Page 61 - Journal of Special Operations Medicine - Summer 2016

Table 1 Cont.
Model Type (Articles, No.)*
Category Procedure Live Tissue Simulator Cadaver
Prox ext hemorrhage ctl N/A N/A No (1) – Intubating a
cadaver 3 times does not
Tourniquet N/A N/A affect future success.
Needle thoracostomy N/A N/A In general, it seems to be
Validity: Tube thoracostomy Yes (1) P Yes (2) T, A assumed that performance
on a cadaver model
predictive
Endotracheal intubation No (1) P Yes (3) L, MET, G, S1 ; No (1) – translates to performance
LS
performance on simulator did on a live patient; however,
not translate to actual neonates there are no studies
demonstrating this for any of
Cricothyrotomy Yes (1) P Yes (1) T the procedures researched.
68W, lower level Army Combat Medics; A, SuperAnnie; AMT, Ambu Megacode Trainer; C, caprine model; G, Gaumard HAL; L, Laerdal Airway
,
Trainer or Laerdal SimMan; LS Laerdal SimBaby; M, Medical Plastics Laboratory; MET, Medical Education Technologies; N/A, no literature
available discussing this aspect; P, porcine model; Prox ext hemorrhage ctl, noncompressible proximal extremity hemorrhage control; S, Simu-
laids; S1, SimOne; SF, Special Forces/Special Operations Medics (Army); T, SimULab TraumaMan; TC, TruCorp AirSim; U, unknown simulator.
Chest seal is not included in this table since none of the literature informed our question.
*A “yes” or “no” answer was given for each procedure in each category for each type of model. The number of publications for which a “yes”
or “no” answer was ascertained is listed in parentheses. Any category for which evidence was found disputing the acceptability or validity of a
particular model includes an explanation.
†Content validity is implicit to the cadaver model as this has the exact anatomy of live humans. However, for proximal extremity hemorrhage
control and effective tourniquet placement, a functional perfused cadaver model would be required.

retention, and skill decay. Table 1 summarizes and di- Tube Thoracostomy
rectly compares the acceptability and validity data be- Twenty-eight articles retrieved were appropriate for in-
tween types of models. depth review of TT; 15 informed at least one key ques-
tion. Three articles compared synthetic models to LT
Hemorrhage Control models. One used actual performance outcomes on
Of 28 articles appropriate for in-depth review of hemor- a cadaver model following TT training on LT versus a
rhage control (i.e., noncompressible proximal extremity simulator (TraumaMan; SimULab; https://www.simulab
wound and tourniquet placement), only one informed a .com), finding no difference between the two training
key question. Schmitz et al. found discriminant validity arms with nonphysician military learners; however, this
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of an assessment tool using performance scores for non- study was significantly underpowered. The other two
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compressible, proximal extremity wound- hemorrhage studies compared the preferences of LT versus simulator
control. This discrimination between groups was not models among a cohort of advanced trauma life support
reported for tourniquet placement, presumably because course participants, with conflicting results but similar
a correction factor was applied for multiple compari- self- efficacy scores. 27,28 Two investigators developed as-
sons (p = .036). However, this is not discussed in the sessment tools demonstrating evidence of discriminant
manuscript. The remainder of the articles retrieved con- validity, including one that found that performance scores
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tained broad discussions about the use of various training on the SuperAnnie (SimCentral; https://www.simcentral
models. 18,19,40–53 .com.au) simulator and actual patients were similar. 22,55

Chest-Seal Placement and Needle Thoracostomy The anesthetized porcine and caprine models, as well as
Six articles retrieved were relevant for open, sucking the TraumaMan and SuperAnnie simulators, all seemed
chest wounds, and seven articles were relevant for NT. to demonstrate acceptability and face validity in the
No articles on open, sucking chest wounds and six ar- described settings. Cadaveric studies proved difficult
ticles on NT informed one key question. to conduct due to problems with standardization and
acquisition. Salamonsen et al. showed convergent va-
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For NT, there is some acceptability and face validity for lidity by finding similar performance scores within each
a small number of synthetic models as well as the cap- cohort of novice, intermediate, and advanced operators,
rine model; however, the difference in chest-wall thick- and discriminant aspects of validity with performance
ness in two mannequins when compared with humans scores showing differences between the cohorts in both
is a threat to content validity in some simulators. One mannequins and live patients. Training on either Trau-
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study did investigate and find discriminant validity us- maMan or the porcine model seemed to be predictive
ing performance scores on a caprine model. 22,24–26 We of performance on cadavers, and performance on the
found no data on learning curves or skill retention or SuperAnnie simulator was predictive of performance on
models with predictive validity with respect to NT. live patients.

Simulation Versus Live Tissue for Training Trauma Procedures 47