Inexperienced but Confident: A Survey of Advanced Life Support Providers and Life-saving Interventions in the Israel Defense Forces

ABSTRACT Objective The objective of this study was to assess the current experience of Israel Defense Forces’ (IDF) advanced life support (ALS) providers in performing life-saving interventions (LSIs), the rate of doctors and paramedics achieving the Trauma and Combat Medicine Branch benchmarks, and the rate of providers feeling confident in performing the interventions although not achieving the benchmarks. Methods This study was based on an online survey delivered to IDF ALS providers. The survey investigated demographics; experience in performing endotracheal intubation, cricothyroidotomy, tube thoracostomy, and intraosseous access on human patients; and confidence in performing these LSIs. All benchmarks chosen referred to the number of times performed in the previous year. The benchmarks were 20 for intubation, 3 for cricothyroidotomy, 4 for tube thoracostomy, and 3 for intraosseous access. Results During the survey period, 175 IDF ALS providers started the survey, but only 138 (79%) completed it, 93 (67%) of them were paramedics. Doctors had higher rates than paramedics of failing to achieve the benchmarks for intubation (96 vs. 57%, P < .001) and intraosseous access (100 vs. 66%, P < .001). All respondents failed to achieve the benchmark for cricothyroidotomy, and all but one paramedic failed to achieve the tube thoracostomy benchmark. Doctors had lower rates of high confidence when failing to achieve the benchmark for intubation (35 vs. 64%, P = .008) and intraosseous access (7 vs. 31%, P = .005) compared to paramedics. Conclusion IDF ALS providers have alarmingly limited experience in performing LSIs. Many of them are confident in their ability despite not achieving evidence-based benchmarks. Additional training is required, maybe as a part of an annual medical fitness test.

Control of epidemics in the Roman army: 27 B.C. - A.D. 476

During the Roman Empire thousands of soldiers were exposed to communicable diseases. The Romans forged a military medical system that surpassed the medical systems of most of their enemies. Under the principles of immediacy and expectancy, the Roman medical staff salvaged and returned to duty many sick and wounded soldiers as rapidly as possible. The selection of and training of healthy legionnaires, hygiene and sanitation and immediate medical care emphasized that the timing of care after diagnosis is as important as the quality of care. The Romans were the first army in history to employ medical corpsmen, field hospitals and triage. The Roman efficacy in combat medicine may be one of the least appreciated aspects of the ability of the Roman army to help create and maintain an empire.