Page 43 - JSOM Spring 2021

Combat Casualty Care Training

Implementation of a Simulation-Based Program in a Cross-Cultural Setting:
Experience of the French Military Health Service in West Africa

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Jean Cotte, MD *; Ambroise Montcriol, MD ; Patrick Benner, MD ;
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Valérie Belliard ; Pierrick Roumanet ; Alain Puidupin, MD ; Marc Puidupin, MD 7
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ABSTRACT
Introduction: In the French army, combat casualty care (CCC) describe the results of multiple SC3 sessions held in Gabon,
training involves the use of simulation. The application of West Africa.
this pedagogic method in a cross-cultural environment has
not previously been described. In this report, we explore the TABLE 1 Levels of Competency
challenges highlighted by multiple training sessions for foreign
medical providers in West Africa. Methods: We collected the Level Provider Type Procedures Courses
data from six 2-week courses held in Libreville, Gabon. Our SC1 All Tourniquet application, 1 day, every
morphine autoinjector,
year
main objective was to describe the course; our secondary ob- positioning the casualty
jective was to assess our trainees’ progress in their knowledge SC2 Combat Intravenous and 2 weeks,
of CCC. Results: The first week involved lectures, technical lifesaver intraosseous access, shock every year
workshops, and single-patient simulations. The second part management, pneumothorax
emphasized multiple-victim simulations and interactions with decompression,
combatants and was held in the Gabonese rainforest. Six- cricothyroidotomy
ty-two trainees undertook the six sessions. Their knowledge SC3 Nurse, Advanced airway 2 ´ 1 week,
improved during the course, from a median score of 4 (of a physician management, field every 3 years,
and before
transfusion, prolonged field
maximum of 40) before to 9.5 after (p < .05). Discussion: Our care, mass casualty deployment
study is the first to describe medical-level CCC training in a
cross-cultural environment. Challenges are numerous, notably
differences in the expected roles of instructors and trainees. Methods
Mitigating those difficulties is possible through cultural aware-
ness and self-awareness. Our results are limited by the absence The French Army Health Service regularly conducts 2-week
of evaluation of improvement in the actual management of SC3 courses in Libreville, Gabon. This program features coop-
patients. Conclusion: CCC training using medical simulation eration between the Operational Medicine Simulation Center
is feasible in a cross-cultural environment. (CESIMMO, Centre d’Enseignement à la Médecine en Mi-
lieu Opérationnel), the International Military Health Service
Keywords: medical simulation; manikin; cross-cultural; com- School (EASSML, l’Ecole d’Application du Service de Santé
bat casualty care Militaire de Libreville ), and the Sixth Marine Infantry Battal-
ion (6BIMA), Libreville.

Introduction We conducted a retrospective observational study of all the
SC3 courses held in Gabon. Our primary objective was the
CCC is an integral part of the training of soldiers in most description of this course. Organizational data were collected,
Western countries. The French Army CCC program, called as well as each student’s country of origin and profession. Our
“Sauvetage au Combat” (SC), is divided into three levels of secondary objective was to evaluate the short impact of the
competency (Table 1). The third level, SC3, is taught to all course on the participants’ theoretical knowledge in CCC.
military nurses and physicians. The main pedagogic modal-
ity of the SC3 course is high-fidelity simulation. Partnerships A written evaluation was undertaken by the trainees both im-
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with our allies, notably in Africa, frequently include training mediately before and immediately after the first week of the
sessions. To our knowledge, the use of high-fidelity simulation course. This test comprises 40 multiple-choice questions and
training to teach CCC in an austere and multicultural environ- is to be completed in 20 minutes. The same test is used for
ment has not previously been documented. In this report, we French Army medical providers.
*Correspondence to jean.cotte@gmail.com
1 Dr Cotte and Dr Montcriol are affiliated with the Anesthesia and Intensive Care Department, Sainte Anne Military Teaching Hospital, Toulon,
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France, and the Operational Medicine Simulation Center, Toulon. Dr Benner is affiliated with the Emergency Department, Sainte Anne Military
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Teaching Hospital, Toulon, and the Operational Medicine Simulation Center, Toulon. Ms Belliard is a nurse affiliated with the Operational
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Medicine Simulation Center, Paris, France. Mr Roumanet is a nurse affiliated with the Operational Medicine Simulation Center, Toulon. Dr
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A. Puidupin is affiliated with the International Military Health Service School, Libreville, Gabon. Dr M. Puidupin is affiliated with the Robert
Picque Military Teaching Hospital, Bordeaux, France.
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