Page 91 - JSOM Spring 2020

with brain and cardiac injuries. Urban fire arm related violence times. The training method proved useful and can be used in a
and CPMS have little difference in wounding patterns. The per- multistep program, in combination with a realistic task train-
centage of potentially preventable deaths (PPD) is reported to ing model and perfused cadaver model, for percutaneous and
be 15–16%. The most commonly injured organs in those with open access training.
PPD were the lung (59%) and spinal cord (24%). The PPD
rate after CPMS is high and is due mostly to nonhemorrhaging Acknowledgments
chest wounds. These injury types are not typically amendable We acknowledge all participating QRT Fire Fighters for par-
with REBOA. 21,22,23 ticipation in the practical phase of the training.

In civilian settings, this provides challenges in training of Financial Disclosure
larger volumes of providers and sustaining their training lev- Prytime Medical Devices, Inc. provided the REBOA Access
™
els. Monitoring degradation of skills over time should be part Task Trainer (RATT) and the catheters used for this study. No
of any program. other support was provided.

The evidence base for the use of REBOA is growing; neverthe- Funding
less, more robust data must become available. We have pub- This study was partly funded by the Alrijne Academy, SZVK,
lished several feasibility studies on training of vascular access the Dutch Ministry of Defense, and the Karel Doorman Fund.
and REBOA placement. 11,12 We also published a consensus
paper on the use of REBOA. These articles contribute to the Disclaimer
18
discussion on when, where, and in which patients this proce- The opinions or assertions contained herein are the private
dure is indicated and who should perform REBOA. When per- views of the authors and are not to be construed as official
cutaneous access fails, open surgical access is a bailout. This or reflecting the views of the Dutch or US Department of De-
report shows that QRT-FF are able to acquire basic skills for fense, or the Dutch or US governments. Several authors are
vascular access and REBOA placement. We do not state that employees of the Dutch government.
QRT-FF should perform these procedures or that this training
is sufficient to perform these complex tasks in real-life, austere Conflictss of Interest
situations. The authors declare that there are no conflicts of interest that
could inappropriately influence (bias) their work.
Our present feasibility study has some important limitations
that must be acknowledged. Although the task training model Author Contributions
used for vascular access training does provide standardization, BLSBvdB and RH prepared the study setup. BLSBvdB, SMV,
the biomechanical limitations of this training adjunct clearly do TTCFvD and RH included participants and performed the
not represent perfectly realistic conditions and haptics. Ideally, study during the EVTM workshop in Leiderdorp and col-
percutaneous access of the femoral artery would be trained on lected the data. TTCFvD performed the statistical analyses.
a human (cadaver) model. In addition, the QRT-FF group was BLSBvdB, SMV, TTCFvD, and RH prepared the manuscript,
smaller than the medic cohort. Although the identical training and TTCFvD prepared the tables and figures. BLSBvdB, SMV,
was provided and skills were scored by the same observers (Drs TTCFvD, JJD, MWB, and RH contributed to the final version
Borger van der Burg and van Dongen), group size may have of the manuscript.
influenced the results of the training. Furthermore, although
the RATT is a flow model, the model is not representative for References
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laboratory conditions are not realistic proxies for the chaos of mate challenge in optimizing trauma care; a review of treatment
options and their applicability in the civilian trauma setting. Scand
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expertise in the examined skills would also likely require using 2. Lendrum R, Perkins Z, Chana M. Pre-hospital resuscitative endo-
ultrasound in combination with a realistic moulage model and vascular balloon occlusion of the aorta (REBOA) for exsanguinat-
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practical training program using a task training model can forces and should be considered. J R Army Med Corps. 2019
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