Page 64 - Journal of Special Operations Medicine - Summer 2016

in this skill. 76,77,80 The two studies on skill retention (one whether currently available synthetic models could be
on TT and the other on ETI), using providers with mini- sufficient to replace live animal models. There is a pau-
mal prior and ongoing experience with the procedures city of information on validity measures such as con-
during the study period, showed skill decay over the tent, construct, and predictive validity, as well as limited
ensuing 6–9 months. 57,81 However, the ETI study found information regarding translational outcomes, learning
that skill decay did not occur when a group of medical curves, skill retention, and whether initial or ongoing
students received ongoing practice and feedback on the LT or synthetic training accelerates learning curves or
skill during the study period, and other percutaneous ameliorates skill decay. A series of studies examining
cricothyrotomy studies showed skill retention for 6–12 current synthetic systems and comparing live animals to
months in experienced providers after one training ses- synthetic systems should further inform these questions.
sion. 81,102–104 Therefore, skill retention or decay may be
based on prior experience, the current practice level of Disclosures
the provider, the amount of ongoing practice or exposure
they have with the skill after initial training, or some com- The authors have indicated they have no financial rela-
bination of these factors. This paucity of data does not in- tionships relevant to this article to disclose.
form us enough to understand the frequency of retraining
required for various trauma skills to avoid such decay in Funding
individuals who regularly perform these procedures after
initial training and those who do not. Furthermore, the This work was supported by the US Army Medical
improvement seen in experienced surgery residents with Research and Materiel Command under Cooperative
cricothyrotomy performance after one practice scenario Agreement No. W81XWH-11-2-0185.
suggests that experienced practitioners may not need long
retraining sessions but rather short refresher opportuni- Acknowledgments
ties where they are able to practice their skills. 82
We acknowledge the assistance of COL Gregory Beil-
The lack of answers to our key areas of investigation man, MD; Gregory Rule; Richard Bianco, MD; and Ro-
in this review and the congressional effort to transition land Gunther, DVM, in this study.
to the use of nonanimal-based methods (i.e., simula-
tors, cadavers) when appropriate for military trainees
has driven a series of subsequent studies to compare Dr Hart is the director of simulation and the associate resi-
commercially available synthetic models to each other, dency director for emergency medicine at Hennepin County
and LT to simulator models for training and assessing Medical Center (HCMC), an urban Level 1 trauma center in
life-saving airway, breathing, and hemorrhage skills. Minneapolis, Minnesota. She is also an assistant professor
15
Ultimately, the information provided by these studies at the University of Minnesota Medical School, has a mas-
should inform methods for improving training models ter’s degree in medical education, and is key personnel on
and optimizing curricula, with recommendations for the the MedSim Combat Casualty Training Consortium (Grant
potential reduction of LT use when appropriate. W81XWH-11-2-0185). E-mail: Hartd000@gmail.com.

Limitations Ms McNeil is the director of the Department of Emergency
Medicine at the University of Minnesota Medical School. She
One limitation of this literature review is that we did is a nationally registered paramedic and was a critical care
not score or eliminate evidence based on the quality of flight medic for 15 years. She is heavily involved in work be-
the studies, due to the paucity of relevant articles. An- ing done by the American Heart Association (AHA) and the
other is that we used PubMed as our only search engine, International Liaison Committee on Resuscitation (ILCOR).
in combination with readily available studies provided
by the US military. We acknowledge that there may be Dr Hegarty is the emergency medicine residency director at
other database or institutional sources that were not Regions Hospital/HealthPartners Institute and is an associate
readily available for us to consider. We also primarily professor at the University of Minnesota Medical School. He
focused on the adult trauma patient and recognize that has been actively involved in the Emergency Medicine Simula-
there are other models that may be more appropriate for tion program.
pediatric/neonatal skills training.
COL Rush is a board-certified general surgeon with vast ex-
perience in far-forward surgery in wartime situations, disaster
Conclusions responses, and peace keeping. His most recent deployment
was with SOTF-S Afghanistan, in which he was a member of
There are very few studies comparing efficacy of exist- the GHOST-T mission for the task force. Dr Rush has been
ing models for training or assessment of critical trauma involved with combat medic and first-responder training since
procedures, and there is insufficient evidence to evaluate entering the Army over 30 years ago and over the last 13 years

50 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016