Page 49 - JSOM Winter 2025

Implementing Operational Skills in the
Education of Combat Medics at the Belgian Defense

An Integrative Model

1
François Waroquier, MSN *; Jesse Jansen, MSN ;
2
Nicolas Deschuyteneer, EMTa ; Jean-Baptiste Watelet, MD, PhD 4
3

ABSTRACT
Background: The Belgian Defense introduced an integrative unique to the battlefield requires combat medic candidates to
and immersive model of an educational program in 2021 spe- acquire a large spectrum of hard and soft skills, which must be
cifically dedicated to combat medic certification. The primary adequately learned and regularly reinforced through training. 2
objective of the study was to compare final theoretical and
practical results between emergency medical technician (EMT) Because of these particularly complex working conditions,
and non-EMT candidates. Methods: This longitudinal cohort several educational dilemmas regarding medical and clinical
monocentric study, conducted in 2021 and 2022, analyzed all requirements have been identified for trauma first responders,
theoretical and practical examination results collected by the and the combat medic. For example, thinking physiologically,
instructors, evaluators and Exercise Controllers. Two main recognition of the potential application of damage control re-
domains (theoretical and practical total scores) and three sub- suscitation and surgery procedures, clinical priorities and time
domains (MED LEADER, MED PROVIDER, TAC LEADER) management, managing limited resources, practicing basic
were specifically explored. Results: One hundred thirty-seven surgical skills, and recognizing cultural differences and ethical
combat medic candidates for an advanced EMT certification issues. 3
were recruited, with a mean age of 30.3 years and a mean
seniority of 8.9 years. Clinically naïve, non-EMT candidates To address these multiple issues, various strategies for initial
represented 62.8% of the population. Clinically exposed EMT and sustained (continuing) medical training have been de-
candidates did not demonstrate superiority in any domains or veloped over many years, with a recent inclusion of medical
subdomains when compared to non-EMT candidates. Discus- technological novelties. However, the relative effectiveness
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sion: Some intrinsic parameters of the course could explain of live tissue (LT) and inanimate simulation (SIM)-based
the non-superiority of the clinically exposed group. Compen- training of combat medics is still subject to intense debate.
5
sating intrinsic motivation and situational awareness should Simulation-based interventions have been demonstrated to
be further explored in the clinically naïve group. Conclusion: be effective in military competency training, including indi-
Non-EMT candidates were able to score robustly, similar to vidual knowledge, skills, thinking, team communication and
their EMT counterparts, in an integrative, hyper-realistic, and collaboration abilities, and competency enhancement and
immersive course promoting multilevel processing. maintenance. An optimal training environment for combat
6,7
medics benefits from all strategies used, in combination or
Keywords: combat medics; education; training; situational separately. 8
awareness
Moreover, in modern warfare, the flexibility and adaptability
of the first-line intervention team are not exclusively import-
ant for adequate care to the casualty, but can also guarantee
Introduction
the health care provider some degree of security and survival
In a contemporary operational theater, combat medics hold in a rapidly changing work environment. In this regard,
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essential responsibilities, from lifesaving interventions to diffi- strong situational awareness (SA) becomes pivotal. Situational
cult medical evacuation to the next level of care. awareness is defined as the perception of elements in the envi-
ronment within a volume of time and space, the comprehen-
From the recent experience of prehospital health care in the sion of their meaning, and the projection of their status in the
ongoing war in Ukraine, combat medics have been found to near future. 10
have limited access to resources or advanced care, as well as
poor guidance for medication usage, and inadequate strategies The Tactical Medical Training Cell of the Belgian Defense in-
for patient assessment or triage. This large variety of scenarios troduced an integrative and immersive model of an educational
1
*Correspondence to Jean-Baptiste Watelet, Medical Component Competence Centre, Belgian Defense, Rue Bruyn, 1. 1120. Neder over Hembeek,
Belgium or jeanbaptiste.watelet@ugent.be
1 SM François Waroquier is affiliated with the Tactical Medical Training Cell (TacMed), Medical Component Competence Centre, Belgian De-
fense, Neder over Hembeek, Belgium. SFC Jesse Jansen is affiliated with the Tactical Medical Training Cell (TacMed), Medical Component
2
Competence Centre, Belgian Defense, Neder over Hembeek, Belgium. SFC Nicolas Deschuyteneer is affiliated with the Tactical Medical Training
3
Cell (TacMed), Medical Component Competence Centre, Belgian Defense, Neder over Hembeek, Belgium. Lt Col (Res) Jean-Baptiste Watelet
4
is affiliated with the Faculty of Medicine at Ghent University, Ghent, Belgium, and with the Medical Component Competence Centre, Belgian
Defense, Neder over Hembeek, Belgium.
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