Page 62 - Journal of Special Operations Medicine - Fall 2017

blast injuries and penetrating trauma. In austere environments 6910-01-445-4093; Armstrong Medical Industries, https://
commonly encountered by Medics, it is even more difficult to www.armstrongmedical.com/) consisting of a head, neck, and
monitor for hyperventilation because they likely will not have lungs was used in the classroom portion of BCT3 for airway
the monitoring equipment to do so. 5 training. A Rescue Randy training manikin (NSN 6910-01-
®
605-207; CMC Rescue, http://www.cmcrescue.com/) was used
If effective, the new device could result in changes to the es- during the combat casualty simulations in the field.
tablished medical equipment sets of military units and integra-
tion of the device into standard medical training. Ultimately, Methods
this type of device could lead to reductions of iatrogenically The first portion of the study was integrated into the surgi-
induced morbidity and mortality by decreasing or eliminat- cal airway skill station, during which one Medic secured the
ing the incidence of hyperventilation in the early treatment of airway in the manikin and a second Medic delivered breaths
combat casualties. with a BVM device. This station consisted of five manikins,
each with the standard and study devices located next to it.
Our hypothesis was that the new device would decrease exces- Two to three Medics were assigned to each manikin at a time.
sive rates of ventilation compared with a traditional device Each group received a review of the procedure before per-
when used by Army Medics in a classroom and a prehospital/ forming the skill. After this, the principal investigator gave a
field environment. demonstration of the study device. Ventilation rates were not
addressed in this training. Volunteers participating in the study
were then identified. Participants were assigned a letter-num-
Study Design and Methods
ber designator (e.g., A1), with the letter indicating which class
Setting and Subjects the participant was in (A = first class, B = second class, and
This study was conducted at the Brigade Combat Team Trauma so on) and the numbers assigned consecutively. Participants
Training (BCT3) course located at Camp Bullis, Texas. BCT3 then each took turns practicing with the study device and then
is a 5-day course required for Army Medics within 180 days continued with the training scenario.
of deployment to a combat theater of operations. This course
was chosen because Medics come from around the country, The assigned numbers were used to randomly assign the partic-
providing a more diverse sample population, and it includes ipants to device order, with odd numbers using the study device
simulated combat training scenarios in field conditions to first and even numbers using the standard device first. The first
more closely simulate real-world performance. Medic in each group performed the surgical airway and the
second Medic delivered breaths with either the standard BVM
Subjects were U.S. Army Medics attending BCT3 who volun- or study device. The investigators timed each iteration with
teered to participate in the study. There were no additional an iPhone stopwatch (Apple; https://www.apple.com/) begin-
exclusion criteria. ning with the first breath given. The number of breaths given
and the total duration of assisted ventilation were recorded.
Study Design The Medic delivered breaths with the first device until the air-
Our study used a prospective, observational, semirandomized, way was secured or a minimum of 1 minute had elapsed. The
cross-over design that was integrated into the 5-day structure Medic was then asked to switch devices and again time was
of the BCT3 course. measured starting with the first breath delivered. Total dura-
tion of assisted ventilation and number of breaths given were
Materials then recorded for the second device. All data were collected on
The standard BVM device used in this study was a Cyclone standardized forms.
®
Pocket BVM distributed by North American Rescue (http://

www.narescue.com). This device was being used at BCT3 at The second portion of the study was integrated into the simu-
the time of this study and was not chosen by the investigators. lated combat training. During this portion of the course, small
The Cyclone Pocket BVM is typical of traditional BVMs. groups of Medics carrying all their equipment were given a
mission to respond to a simulated event. They then moved on
The study device is a prototype (Figure 1) under development foot through a course roughly 600–800m long, treating and
by CMS and has not been approved by the U.S. Food and evacuating casualties (Figures 2 and 3). This is the culminating
Drug Administration. event of BCT3 and is designed to be both physically demand-
ing and stressful to the Medics. Groups consisted of three to
In addition to the BVM devices, two types of training mani- four Medics, including one senior Medic per group.
kins were used. A Training Resuscitation Manikin (NSN
All study participants had their study identification marked on
Figure 1 Prototype BVM by CMS. their helmet so the investigators could identify them. Each group
responded to their scenario individually and the investigators
could not influence which study participants were assigned to
particular scenarios. In addition, not all scenarios required an
airway or breathing intervention. Finally, the senior Medic in
each group directed the care provided by the junior Medics and
when the need to provide an airway or breathing intervention
arose, it was the junior Medics who performed these tasks.

When a simulated casualty required assisted ventilation, mea-
surements were recorded in similar fashion to the first portion

60 | JSOM Volume 17, Edition 3/Fall 2017