Page 124 - JSOM Winter 2018

Results: The scenario simulated in 3D-SC1 is an attack on a Health Aspects of Mountain Warfare
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patrol of 3 soldiers with an improvised explosive device explo- T. Rieder , R. Lechner 2
1
sion as a result of which one soldier dies, one soldier is slightly 1 Medical Unit of Füssen Barracks, Mountain Reconnaissance
stunned, and the third soldier experiences a leg amputation Battalion 230
and other injuries. This scenario was first tested with manne- 2 Department of Anesthesiology and Intensive Care, Bundeswehr
quins in military simulation centers, before being transformed Hospital Ulm, Ulm, Germany
into a virtual 3D real-time scenario using a multi-support,
multi–operating system platform, Unity. Processes of gamifi- ountain environment is one of the most challenging ar-
cation and scoring were applied, with 2 levels of difficulty. Meas of warfare. Cold, wind, rugged terrain, avalanches/
A personalized debriefing was integrated at the end of the landslides, ultraviolet radiation, altitude/hypobaric hypoxia
simulations. The design and production of 3D-SC1 took 9 and often a combination of those factors are environmental
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months. The deployment, performed in 3 months, has reached threats, which cause specific health disorders, standard mil-
84 of 96 (88%) French Army units, with a total of 818 hours itary medical units are often not sufficiently prepared for. In
of connection in the first 3 months. addition, military tactics aggravate those environmental chal-
lenges, compared to civilian mountaineering. A short prepara-
In the assessment study, a total of 96 subjects were evaluated:
seven could not be followed-up, while 50 were randomly tion time, a lack of acclimatization possibilities, a prolonged
allocated to the Intervention group, and 39 to the Control stay at high altitudes, additional equipment, a weak chain of
group. Between measure 1 and measure 2, the mean (SD) per- evacuation and hostile forces caused large number of casual-
formance score increased from 9.9 (3.13) to 14.1 (1.23), and ties in past mountain campaigns, and still do today. A signifi-
from 9.4 (2.97) to 12.5 (1.83), for the Intervention group and cant proportion of those casualties is caused by environmental
Control group, respectively (p < 0.0001). The adjusted mean factors.
difference in performance scores between 3D-SC11 and DVD Not least through the war on terrorism, mountain warfare is
training was 1.1 (95% confidence interval 0.3, 2.5) (p = 0.14). not a problem of the past - in contrast, it is of increasing fre-
Overall, the study found that supplementing SC1 training with quency. Therefore, it is of utmost importance, that military
either 3D-SC1 or DVD improved performance, assessed by a leaders are able to identify, the most challenging environmen-
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hands-on simulation. tal factors in addition to tactical threats: Rugged terrain, cold
Conclusion: The development of 3D-SC1 involved a collab- weather and altitude/hypobaric hypoxia. According to the
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orative platform with interdisciplinary actors from the French main environmental hazards, different preventive measures
Military Medical Service, medical university, and videogame exist. Personnel selection, intensive mountain mobility train-
industry. Training each French soldier with simulation exer- ing, behavioral training in extreme environments, adapted
cises and mannequins is challenging and costly. Implementa- time calculations, use of pack animals, a special diet, sufficient
tion of 3D-SC1 into the training program offers a unique and mountain equipment, training in treatment of mountain spe-
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efficient opportunity at a lower cost to improve training and cific diseases and prolonged field care, training in air rescue
subsequently the real-time performance of soldiers when man- and alternative evacuation techniques can reduce the influence
aging combat casualties; ideally, these should be combined of mountainous environment. However, most of them have to
with physical simulations. be initiated well in advance, some of them even years before
deployment.
References The environmental factor truly unique to mountainous envi-
1. Pasquier P, Mérat S, Malgras B, Petit L, Queran X, Bay C, ronment is long-term exposure to altitude/hypobaric hypoxia.
Boutonnet M, Jault P, Ausset S, Auroy Y, Perez JP, Tesnière Experience outside specialized mountain units is often very
A, Pons F, Mignon A. A Serious Game for Massive Training rare and the effects are therefore often underestimated. Besides
and Assessment of French Soldiers Involved in Forward Com- performance decrements (some strenuous military tasks like
bat Casualty Care (3D-SC1): Development and Deployment. move under direct fire or carriage of heavy equipment might
JMIR Serious Games 2016;4(1):e5.
2. Planchon J, Vacher A, Comblet J, Rabatel E, Darses F, Mignon be impossible at high altitudes) potentially lethal high-altitude
A, Pasquier P. Serious game training improves performance in illnesses exist. To deal with this challenge, acclimatization pro-
combat life-saving interventions. Injury 2018;49(1):86–92. tocols, adapted time calculations and profound knowledge in
(medical) prevention and treatment of high altitude illnesses
is paramount. However, natural acclimatization during com-
bat missions is almost impossible, due to logistical and tactical
reasons. Preacclimatization at natural heights or in hypobaric
chambers is possible, however, deacclimatization has to be
considered. A promising alternative may be acclimatization in
normobaric hypoxia shortly before operations at altitude are
launched.

122 | JSOM Volume 18, Edition 4 / Winter 2018