Page 75 - Journal of Special Operations Medicine - Spring 2016

As US military operations shift back toward uncon- Combining prerecorded lectures or case-based e-mod-
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ventional warfare in remote and austere locations, the ules with hands-on training in the classroom setting
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scope of practice for the SOF practitioner expands. We potentially saves time while offering a comparable edu-
must look beyond the fundamental protocols of Tactical cational benefit.
Combat Casualty Care (TCCC) and timely evacuations,
which focus primarily on preventing mortality. Tyranny By extrapolation, the authors propose to redesign the
of distance dictates the necessity of providing care for SOLCUS curriculum according to the flipped classroom
up to multiple days at a time. In PFC situations, the model. We are developing the SOLCUS education project
SOF Medic must function beyond standardized plan- as an SOF-specific and open-access online resource that
ning guidelines and aim at reducing morbidity of the accompanies the hands-on classroom content. The dura-
most seriously injured or critically ill patients. Given tion of the video lectures is generally limited to 5 minutes
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such abstract goals to ponder, broadening the SOLCUS and has the potential to allow for shorter, yet effective,
curriculum to include limited cardiovascular and pul- SOLCUS courses. Additionally, the materials can be ac-
monary applications is desired. cessed at various times. It facilitates spaced repetition,
which is a recognized determinant of knowledge sus-
A growing body of literature supports the feasibility and tainment. Our project in progress can be viewed at the
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applicability of prehospital ultrasound for focused re- PFCare.org/ultrasound or vimeo.com/solcus.
suscitative assessment. Admittedly, many publications
pertain to physician-performed ultrasound, particularly Tele-ultrasound
in the European setting. Nevertheless, a number of stud- An SOF Medic has the capacity to function independently
ies have also demonstrated that nonphysician prehos- in the PFC settings; however, tele-consultation services
pital providers can be trained to obtain and interpret must be available and easily accessible. That is why we
focused echocardiographic, 6–11 pulmonary, 7,8,10,12–14 and suggest the clinical and educational benefit of remotely
vascular 10,15 studies. mentored tele-ultrasound. Thanks to rapidly evolving
technology, video and image transmission can be used to
The authors have already attempted to train US SOF offer remote supervision in the ultrasound training and
Medics in ultrasound-guided resuscitation. The pro- patient-care settings. Global POCUS mentoring requires
totype workshops included a combination of brief in- only Internet connectivity and initiative. It is neither
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classroom and Web-based lectures, with the primary costly nor technically challenging, although more ro-
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focus on hands-on education and simulated case sce- bust military-grade infrastructure could likely improve
narios. The initial experiences were encouraging, and the quality of visual data transmission. 26
the feedback from participating SOF Medics was largely
positive. Access to experienced educators is a limiting factor to
any POCUS program. It is particularly problematic
Content Delivery within the military environment because of the low sup-
It has long been recognized that Web-based content is ply of instructors, high rate of personnel turnover, and
regularly used by health sciences students, and a grow- the many time zones in which SOF conducts operations.
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ing number of resources are available as open-access Low-cost smartphone- and laptop-based systems can be
digital media. The medical community at-large, includ- successfully used to guide minimally trained or even
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ing the US Army Medical Department, broadly advo- ultrasound-naive examiners, including midlevel pro-
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cates this democratization of knowledge. viders and paramedics. Remote teaching is poten-
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tially as effective as in-person coaching, and permits a
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Additionally, health professional education has em- small number of faculty to supervise a large number of
braced the flipped classroom model as a novel and ef- trainees. Incorporating telesupervision into the SOL-
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fective approach to content delivery. The model revolves CUS flipped classroom could offer a viable solution to
around the opportunity to preview course-related mate- delivering high-volume ultrasound training. Further-
rial prior to the actual class and shifts the focus toward more, it would likely benefit SOLCUS skill sustainment
practical problem-solving activities during the class- and QA interventions.
room encounter. Overall, the flipped classroom format
facilitates independent learning and critical thinking, Remote POCUS guidance is also applicable in the clini-
while promoting instructor flexibility. 17,18 cal setting. 26,28,32–34 This concept seems particularly at-
tractive from the perspective of an SOF Medic delivering
It has already been shown that Web-based POCUS edu- extended care in a low-resource environment. Despite
cation constitutes a valid alternative to classroom-based limited experience and minimal training, an SOF pro-
learning. 19–22 An e-curriculum offers greater flexibil- vider could be telementored to obtain high-quality,
ity, while resulting in similar knowledge retention. 19,20 clinically useful ultrasound images. Additionally, a
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Point-of-Care Ultrasound Update 59