Page 65 - JSOM Winter 2017

Advise and Assist

A Basic Medical Skills Course for Partner Forces

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Michael D. April, MD, DPhil, MSc *; Thales Lopes, BSN ; Steven G. Schauer, DO, MS ;
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Mario Meneses ; Heather Roszenweig ; Daniel Byram ; Zachary Timms-Williams ;
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Thomas P. Shields, BS ; Amber N. Cross ; Luke J. Hofmann, DO 10
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ABSTRACT
Background: Training partner forces in battlefield first- Introduction
responder medical skills is an important component of US mil-
itary advise-and-assist operations. We designed and executed a Training foreign militaries and internal defense forces is a key
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training curriculum focused on high-yield–based medical skills mission of Special Operations Forces (SOF). US geopolitical
to prevent death on the battlefield for non-English–speaking strategy increasingly entails the expansion of this mission to
members of the Turkish, Azerbaijani, and Albanian militar- conventional forces as the scope of combat operations has
ies deployed to Afghanistan. Methods: We designed a 2-hour transitioned from direct action to advise-and-assist opera-
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training curriculum focusing on four basic medical skills: (1) tions. This is particularly true in Afghanistan, where the con-
assessment of scene safety; (2) limb tourniquet application; temporary North Atlantic Treaty Organization (NATO)-led
(3) wound bandaging; and (4) patient transportation via litter. Resolute Support mission focuses on training, advising, and
Our combat medics delivered standardized training using both assisting the Afghanistan National Army (ANA) and Afghani-
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didactic and practicum components. Instructors made before- stan National Police.
and-after assessments of the proficiency of each participant
for each skill in accordance with the Dreyfus model of skill Military healthcare providers, ranging from medics to physi-
acquisition. We also administered before-and-after, Likert- cians, may contribute to this mission through the development
scale–based surveys for training participants to report their of curricula to train foreign militaries on medical skills. The
self-assessed comfort level with each of the four skills. Results: content of such training may span a wide gamut of skills of
We delivered training to 187 participants over five classes. All varying complexity, based on the background and proficiency
28 participants in the final teaching class completed the study. of the trainees. The military medical education literature high-
Instructors categorized each participant’s skill level as novice lights the importance of tailoring curriculum development
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before training for all four skills. After the training curriculum, based on trainee educational background and prior experience.
all participants achieved a skill level consistent with advanced
beginner for all four skills. Participants reported significant During a deployment to Kabul, Afghanistan, our team devel-
improvements in self-reported comfort levels for all taught oped a basic medical skills training curriculum modelled on
procedures (p < .001 by Wilcoxon signed-rank test for all four the US-based battlefield first-responder courses. We designed
skills). The largest reported increase in median comfort level this curriculum to teach basic medical skills to nonmedic for-
was for tourniquet application: median pretraining comfort eign forces who had no prior medical training. We sought to
level, 4 (interquartile range [IQR], 0–6.25) versus 9.5 (IQR, develop and assess the skills of the trainees. Our reasoning was
9–10) posttraining. Conclusion: Our curriculum resulted in that development of a standardized, evidence-based training
significant improvements in instructor-assessed proficiency course would lead to significant improvement in the medical
and self-reported comfort level for all four basic medical skills. readiness of our partner forces.
Although our outcome measures have important limitations,
this curriculum may be useful framework for future medics Our curriculum specifically focused on four basic medical
and physicians designing battlefield first-responder training skills: (1) assessment of scene safety, (2) limb tourniquet ap-
curricula for members of foreign militaries. plication, (3) wound bandaging, and (4) patient transporta-
tion via litter. We conducted a before-and-after performance
improvement project to assess the training. This entailed
Keywords: education; wounds and injuries; emergency med- pretraining and posttraining surveys to ascertain participant
ical services; military personnel
self-reported comfort level with each of the four skills. It also
entailed instructor assessment of participant proficiency with
each of the four skills based on the Dreyfus model of skill

*Address correspondence to Michael.D.April@post.harvard.edu
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1 MAJ April is with the Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX. CPT Lopes is with the Inten-
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sive Care Unit at Walter Reed National Military Medical Center, Bethesda, MD. MAJ Schauer is with the En Route Care Research Center, 59th
Medical Wing, Fort Sam Houston, TX. W02 Meneses is with Randwick Health Centre, Randwick Barracks, New South Wales, Australia. CPL
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Byram is with Gallipoli Barracks, Enoggera, Queensland, Australia. CPL Rosenzweig is with the 1st Close Health Battalion, Royal Australian
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Army, RAAF Base Edinburgh, South Australia, Australia. CPL Timms-Williams is with the 1st Close Health Battalion, Royal Australian Army,
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Darwin, Northern Territory, Australia. SGT Shields is with 1st Battalion, 66th Armored Regiment, 3rd Armored Brigade Combat Team, 4th
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Infantry Division, Fort Carson, CO. SSgt Cross is with 96th Medical Group, Eglin Air Force Base, FL. LTC Hofmann is with the Department
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of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX.
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