Page 60 - Journal of Special Operations Medicine - Spring 2014

and nurse practitioners may attend as auditors), the Figure 2 Critical actions and LSIs* required.
Trauma Nursing Core Course (RNs), and Pre- Hospital 1. Identify impending airway obstruction.
Trauma Life Support (other healthcare providers). Par-
ticipants are awarded continuing education or addi- 2. Give supplemental oxygen via non-rebreather mask
during primary survey.
tional credentialing on successful completion of some
of these courses. 3. Identify tension pneumothorax and treat with needle
decompression during primary survey.*
Design 4. Adjust tourniquet to proper function or place additional
A clinical case record from the Joint Theater Trauma tourniquet during primary survey.*
Registry (now U.S. Department of Defense Trauma Reg- 5. Complete primary survey.
istry) was used to construct a simulation scenario and 6. Establish definitive airway (rapid-sequence intubation
to program the HFPS mannequins for experimental and or surgical cricothyrotomy) within 8 minutes.*
control cases (Figure 1). The scenario was composed of 7. Properly place tube thoracostomy.*
14 critical medical actions (Figure 2; also see Figure 3).
8. Identify compensated hemorrhagic shock during
secondary survey.
Figure 1 Simulated casualty encounter.
9. Initiate hypotensive resuscitation with hetastarch.*
Experimental Scenario 10. Restrict total intravenous volume to restore peripheral
A 25-year-old male active duty service member who is a pulse.
blast and burn casualty that occurred within 20 minutes
of arrival at the simulated aid station.* 11. Administer appropriate parenteral antibiotics.
Injuries 12. Administer appropriate parenteral analgesic.
1. Airway burn with progressive laryngeal edema 13. Oder “Urgent” or “ALPHA” MEDEVAC.
2. Blast overpressure injury to chest causing tension 14. Package patient with blankets/passive rewarming
pneumothorax devices.
3. Incomplete amputation of lower extremity with
incomplete tourniquet application Figure 3 Data collection instrument for EM-ANGEL Study
4. 20% total body surface area burn (“emergency medicine angel on your shoulder”).
5. Hemorrhagic shock
Note: *This case and scenario was constructed from an actual casualty
record from the Joint Theater Trauma Registry, U.S. Army Institute of
Surgical Research. 2004.

Before exercise commencement, subjects spontaneously
formed resuscitation teams of four to six individuals,
after which members of the course faculty would cross-
level the teams to ensure a roughly equal distribution of
physicians, nurses, dentists, and other practitioners. After
receiving a briefing on the study and an opportunity to
opt out of participating if selected, respective teams were
randomly assigned to one of eight NATO litter/stretch-
ers, each containing an HFPS mannequin with appropri-
ate moulage applied to match each respective scenario.
Among these, two manikins were dressed, equipped, and
moulaged identically; these manikins were placed in dia-
metrically opposed locations within the lab, serving as
experimental and control stations, respectively (Figure 4).

Team leaders in the experimental group were then
equipped with the telemedical interface (DREAMS Tele-
®
medical System, Texas A&M University, College Station,
Texas), consisting of a wireless boom headset/microphone
wearable under a helmet (Figures 5 and 6). Prior to on-
set of the exercise, two remote wireless cameras were
clamped above the head of the bed (full team view) and
over the center of the bed (selectable view of head/neck,

52 Journal of Special Operations Medicine Volume 14, Edition 1/Spring 2014