Page 92 - Journal of Special Operations Medicine - Summer 2017

interventions such as a cricothyroidotomy placement or Review
fluid infusion, and have realistic features, such as res- This study was determined by the Walter Reed National
pirations and palpable pulses. Additionally, while these Military Medical Center Institutional Review Board
initial manikin HPS devices mimicked complicated (IRB) Department of Research Programs as exempt
physiologic responses to anesthesia, the level of fidelity from IRB human subjects research requirements and
requisite in each device changes depending on the task classified as quality improvement research. The data
being trained and stage of education. 17–18 Adapting these were collected to assess and improve techniques and
devices to other medical training needs, manikin HPS education during an unmodified course of instruction.
have now been used successfully to enhance learning The survey tool was approved by the Deputy Chief of
in curricula for surgery, emergency medicine, advanced Staff—Surgeon, USASOC. The study results and pub-
cardiac life support (ACLS), paramedics, nursing, and lication were reviewed and approved by the USASOC
clinical testing for medical students. 19–24 Public Affairs Office.

Scenario training with manikin HPSs has been shown to Measures
improve a myriad of medical education tasks at various The survey was developed by USASOC medical-instruc-
levels, including physician-intern trauma management tor personnel not involved in analysis of the results. The
skills, emergency medicine teamwork, overall patient survey questions were identical for both samples and all
25
11
outcomes, triage skills, predeployment confidence, 27,28 survey data were anonymous and de-identified. In to-
26
and ACLS decision-making. The Armed Forces were tal, 102 independent survey variables were divided into
17
essential in the development and implementation of three categories—general characteristics, procedures,
these medical simulation models and initially were re- and injuries—and assessed using an identical measure.
sponsible for more than 75% of manikin HPS sales. 29–31 Survey elements asked participants to score device el-
ements or techniques in importance via a five-point
Continuing in this tradition, Brooke Army Medical Likert scale (range: 1 = not important to 5 = extremely
Center (BAMC) developed an industry-leading simu- important).
lation center to prepare military physicians and field
providers for critical situations. Although manikin Data Analyses
32
HPS training devices have been in use since the incep- The data were first analyzed as separate groups and
tion of centers such as BAMC’s, there exist no studies summed means were generated for each variable within
designed to assess which features enlisted field medical each group. A two-tailed Student t test was used to de-
providers value most. HPS characteristics are generally termine the magnitude of differences between the two
determined by industry and a model for each center samples.
may be selected from a group without input from those
instructed on the devices. This study sought to eluci- Data within categories were then aggregated as one
date key HPS features valued by experienced tri-service sample and combined means were generated. A Grubbs’
Special Operations Forces (SOF) Medics from within normed residual test was performed within each cat-
US Army Special Operations Command (USASOC) and egory to identify outliers. Additionally, within each
other elements of US Special Operations Command category, a summed mean of all Likert scores was gener-
(USSOCOM). ated to create a comparison variable to evaluate each
individual survey item for significant differences from
the mean. After each assessment of this kind, a power
Methods analysis was conducted with 1—β at 0.95. The type I
error rate at 5% sample size requirements varied from
Participants 29 to 284, less than the 376 participants in the study.
This study reports data collected from two different
groups: USASOC (Army) and USSOCOM (Navy/Air
Force). It was formulated and conducted between April Results
and October 2014 at Fort Bragg, North Carolina. A
total of 509 enlisted SOF Medics and nine medical of- Objective Measures
ficers were surveyed during this time; 428 participants Participant data are summarized in Table 1. Overall,
were from USASOC and 90 (including all nine officers) participants demonstrated a high degree of interest in
were from USSOCOM. Of those, 376 completed the ex- HPS devices and features, as assessed by high overall
tended survey with valid responses—320 from USASOC ratings of most factors. Features and procedures that
and 56 from USSOCOM. Data collected from those received high importance scores, defined as those with
who completed only partial surveys or provided invalid mean ratings higher than 4.5 out of a possible 5, cor-
responses were excluded from all analyses. responded closely with pillars of the Tactical Combat

90 Journal of Special Operations Medicine Volume 17, Edition 2/Summer 2017