Page 68 - JSOM Summer 2018

FIGURE 2 Order of surgical procedures.
WEEK 1 WEEK 2 WEEK 3
Day 1 Day 2 Day 3 Day 1 Day 2 Day 3 Day 1 Day 2 Day 3
EPF-1 LCS-1 No Motion No Motion LCS-1 EPF-1 EPF-1 No Motion LCS-1
Pelvis Abdominal Ankle Ankle Femur Pelvis Pelvis Abdominal Ankle
Femur Pelvis Pelvis Abdominal Abdominal Femur Femur Ankle Abdominal
Ankle Ankle Femur Femur Pelvis Abdominal Abdominal Femur Femur
Abdominal Femur Abdominal Pelvis Ankle Ankle Ankle Pelvis Pelvis
Pelvis Femur Pelvis Ankle Ankle Pelvis Ankle Pelvis Pelvis
Ankle Ankle Abdominal Abdominal Abdominal Ankle Abdominal Femur Abdominal
Abdominal Pelvis Ankle Femur Pelvis Femur Pelvis Abdominal Ankle
Femur Abdominal Femur Pelvis Femur Abdominal Femur Ankle Pelvis
WEEK 4 WEEK 5 WEEK 6
Day 1 Day 2 Day 3 Day 1 Day 2 Day 3 Day 1 Day 2 Day 3
EPF-1 LCS-1 No Motion No Motion LCS-1 EPF-1 EPF-1 No Motion LCS-1
Ankle Femur Femur Pelvis Ankle Ankle Femur Pelvis Pelvis
Pelvis Ankle Pelvis Femur Femur Abdominal Pelvis Ankle Ankle
Femur ABdominal Abdominal Abdominal Pelvis Femur Abdominal Femur Abdominal
Abdominal Pelvis Ankle Ankle Abdominal Pelvis Ankle Abdominal Femur
Abdominal Abdominal Femur Ankle Femur Femur Femur Pelvis Ankle
Femur Femur Ankle Femur Ankle Abdominal Ankle Ankle Femur
Ankle Ankle Abdominal Abdominal Pelvis Ankle Pelvis Femur Abdominal
Pelvis Pelvis Pelvis Pelvis Abdominal Pelvis Abdominal Abdominal Pelvis
EPF, Expeditionary Fast Transport; LCS, Littoral Combat Ship.
FIGURE 4 Medical Mission Module Support Container operating
room configuration.

FIGURE 3 The Medical
Mission Module Support
Container aboard
a Stewart motion
table (Moog Series
6DOF500E, Model 170).

subtask or for team members to sit and recuperate in the event For the abdominal procedure, reduction in blood loss was
of a motion sickness incident. used as a key indicator of performance for damage control.
Blood loss was measured based on the flow rate before the
Assessment of Surgical Performance surgeon initiated packing sponges into the abdomen, and this
Success was determined by the state of the patient surrogate flow rate was compared with the flow rate when packing was
after the surgery, regardless of the workload involved, time complete. The prepacking flow rate was based on elapsed time
consumed, or number of minor errors committed. The surgi- and the flow quantities measured from when the blood pump
cal SMEs evaluated the surgical teams by assessing specific, started to when the first pack was installed. The postpacking
quantifiable, and repeatable variables for each of the four pro- flow rate was based on the elapsed time and blood quantity
cedures. For instance, incision length and pin placement were lost from the start of the bowel repair until the end of the
measured after completion of the femur and pelvic fixation. procedure. Based on the prepacking and postpacking results,
Measured data were then aggregated into a five-point Likert- a calculation of the percent reduction in flow was determined
type scale (Figure 5). using the following equation:

66 | JSOM Volume 18, Edition 2/Summer 2018