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procedures. The emergency medicine residents in the Takeyesu compared the Generation 6 to the prototype Generation 7 de-

et al. study reported higher fidelity in the cadaver training vice in a small mannequin-based study in the spring of 2016
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model when compared with simulation for cricothyroidot- and concluded that the C-A-T Generation 7 performed bet-
omy and tube thoracostomy, as well as improved confidence ter, was easier to use, and was preferred to the Generation 6
when the cadaver training model was used. Furthermore, model. Their study, however, did not show statistically signif-
when training US Navy Corpsmen in needle decompression icant differences in effectiveness in bleeding control or time to
for tension pneumothorax, better results were had with the bleeding control. The most important limitation of the cur-
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fresh- cadaver training model used by Grabo et al. than with rent study is the potential for bias introduced because the PCT
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standard slide-based lectures when measuring accuracy of an- group received more tourniquet training and was familiar with
giocatheter placement. Hart et al. conducted a study of 559 the testing model, having been exposed to it in their training.
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Army Combat Medics in which the use of live tissue (goat) ver- Although we readily acknowledge this as a potential for bias,
sus synthetic tissue model was evaluated for training in critical this can also be viewed as a potential advantage of this model
airway, breathing, and hemorrhage control procedures. Rele- in that it provides more realistic, high-fidelity, and dynamic
vant to the study presented here, the group that was trained training that more closely imitates a real-life scenario.
and tested on live tissue in the Hart et al. study, however, had
fewer critical fails than the groups trained and tested on syn- Conclusion
thetic models.
US Navy corpsmen who received PCT were better trained in
Studies like those mentioned in the preceding paragraph lend tourniquet application for lower limb hemorrhage than were
support to the idea that high-fidelity and dynamic training their counterparts who received TT. The use of a perfused-ca-
models for procedural skills might be better teaching mo- daver model offers an exciting modality for training lifesaving
dalities. Previous work at LAC+USC has shown that the use procedures, such as tourniquets, with fresh tissue and simu-
of perfused, fresh cadaver simulation in a surgical training lated bleeding from compressible vessels. Additional studies
program was useful in replicating human-tissue handling. are indicated to develop this model for its use in limb tourni-
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Carden et al. showed that dynamic simulation training using quet and other lifesaving procedures for Military Medics and
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mannequins with ongoing hemorrhage for teaching temporary surgical teams.
vascular shunt placement to general surgery residents was
equivalent to cadaver training. The addition of dynamic hem- Poster Presentation
orrhage simulation was thought to augment the trauma skills This study was presented in poster form at the Annual Meet-
training. Human cadaver simulation with circulation in the ing of the American Association for the Surgery of Trauma,
major vessels is a novel concept for training trauma surgeons, September 2017, Baltimore, Maryland.
especially as an alternative to a live animal model. 17
Disclaimer
The next generation of bleeding control interventions for limb The views presented here are those of the authors and do not
hemorrhage likely involves developing standards in education necessarily represent the views of the Department of the Navy
and skill sets for tourniquet users. The results of the current or the Department of Defense.
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study suggest that the use of a human fresh cadaver with hem-
orrhage simulation is also applicable for high-fidelity, dynamic Disclosures
training and possible integration into the curriculum of Mil- The authors have no conflicts of interest and nothing to
itary Medics for lifesaving battlefield procedures. Additional disclose.
opportunities exist for the development of predeployment and
sustainment training for military surgical teams to perform Author Contributions
damage-control surgical techniques on these high-fidelity, dy- DG, TP, AS, KI, and CF contributed to the study design, data
namic perfused cadavers for training and skills sustainment. interpretation, and critical revision of the manuscript. CL con-
tributed to data interpretation. MM, SK, AW, and DD contrib-
This study has several limitations. Although fresh, never- uted to critical revision of the manuscript.
frozen, nonembalmed, perfused cadavers were used in this
training model, this may not completely reproduce the anat-
omy, physiology, and tactile feedback of live patients. In gen- References
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eral, age of the cadaver was older and muscle mass was lower Special Operations Forces in the global war on terrorism: 2001–
than that of the average combat casualty. As such, the amount 2004. Ann Surg. 2007;245(6):986–991.
of pressure needed to compress the vessel would be less than in 2. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield
a more commonly encountered young male combat casualty. (2001-2011): Implications for the future of combat casualty care. J
Unlike battlefield trauma, this study involved placing limb Trauma Acute Care Surg. 2012;73(6 supplement 5):S431–437.
tourniquets in a highly controlled, sterile environment. Factors 3. Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital tourni-
quet use in Operation Iraqi Freedom: effect on hemorrhage control
such as the battlefield environment, wounding patterns, pa- and outcomes. J Trauma. 2008;64(2 Suppl):S28–S37.
tient movement and clothing, as well as multiple injuries could 4. Kragh JG, Walter TJ, Baer DG, et al. Survival with emergency
not be reproduced. To be consistent for the corpsmen who tourniquet use to stop bleeding in major limb trauma. Ann Surg.
entered the study in the early phase, the C-A-T Generation 6 2009;246(1):1–7.
was used throughout the study despite C-A-T Generation 7 5. Kragh JF, Dubick MA, Aden JK, et al. U.S. Military use of tour-
beginning production in late 2015 and becoming available at niquets from 2001 to 2010. Prehosp Emerg Care. 2014;19(2):
184–190.
NTTC toward the mid to later part of the study. The primary 6. National Association of Emergency Medical Technicians. TCCC
difference between use of these devices is that the Generation for medical personnel guidelines and curriculum. http://www.naemt
7 device is designed with a single-pass buckle. Kragh et al. .org/education/TCCC/guidelines_curriculum.
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