Page 67 - JSOM Summer 2018

aboard an M3SC. Motion sickness (also known as seasickness, simulation part (Simulaids, https://www.simulaids.com/). For
kinetosis, or vestibular motion sickness) is a common physi- the abdominal procedure, the manikin’s liver was connected to
ological phenomenon that can occur in healthy personnel in an electric blood pump to provide a constant blood pressure
response to physical, visual, or virtual motion stimuli. This and flow for damage control and blood loss measurement.
3,4
complex syndrome can elicit signs and symptoms including STOPS developed a left-leg attachment with a faux femur in-
nausea, vomiting, cold sweating, pallor, increases in salivation, sert to surgically stabilize the displaced transverse fracture of
drowsiness, headache, and even severe pain. In some cases of shaft of femur and developed an artificial right-leg attachment
5
severe motion sickness, many aspects of manual performance for the partial traumatic amputation of the lower leg to simu-
and cognitive tasks are substantially impaired. 6 late these injuries (Figure 1).

Research done by the Office of Naval Research, Warfighter
Protection and Applications Division, showed that Naval sur-
geons and duty corpsmen could execute simple medical pro-
cedures (including open-wound suture and intravenous access
insertion) under mild-to-moderate sea motion conditions with-
out significant errors in performance. To investigate the effects
of high deck accelerations on more complex surgical tasks, the FIGURE 1 Modified human-worn
Office of the Chief of Naval Operations, N81 Assessments Di- partial-task surgical simulator.
vision, conducted a study at the Naval Surface Warfare Center
in Panama City, Florida, from August to October 2015. The
objective of this study was to quantify the ability of US Navy
medical personnel to perform critical surgical procedures
aboard US Navy ships under high sea states. Volunteers were
asked to perform a series of medical procedures on mechanical
surrogates (e.g., the Littoral Combat Ship [LCS] and the Expe-
ditionary Fast Transport [EPF]) while exposed to motion. Spe- Motion Conditions (Sea States) and
cific interactions addressed in this study included (1) surgical Operating Room Configuration
performance versus motion condition, (2) physiologic work- For the purposes of statistical confidence, each surgery had to
load versus motion condition, and (3) physiologic workload be performed multiple times under three different sea state (SS)
versus operating room role. Data gathered from this study will motion conditions: (1) no motion, (2) SS 3 at 20 knots, and
contribute to the design and efficacy of an M3SC. (3) SS 4 at 15 knots. Motion conditions remained constant
throughout each record test day so as not to confuse which
condition affected performance. Presentation of motion con-
Methods
dition each week, by day, was randomized to further address
Members of the Human Systems Integration Team at the Na- the learning effect. The teams completed the four surgical pro-
val Surface Warfare Center Panama City Division assembled cedures twice a day for a total of eight randomized procedures
six surgical teams each consisting of a general surgeon, a surgi- (Figure 2).
cal technologist (tech), an anesthesiologist, and a perioperative
nurse from volunteer Naval medical personnel across multiple Researchers used a motion base (Moog Series 6DOF500E,
medical commands. The teams treated the most frequently oc- Model 170 [a.k.a., Stewart motion table]; Moog, http://www
curring improvised explosive device injuries seen in the past .moog.com/) to emulate ship motion under different sea-state
10 years of conflict, as identified by a panel of Navy surgical conditions (Figure 3). The Stewart table, capable of produc-
subject matter experts (SMEs) using the Joint Medical Plan- ing motions in the roll, pitch, yaw, heave, surge, and sway
ners Tool. The tool provided patient condition occurrence directions of a ship, used collected motion data from the LCS
frequency data according to the International Classification 1 (USS Freedom) and the EPF 1 (USNS Spearhead) ships to
of Disease codes, as follows: (1) abdominal injury requiring develop simulator motion profiles. The profiles represented
exploratory laparotomy and damage control (S39.81XA); (2) shipboard motion condition within each ship’s mission bay
multiple pelvic fractures with unstable disruption of the pelvic in forward areas where an M3SC may be located. LCS 1 at
ring (S32.811B); (3) displaced transverse fracture of left femur SS 3 (significant wave height [SWH] range: 1.6–4.1 ft; mean
shaft (S72.322S); and (4) partial traumatic amputation of the SWH, 2.9 ft; period range, 5.1–15.4 seconds) at 20 knots was
right lower leg (S88.922A). selected. For EPF 1, SS 4 (SWH range, 4.1–8.2-ft; mean SWH,
6.17 ft; period range, 6.1–16.2 seconds) at 15 knots was used.
Over the course of the study, 144 recorded surgical procedures
were performed on surgical surrogates under different motion A 10-ft configured operating room was installed on the mo-
2
conditions. To standardize the assessment of the success of an tion platform that used initial design concepts for a dedicated
operation, the research team used a modified human-worn, M3SC (Figure 4). The operating room was equipped with an
partial-task, surgical simulator (Surgical Cut Suit; Strategic anesthesia apparatus, portable oxygen monitor, instrument
Operations, http://www.strategic-operations.com) as the med- table, military field operating table, surgical lights, and a vi-
ical surrogate to provide surgeons and rescue personnel with tal signs monitor. To prevent injury and damage to the equip-
a realistic operative experience. The Cut Suit includes bones, ment, the wheels were removed and heavy items were bolted
organs, muscle, and skin designed to simulate the realistic look to the simulator deck. The vital signs monitor displayed de-
and feel of severe traumatic events. To simulate each of the picted the patient’s vital signs and relevant radiographs. Fi-
four improvised explosive device injuries, the Cut Suit was nally, two folding seats were mounted to provide a place to
combined with a Rescue Randy torso and add-on surgical rest for members of the surgical team not actively engaged in a

The Effect of High Deck Accelerations on Surgical Tasks | 65