Page 31 - JSOM Fall 2022

A Lost Opportunity

The Use of Unorthodox Training Methods for Prehospital Trauma Care

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Jonathan McCarthy, SOCM ; Michael J. Lauria, MD, NRP ;
Andrew D. Fisher, MD, MPAS *
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ABSTRACT
Prehospital trauma care guidelines and instruction have ad­ techniques is a disservice to medic and layperson trauma
vanced significantly over the past 20 years. Although there training. There is a time and place for training that inculcates
have been efforts to create a standardized approach to instruc­ an understanding of and develops resilience toward combat
tion, the use of unorthodox techniques that lack supporting stress. However, this should be done in a measured, deliber­
evidence persists. Many instructors use unrealistic scenarios, ate manner with the appropriate group of learners. By and
“no­win” scenarios, and unavoidable failing situations to large, effort should be expended to teaching high­yield, evi­
train students. Doing so, however, creates student confusion dence­based tactical medicine using evidence­based techniques
and frustration and can result in poor skill acquisition. These and modalities.
training techniques should be reconsidered, with focus placed
instead on the development of technical skills and far skill Pitfalls and training failures may be readily identified in TCCC,
transfer. Knowing when to apply the appropriate type and TECC, and STB training techniques encountered in military
level of stress within a training scenario can maximize student and civilian circles. The effects of environment on learning and
learning and knowledge retention. Furthermore, modalities skills development are ingrained in cognitive psychology and
such as deliberate practice, cognitive load theory (CLT), and neuroscience. It is critical to understand the paradigms regard­
stress exposure training (SET) should be incorporated into ing the incorporation of stress into training. We seek to offer
training. To improve delivery of prehospital trauma education, methods for instructors with novice understanding of these
instructors should adopt evidence­based educational strate­ areas to best optimize the learning environment for long­term
gies, grounded in educational and cognitive science, that are retention of knowledge and skills, as well as to facilitate the
targeted at developing long­term information retention as well application of these skills in novel situations.
as consistent, accurate, and timely life­saving interventions.

Keywords: training techniques; trauma care; education; teach- Discussion
ing; military medicine Too Much, Too Soon: Effects of Environment
on Learning and Skills Development
Teaching critical combat medical skills under simulated com­
bat conditions is often a goal of high­fidelity training in the
Introduction
military. This type of training is reasonable and can be help­
Over the years, prehospital, combat­oriented medicine has ful, but educators and training staff need to exercise caution
embraced evidence­based medicine and pursued scientific en­ regarding trainees’ command of the material, the level of en­
deavors to provide better patient care and improve outcomes. vironmental stress present, training complexity, and the time
However, the degree to which there has been an equivalent course in which stressful stimuli are applied.
reciprocating effort to apply an evidence­based approach to
training and educational modalities remains in question. It is a Drills such as live fire exercises while students practice packing a
particularly salient question given that our communities have wound appear at face value to be “high speed.” However, when
developed standardized, high­quality guidelines for Tactical it comes to developing accurate and timely technical skill execu­
Combat Casualty Care (TCCC), Tactical Emergency Casualty tion, these drills may not help and could be detrimental to stu­
Care (TECC), and Stop the Bleed (STB). dents’ learning. More specifically, whether they will be effective
as learning tools is highly dependent on a learner’s skill level.
Notable concerns exist regarding the training of individuals Objective measures that define experience or specific, objective
utilizing “unorthodox” methodologies as well as adherence criteria that characterize a novice or expert in a given field vary
to such time­honored catchphrases as “train to failure” or significantly. In general, a novice is an individual with little or
“you don’t have to practice to be hard.” Knowingly allowing no knowledge or experience in a particular domain. Conversely,
students to fail, purposefully applying excessive stress to nov­ an expert is an individual with significant or comprehensive
ices, ignoring the cognitive science literature regarding skills knowledge of experience in a particular domain. An important
acquisition, or conflating being “cool” with effective training difference between novices and experts, as it relates to technical
*Correspondence to anfisher@salud.unm.edu
1 Jonathan McCarthy is affiliated with SIMMEC Training Solutions, Oceanside, CA. Dr Michael Lauria is affiliated with the University of New
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Mexico School of Medicine, Albuquerque, NM. Major Andrew D. Fisher is affiliated with the University of New Mexico School of Medicine,
Albuquerque, and with the Texas National Guard, Austin, TX.
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