Page 50 - JSOM Winter 2025

program in 2021, especially designed for emergency medical of trauma patients. All of them were educated in Basic Life
technicians (EMT) Advanced Combat Medic certification. Support (BLS) and Prehospital Trauma Life Support (PHTLS).
This model is currently systematically proposed to all Combat
Medic candidates for the advanced course. After identifying Considered as clinically naïve, the second group was com-
the essential components for individual and collective medical posed of non-EMT personnel from Para-Commando combat
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training, as recommended by the NATO SOF doctrine, the units or Special Operation Forces. Excluding their TC3 for-
principles of the course profile shape theoretical and practical mation and training, they had not been exposed to clinical
skills to support individual professional development and, by situations beforehand and had not participated in Real Life
extension, leadership maturation. Different training principles Support activities at the Belgian Defense. They applied on a
such as LT and SIM training are combined; the course mainly voluntary basis for the specific position of first-line respond-
relies on the latter because of the abundance of peer-reviewed ers in their unit.
evidence from military studies that clearly demonstrates train-
ing methods using human patient simulators for teaching Course (Table 2)
trauma care skills are as effective or better than LT, while also After an initial entrance exam on general anatomy and physiol-
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being more cost-effective. Finally, specific efforts are placed ogy, candidates follow a three-week theoretical module cover-
on hyper-realistic and immersive simulation training scenar- ing TC3, PHTLS and Advanced Medical Life Support (AMLS)
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ios as stimulators of team performance. As per Salas et al. principles. Prehospital Trauma Life Support is a continuing ed-
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and Kozlowski, the course organizers conceived team perfor- ucation program to promote excellence in trauma patient man-
mance as a multilevel process that includes the interrelation agement by all providers involved in the delivery of prehospital
between individual-level and teamwork and team work pro- care. Standard Operating Procedures (SOPs) are explained and
cesses. Thus, optimal tasks, as well as team performance, de- tested. The SOPs concerned TC3 phases, catastrophic Hemor-
pend on the coordinated activities of a team of individuals. 16,17 rhage (c), Airway (A), Breathing (B), Circulation (C), Disability
(D), Exposure (E) protocol, with specific procedures for emer-
The primary objective of the study was to compare final theo- gency trauma or medical situations, and a large spectrum of
retical and practical results between EMT and non-EMT can- environmental situations. After successfully completing a the-
didates for advanced Combat Medic certification. Considering oretical exam in these domains, the candidate is enrolled in a
that the non-EMT, mainly from SOF units, can rely on their three-week practical module, consisting of dead tissue training,
particular agility and situational awareness, it would be in- trauma patient simulator (mannequin simulation), and clinical
teresting to compare the groups to each other and to identify scenarios individually or in a team, as well as a large spectrum
their respective strengths or weaknesses. A secondary objective of clinical practicals in CASEVAC, complex casualty extrica-
was to explore how the candidate category could act as poten- tion, MASCAL (mass casualty exercise or simulation for emer-
tial key success factor for this course. gency responders), or amphibious medical incidents. A 72-hour
final synthetizing on-field examination evaluates all candidates
based on three independent domains: their capability as a Med-
Methods
ical Provider, as a Medical Leader and as a Tactical Leader.
This longitudinal cohort-monocentric study was carried out
with Advanced Combat Medic candidates at the Centre of Outcomes
Medical Expertise, Belgian Defense, from January 2021 until The study outcomes were subdivided into main domains (the-
December 2022. All their theoretical and practical examina- oretical and practical total scores at the final examination) and
tion results were systematically collected by the instructors, subdomains: “MED LEADER”, defined as reactivity in med-
evaluators and Exercise Controllers. ical decision-making, guidance of the medical activities, and
leadership of the medical team; “MED PROVIDER”, defined
Populations (Table 1) as technical medical skills (quality of material preparation,
Each member of the Belgian military must fulfill a Tactical completeness and safety in execution, quality of reporting to
Combat Casualty Care (TC3) educational program and must MED LEADER); “TACTICAL (TAC) LEADER”, defined as
refresh their knowledge once a year. Two profiles of Advanced responsible for team security, controller of Situational Aware-
Combat Medic candidates were distinguished. ness, coordinator of tactical actions of the medical team.
The first group was composed of basic EMT. All of them had The role of MED LEADER was assessed by the quality of the
conducted their full military training and were attached to a diagnostic and therapeutic approach, effectiveness of medical
unit of the Belgian Medical Component. Additionally, they control over technical skills by team members, general clinical
had served at least 120 hours a year in a civilian emergency guidance, adequate communication with the next level of care,
department, including direct participation in the management monitoring of safety rules, and final clinical responsibility.

TABLE 1 Clinical Background of Studied Populations
EMT Non-EMT
Initial training Civilian EMT MIL SOF or parachutist unit
• Basic TCCC • Basic TCCC
• BLS
Clinical exposure
• 120h per year in civilian/military setting (emergency
unit, fire department)
Refresh TCCC every year TCCC every year
EMT = emergency medicine technician; MIL SOF = Military Special Operations Forces; BLS = basic life support.

48 | JSOM Volume 25, Edition 4 / Winter 2025