Page 96 - JSOM Fall 2021

Sailors within the enlisted rate of HM work in a variety of not available. The pediatric clinical vignette was different with
medical settings, from clinical care to technical lab work to respect to mechanism of injury, consisting of blunt injury caus-
surgical settings. Their basic clinical training is equivalent to ing tension pneumothorax and cardiac arrest as secondary
that of a civilian emergency medical technician. All HMs had injuries following an IED blast. Participants were mentored
previously received TCCC training, and none was currently through tube thoracostomy via the Seldinger technique and
working in a trauma clinical care setting at the time of the cardiopulmonary resuscitation (Figure 2).
exercise. They were, as such, considered novice operators with
respect to performing advanced resuscitative maneuvers and, FIGURE 2 A US Navy Hospital Corpsman performs a tube
therefore, our target population of interest. thoracostomy via telementorship in a simulated pediatric trauma
patient.
Preparing the Scenario
Using synchronous VTC equipment, connection was estab-
lished between the USNS Mercy (T-AH 19) as the originating
site while underway in the Pacific Ocean to a distant site at
NMCSD, a tertiary care medical treatment facility located in
San Diego, California.

As part of the adult scenarios, the AR goggles were available
to be donned by the participant (Figure 1). This allowed point-
of-view visual cues to be given by the surgeon consultant via a
built-in AR application. All scenarios began with participants
waiting outside the scenario room aware they were respond-
ing to a medical emergency, then apprised on further clinical
specifics of the scenario and clinical details once they entered
the room. At this time, they were also informed that surgical Data Collection
teleconsultation was available upon request. In total, 17 HMs Data collected included quantitative and qualitative measures.
participated in this study. All participants in the adult scenar- Quantitative measures included the number of attempts to
ios used the AR goggles and, in both adult and pediatric sce- successful completion of the procedure and time to complete
narios, used surgeon audio and video teleconsultation. procedures. This was defined as time elapsed between the de-
cision to perform a procedure until completed successfully, as
FIGURE 1 A US Navy Hospital Corpsman performs tube determined by the proctoring surgeon. Descriptive statistics
thoracostomy via telementorship using augmented reality goggles are reported in terms of mean and standard deviation. Fol-
in a simulated adult trauma patient while underway in the Pacific
Ocean. A surgeon telementor from Naval Medical Center San Diego lowing completion of the exercise, qualitative data were col-
stands in the background. lected in the form of a debrief of procedural learning points
for the responders and VH experience for the mentors. This
feedback was then assimilated by the multidisciplinary team
qualitatively.

Results
Adult Trauma Scenarios
Twelve HMs participated in the adult scenarios. These were
conducted in various undisclosed locations throughout the Pa-
cific Ocean. All HMs donned the AR goggles with spatially
marked locations for all three procedure sites. No subjects had
previous experience using the goggles. All HMs successfully
performed the procedures on their first trial. The mean length
of time to complete proper placement of a tourniquet for an
extremity hemorrhage was 46 seconds (SD, 19 seconds), a nee-
dle thoracostomy was 70 seconds (SD, 67 seconds), a tube
Adult Trauma Scenarios thoracostomy was 313 seconds (SD, 152 seconds), and a cri-
Participants entered the room to encounter a TCCC training cothyroidotomy was 274 seconds (SD, 82 seconds).
manikin. The scenario consisted of an explosion on the ship
and a closed-space fire leading to airway, breathing, and circu- Pediatric Trauma Scenarios
lation emergencies. Participants were given a brief primer on Five HMs participated in the pediatric scenarios. All (100%)
proper donning of the AR goggles and, as the clinical scenario completed basic cardiopulmonary resuscitation and tube tho-
evolved, the remote NMCSD surgeon mentored the participant racostomy successfully on first attempt. The mean length of
through tourniquet placement, needle thoracostomy, tube tho- time to complete tube thoracostomy was 532 seconds (SD,
racostomy, and open cricothyroidotomy using the AR appli- 109 seconds).
cation to provide visual cues for completion of the procedure.

Pediatric Trauma Scenarios Discussion
Pediatric scenarios were conducted in similar fashion to the VH has a notable role in shaping the future of military med-
adult correlates, with the exception that the AR goggles were icine. The Navy and Defense Health Administration (DHA)

94 | JSOM Volume 21, Edition 3 / Fall 2021