Page 76 - Journal of Special Operations Medicine - Fall 2017

Optimization of Simulation and Moulage
in Military-Related Medical Training

Christopher Petersen* ; Stephen Rush, MD ; Isabelle Gallo ;
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Bryan Dalere ; Brian Staak ; Litt Moore ; Win Kerr ; Matthew Chandler ; Will Smith, MD 9
ABSTRACT
Preparation of Special Operations Forces (SOF) Medics as first the operation and maintenance of this equipment, as well as
responders for the battle space and austere environments is the impracticality of moving this equipment over rough terrain
critical to optimize survival and quality of life for our Opera- and by air. An article in the Scandinavian Journal of Trauma,
tors who may sustain serious and complex wounding patterns Resuscitation and Emergency Medicine noted similarly that
and illnesses. In the absence of constant clinical exposure for “[m]uch emphasis has been put on increasing the fidelity, but
these medics, it is necessary to maximize all available train- as the simulators become increasingly advanced, their mobil-
ing opportunities. The incorporation of scenario-based train- ity decreases and the demand for experienced operators and
ing helps weave together teamwork and the ability to practice instructors increases. So do inevitably the costs.” 2
treatment protocols in a tactical, controlled training environ-
ment to reproduce, to some degree, the environment in and Military medics are adult learners who learn by different
stressors under which care will need to be delivered. We re- methods compared with earlier stages in their formal brick-
viewed the evolution of training scenarios within one Para- and-mortar didactic-style education. A 2009 report in the
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rescue (PJ) team since 2008 and codified various tools used to Mount Sinai Journal of Medicine stated that “clinical medi-
simulate physical findings and drive medical exercises as part cine is becoming focused more on patient safety and quality
of scenario-based training. We also surveyed other SOF Medic than on bed-side teaching and education . . . [and as a result,
training resources. a] disconnect still exists between the classroom and clinical
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environment.” Therefore, as the link widens between class-
Keywords: Pararescue; training, scenario-based; SOF Med- rooms and the battlefield or remote outposts, it is necessary to
ics; simulation; moulage; training, military-related medical train medics via various simulation techniques. Presently, the
best simulation medium for military medical providers is not
known because most of these simulations lack the ability to
drive medics to properly diagnose a patient.
Introduction
Preparation of SOF Medics as first responders for the battle Until now, the clinical and training value of getting the diag-
space and austere environments is critical to optimize survival nosis correct has been the focus, not the ability of the medic to
and quality of life for our Operators who may sustain serious make decisions based on patient assessment or to accurately
and complex wounding patterns and illnesses. In the absence learn and rehearse appropriate skills. After almost a decade
of constant clinical exposure for these medics, it is necessary to of training medics during Operation Enduring Freedom and
maximize all available training opportunities. The incorpora- Operation Iraqi Freedom, the lack of such data and guidance
tion of scenario-based training helps weave together teamwork prompted us to determine the optimal means to train med-
and the ability to practice treatment protocols in a tactical, ics, with a concentration in the use of moulage (i.e., mock in-
controlled training environment to reproduce, to some degree, jury) techniques to compensate for lack of a clinical setting
the environment in and stressors under which care will need to and, furthermore, simulate realistic scenarios. This was ob-
be delivered. All protocols are practiced as established by the served among one PJ team from 2008 to the present by using
Pararescue Medical Operations Handbook. 1 simulation techniques to standardize or, alternatively, display
practices during medical exercises and evaluations to reduce
Scenario-based training at the unit level is the most readily proctor inputs.
available and least expensive training; using role players or
simple mannequins allows the medics to practice and repeat Materials and Methods
protocols in the context of operations training. Mannequins
found in simulation laboratories are expensive, complex, and We reviewed the evolution of training scenarios within one
computerized and contain software. They are impractical in PJ team since 2008 and codified various tools used to simu-
these settings due to the lack of skilled personnel dedicated to late physical findings and drive medical exercises as part of
*Correspondence to christopher.petersen.12@gmail.com
1 TSgt Petersen is a USAF PJ, NRP, and a medical student at Hofstra Northwell School of Medicine. Lt Col Rush is a USAF pararescue flight
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surgeon. Ms Gallo is a student at Stony Brook University, Stony Brook, NY. SSgt Dalere is a USAF PJ, NRP. 2LT Staak, USAF, is a medical
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student at USUHS and prior PJ. SGM Moore is in the U.S. Army and is the Chief Medical NCO for the Department of Combat Medic Training.
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7 Mr Kerr is the director of the Special Operations Combat Medical Skills Sustainment Course located at Ft Bragg, NC. SFC Chandler, Flight
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Paramedic, is a PA Student at the Interservice Physician Assistant Program at Fort Campbell, KY. Lt Col Smith is medical director, National Park
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Service; clinical assistant professor, University of Washington School of Medicine; emergency medicine, St. John’s Medical Center, Jackson, WY.
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