Page 81 - Journal of Special Operations Medicine - Fall 2017

Figure 16 The combat pill pack. As the
introduction of antibiotics to the battle-
field has helped to decrease the number Figure 17 Lollipop simulating a fent anyl
of infections, many organizations now lozenge. When indicated, the medic gives
mandate their members carry the combat a lozenge to the patient with appropriate
pill pack, a combination of acetamino- instructions. Patients are instructed to con-
phen, meloxicam, and moxifloxacin. All tinue having pain for several minutes and
individuals should carry a small plastic occasionally pass out, simulating respira-
bag with three pieces of candy, whereby tory depression requiring naloxone admin-
the medic upon scene can ask if the in- istration and airway support, emphasizing
jured has taken his or her combat pill the importance of continuous monitoring.
pack. If the patient has not done so, the
medic can direct the patient to consume
their pre-allocated medication.

medicine on patients in hospitals or in ambulances after grad- up-to-date clinical practical guidelines based on feedback from
uation from formal military medical training. The traditional theater trauma patients; this shared approach to training, as it
educational and assessment approach using lectures, clinical relates to ideas and materials, would benefit all warfighters. 6
shadowing, written examinations, and objective-structured
clinical examinations are not enough in totality for physi- Simulation as a teaching technique can be used so the learner
cians to help address all competencies regarding education, can participate in mastery learning and deliberate practice,
6
practice, and team-based learning. As a whole, medics re- embrace outcome measurement, and address cultural barri-
quire medical exercises that are driven by their assessment ers. The use of cadavers to practice invasive battlefield proce-
7
and inspection of patients rather than proctor inputs. Regard- dures required of medics is the best available; human cadavers
less of the type of simulation training selected by the instruc- are frequently used to perform procedures on human anatomy
tor, much of the training is learner dependent, because each that lack diagnostic drivers.
medical exercise requires full participation and engagement
3
by the individual. However, simulation can be extremely cost Due to limitations of cost and reality, most training exercises
prohibitive and, therefore, not practical for use when per- use role players. The use of appropriate props and moulage
forming frequent situational medical exercises. Moulage is techniques eliminate much of the verbalization of findings and
commonly used during training; there is a paucity of research contrived nature of putting on situational medical exercises;
and guidelines regarding how to best display various signs therefore, it is possible to better approximate physical findings
and symptoms related to combat trauma. This is necessary to driving the scenario. No substitute exists for learning how to
drive clinical diagnostic acumen, as well as push the trainee incise a human’s skin, thus the use of human cadavers helps
to perform the protocols associated with the desired learning close the gap from not having suitable clinical training. Once
objectives for the exercise. the skill is learned on a suitable model, it can be successfully
incorporated into scenario-based training to reinforce the
Deliberate practice and mastery of basic skills must use cer- technique. Skill stations can also be performed separately from
tain commonalities regardless of the specific medical exercise a medical exercise, allowing the medic to continue to hone his
created and used. All these techniques should be reviewed as or her skills. These stations will test the medic, ensuring he
standard rules of engagement before training to maximize the or she is adequately prepared with the required equipment to
value of the training. Trainees must be able to correctly iden- perform the task, in addition to teaching the medic the amount
tify the cue stated by the instructor during their assessment of time the task will take to perform correctly without dis-
of the patient, treat the patient appropriately, and view the tractions. Finally, we believe that practicing a protocol in its
results of their treatment repeatedly to root the pathways for totality is necessary for adequate subconscious learning of the
diagnosis and treatment according to military medical pro- task in a suitable setting so that appropriate emotional contex-
tocols. Through observation within this study, trainees may tualization will occur.
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incorrectly diagnose patients during simulations because of
ineffective moulage, vague instructions given to the role player Undoubtedly, the goal within the SOF medical community is
or medic, vague signs and symptoms, poor coaching of the mastery of the basics, of which expert performance is contin-
role player, the role player not staying in role, or lack of prac- gent upon four conditions: intense repetition of a skill, rigorous
tice. Therefore, feedback must be provided immediately, and assessment of that performance, specific informative feedback,
the individual being evaluated must engage in repetitive prac- and improved performance in a controlled setting (i.e., lack
tice until the treatment algorithms are committed to memory. 7 of real-life threat to the patient and providers), which allows
for medical oversight and evaluation. In our training environ-
3
Equally as important, at the outset of training, instructors must ment, we define a controlled setting as a noncombat setting in
identify the requisite-defined learning objectives and tasks to which direct medical director observation is performed. Ide-
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help guide the immediate feedback sessions. As the algorithms ally, a controlled setting will use the photographs discussed to
become ingrained by repetitive practice, clinical variation and be briefed before the exercise, driving the medics to make the
stress can be added over time. Often in the military, individual correct diagnosis and treatment of the simulated patient. A
organizations slightly modify doctrinal tactics to develop their study noted that students tend to remember 90% of what they
own techniques and procedures. However, in medicine, cross- do, compared with only 10% of what they read. 3
talk between organizations has helped standardize treatments
and protocols (e.g., Committee for Tactical Combat Casu- A study performed in Victoria, Australia, surveyed more
alty Care, the Joint Trauma Service [JTS]). The JTS provides than 200 health care professionals, including doctors, nurses,

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