Page 77 - Journal of Special Operations Medicine - Fall 2017

scenario-based training. We also surveyed other SOF medic environment. As part of a larger medical scenario or as a stand-
training resources. The techniques generally involve low lev- alone exercise, this ensures all essential steps are performed in
els of technology, taken from theatrical makeup courses, yet a checklist-based approach. This allows the medic numerous
proved to be easily reproducible. When possible, commercially opportunities to perform the task, become familiarized with
available rubber injuries with Velcro straps were used because gear, and accurately learn these procedures, in addition to
they are recognizable as the injuries they represent (e.g., open making decisions based on assessment of the patient, and thus
fracture and burns). perform the appropriate hands-on skills. Providing refresher
classes to junior medics before a trauma assessment increases
Each finding was shown and explained to the PJ before train- the individual’s exposure to such material and ensures medics
ing so each individual would know what the moulage repre- receive adequate training.
sented. The objective was that if they were close enough to
elicit a visual or tactile recognition resembling the injury or A related observation we have made is that if the medic is
finding, it would imprint the basis of the diagnosis for recogni- trained in a stressful scenario and cannot recall the treatment
tion in a real-world situation. The ideas were compiled, listed, protocol very well, the result has been a nervous medic who
and photographed for this article. We did not look at training incorrectly performs protocols and procedures. Conversely, if
decay because the value was determined in debriefs after com- the medic has proven competency through testing and stand-
bat deployments and mission report reviews to determine that alone skills performance, and stress is incrementally added,
treatments were rendered per protocol based on the diagnosis. the correct performance of the protocol under such conditions
is reinforced. Stressors added can be more than tactical-related
scenarios; they may incorporate various environmental factors
Results
(e.g., darkness, cold weather, and rain). This incremental ap-
While information was gathered, photographs were taken in an proach allows for some subconscious, automatic performance
attempt to standardize, or alternatively display best practices of the protocol and enables maximal alertness for situational
as used by SOF medical instructors and trainers during medi- awareness.
cal exercises and evaluations, and to reduce proctor inputs.
The following photographs are broken down into two main Discussion
categories: (1) signs and symptoms, and (2) skills sustainment.
Signs and symptoms photographs are used to drive the medic Special Forces Medics (18D), PJs, Special Amphibious Recon
toward making the correct diagnosis and treatment of injuries Corpsman, and Special Operations Combat Medics have lim-
sustained. Skills stations are designed for the military medic to ited medical training. Additionally, due to various medicole-
practice and perform the task hands-on, albeit in a controlled gal challenges, many medics are unable to practice clinical
5
SIGNS AND SYMPTOMS
Figure 1 Simulated vomit with airway obstruc- Figure 2 Subcutaneous emphysema is represented by a plastic bag of rice taped to the
tion is depicted with stew in a role player’s mouth. chest. Subcutaneous emphysema, once palpated, will create a tactile memory and set in
In past medical exercises, the vomit may have motion various maneuvers to manage thoracic trauma. Palpation of the rice in the plastic
been noted by the instructor verbalizing, “blood bag produces a sensation such that this finding should be recognized in real-world mis-
and mucus,” “dirt,” or “vomit in the mouth,” sions. It is more probable that a medic who feels or sees findings and is trained to react to
whereas now, the medic will no longer have to those findings will achieve clinical fidelity than a medic processing an instructor’s verbal-
rely on the proctor’s verbal inputs. Instead, the ized physical finding, then reacting.
medic would respond to what they see and feel,
as one would in a real situation. Therefore, the
medic responds to the visual cue and must clear
the airway.

Figure 3 Broken ribs. Tongue blades broken in half and taped to the chest with overlying
tape so the sharp edges of the tongue blades do not cut the examiner. The simulated break
is unmistakable on palpation. Bending and breaking tongue blades, but not separating the
broken ends, approximate tenting of the skin from broken ribs or other bones. As a result,
the medic will feel the tenting of the skin (i.e., tape, in the simulation) and the bone ends.
Placing two or three broken ribs with additional ribs taped two or three a few inches apart,
simulates the floating rib fractures of a flail chest; however, paradoxical motion cannot be
simulated.

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