Page 56 - JSOM Winter 2021

Comprehensive Ultrasound Course for

Special Operations Combat and Tactical Medics

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Huma Fatima, MD ; Sumanth Kuppalli, MD ; Vincent Baribeau, BS ;
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Vanessa T. Wong, BS ; Omar Chaudhary, MD ; Aidan Sharkey, MD ; John W. Bordlee, MD ;
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Akiva Leibowitz, MD ; Kadhiresan R. Murugappan, MD ; Ameeka Pannu, MD ;
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Lindsay A. Rubenstein, MD ; Daniel P. Walsh, MD ; Lisa J. Kunze, MD, PhD ;
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Justin K. Stiles, MD ; Jeffrey Weinstein, MD ; Feroze Mahmood, MD ;
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Robina Matyal, MD ; Derek N. Lodico, DO ; John D. Mitchell, MD *
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ABSTRACT
Background: Advances in ultrasound technology with en- military medicine, particularly when other imaging modalities
hanced portability and high-quality imaging has led to a are unavailable. There are several well-recognized publications
surge in its use on the battlefield by nonphysician provid- describing positive outcomes of ultrasound in the hands of
ers. However, there is a consistent need for comprehensive military physicians, which opened the door for nonphysician
and standardized ultrasound training to improve ultrasound providers utilizing ultrasound. The use of ultrasound by non-
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knowledge, manual skills, and workflow understanding of physician providers is continuing to grow and military medics
nonphysician providers. Materials and Methods: Our team are a targeted group of interest due to their unique nature of
designed a multimodal ultrasound course to improve ultra- delivering medical care on the battlefield.
sound knowledge, manual skills, and workflow understanding
of nine Special Operations combat medics and Special Op- Military medics are trained to provide medical care at the
erations tactical medics. The course was based on a flipped scene of the injury, making crucial diagnostic and therapeutic
classroom model with a total time of 43 hours, consisting of decisions. Utilization of ultrasound can improve clinical de-
an online component followed by live lectures and hands-on tection of injuries such as internal bleeding, reduced cardiac
workshops. The effectiveness of the course was determined us- function, bone fractures, and pneumothoraces. A literature
ing a knowledge exam, expert ratings of manual skills using a review assessing military medics’ ability to utilize ultrasound
global rating scale, and an objective structured clinical skills demonstrated favorable results and supported standard-
examination (OSCE). Results: The average knowledge exam ized ultrasound training for military medics. Additionally,
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score of the medics increased from pre-course (56% ± 6.8%) ultrasound-guided interventions such as central venous line
to post-course (80% ± 5.0%, p < .001). Based on expert rat- placement, intravenous access, and regional nerve blocks to
ings, their manual skills improved from baseline to day 4 of stabilize those wounded on the battlefield can be performed
the course for image finding (p = .007), image optimization by military medics. Analysis of Special Operator Level Clin-
(p = .008), image acquisition speed (p = .008), final image ical Ultrasound (SOLCUS), an ultrasound curriculum created
quality (p = .008), and global assessment (p = .008). Their for Special Operations Forces medics, demonstrated promis-
average score at every OSCE station was > 91%. Conclusion: ing results in these procedures with decreased regional block
A comprehensive multimodal training program can be used complications. 2
to improve military medics’ ultrasound knowledge, manual
skills, and workflow understanding for various applications of Medical education for clinical procedures is variable among
ultrasound. Further research is required to develop a reliable, specialties and institutions, with the majority of learners learn-
sustainable course. ing during their regular clinical workflow with supervision.
This method has several drawbacks including nonobjective
Keywords: ultrasound; medics; competency; curriculum feedback from the supervisor and inconsistent training time.
This is no different with ultrasound, as competency requires
repetition and hands-on teaching. Multimodal educational
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ultrasound courses using simulation-based learning with
Introduction
web-based and live teaching sessions have promising results.
Proficiency in ultrasound is an established and desirable skill- Novices such as anesthesiology and surgical interns demon-
set among physicians across all specialties. It is an immensely strated ultrasound proficiency and retention of skill and
helpful tool for diagnostic and procedural purposes and its use knowledge after completing an ultrasound course that utilized
has expanded across healthcare. The portability of ultrasound simulation-based, web-based, and live teaching. Military
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and ability to obtain rapid results are ideal characteristics in medics are skilled, highly motivated and may similarly benefit
*Correspondence to jdmitche@bidmc.harvard.edu
† Drs Huma Fatima and Sumanth Kuppalli are co-first authors.
1 Dr Huma Fatima, Dr Sumanth Kuppalli, Vincent Baribeau, Vanessa T. Wong, Dr Omar Chaudhary, Dr Aidan Sharkey, Dr John W.
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Bordlee, Dr Akiva Leibowitz, Dr Kadhiresan R. Murugappan, Dr Ameeka Pannu, Dr Lindsay A. Rubenstein, Dr Daniel P. Walsh,
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13 Dr Lisa J. Kunze, Dr Justin K. Stiles, Dr Feroze Mahmood, Dr Robina Matyal, and Dr John D. Mitchell are all affiliated with the
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Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
15 Dr Jeffrey Weinstein is affiliated with the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston,
MA. Dr Derek N. Lodico is affiliated with the Navy Trauma Training Center, Los Angeles County and University of California, Los Angeles, CA.
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