act based on a drill. They want to be drilled in practical training by the civilian 119 rescue team. In Sudan, 37 military medics were trained as civilian pre-hospital care providers and the participants successfully completed an intensive 40-hour course consisting of didactic teaching sessions, small-group discussions, and practical skill stations. This improved their knowledge of subjects related to wound care, hemorrhage, and head trauma [8].

In our present study, more than half of the respondents answered that they taught their skills to colleagues in the last year; however, very few got a chance to manage real cases in the last 12 months. Although only a few attended conferences for emergency medicine in the last 12 months, their perceived educational needs were great. Most of them did want to gain field experience through 119 Rescue Center dispatch, even in their off duty time. Without clinical experience, they cannot play their role in emergencies. They should be dispatched to 119 Rescue Center or emergency centers of civilian hospitals for appropriate professional competence.