Page 90 - JSOM Summer 2023

Toward A Serious Game to Help
Future Military Doctors Face Mass Casualty Incidents

Henri de Lesquen, MD *; Raphael Paris, MD ; Marguerite Fournier ;
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Jean Cotte, MD ; Anthony Vacher, MD ; Damien Schlienger, MD ;
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Jean Philippe Avaro, MD, PhD ; Bruno de La Villéon, MD 8
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ABSTRACT
Introduction: To prepare military doctors to face mass casualty for training future military doctors. MCI management in a
incidents (MCIs), the French Army Health Service contributed CCP involves the simultaneous individualized assessment of
to the development of TRAUMASIMS, a serious game (SG) for casualties, immediate lifesaving intervention, and triage to
training medical responders to MCIs. Methods: French military organize CCP evacuation. To this purpose, Tactical Combat
doctors participated in a three-phase training study. The ini- Casualty Care (TCCC) and its French version, the FFCCC, in-
tial war trauma training was a combination of didactic lectures clude both primary survey and immediate corrective actions. 1–3
(Phase 1), laboratory exercises (Phase 2), and situational train-
ing exercises (STX) (Phase 3). Phase 1 lectures reviewed French Importance
Forward Combat Casualty Care (FFCCC) practices based on How can military doctors be prepared to face MCIs if train-
the acronym MARCHE (Massive bleeding, Airway, Respi- ing is rarely implemented? Significant constraints, such as
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ration, Circulation, Head, hypothermia, Evacuation) for the distance, a lack of personnel and financial resources, and, re-
detection of care priorities and implementation of life-saving cently, the health regulations imposed during the COVID-19
interventions, triage, and medical evacuation (MEDEVAC) re- pandemic, required the adaptation of traditional training
quests. Phase 2 was a case-control study that consisted of a tra- methods. Thus, a pedagogical tool was necessary that would
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ditional text-based simulation of MCIs (control group) or SG win trainees’ support and provide the necessary triage skills:
training (study group). Phase 3 was clinical: military students implementation of a categorization system, resource manage-
had to simultaneously manage five combat casualties in a pre- ment in austere settings, and prioritization for evacuation.
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hospital setting. MCI management was evaluated using a stan- A panel of experts in prehospital care and trauma surgery as
dard 20-item scale of FFCCC benchmarks, 9-line MEDEVAC well as healthcare networks from the FMHS, the Paris Fire
request, and time to evacuate the casualty collection point Brigade, and the French emergency medical services collabo-
(CCP). Emotional responses of study participants were second- rated to conceive TRAUMASIMS with a French start-up that
arily analyzed. Results: Among the 81 postgraduate military specializes in SG for medical education (Medusims SAS, Paris).
students included, 38 took SG training, and 35 trained with Whereas triage could be defined as allocating treatment to vic-
a text-based simulation in Phase 2. Regarding the error rates tims of disasters or wounded combatants to preserve the great-
made during STX (Phase 3), SG improved FFCCC compliance est number of survivors, this computer-based training focused
(11.9% vs. 23.4%; p < .001). Additionally, triage was more on nontechnical skills for medical MCI management in a pre-
accurate in the SG group (93.4% vs. 88.0%; p = .09). SG train- hospital setting, as follows: (1) categorizing those wounded in
ing mainly benefited priority and routine casualties, allowing action using a three-level method (CAT [category] A = Urgent,
faster clearance of the CCP (p = .001). Stress evaluations did B = Priority, C = Routine); (2) CCP clearing; and (3) prehospi-
not demonstrate any effect of immersive simulation. Conclu- tal trauma care compliance with the FFCCC practices.
sion: A brief SG-based curriculum (2 hours) improved FFCCC
performance and categorization of casualties in MCI STX. Objectives
The TRIAGE study (Training for Rescue with an Interactive
Keywords: traumatology; damage control; triage; mass Applied Game based on Experiences) aimed to evaluate the
casualty; simulation; medical education performance of TRAUMASIMS in MCI management to val-
idate its use for military doctor education. The primary ob-
jective was to assess the effectiveness of this computer-based
training tool for the initial training of French military doctors
Introduction
in the initial assessment and management of MCIs by analyz-
Background ing the error rate in the implementation of the FFCCC pro-
In preparation for high-intensity warfare, the French Military tocols. The secondary objective was assessment of the main
Health Service (FMHS) considered MCIs as a realistic prospect challenges of triage: (1) the identification of CAT A (Urgent)
*Correspondence to henridelesquen@gmail.com
1 Dr Henri de Lesquen is affiliated with the Department of Thoracic and Vascular Surgery, Saint Anne Military Teaching Hospital, Toulon, France.
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2 Dr Raphael Paris is affiliated with the Intensive Care Unit, Laveran Military Teaching Hospital, Marseille, France. Marguerite Fournier is af-
filiated with the Université Claude Bernard Lyon 1, Lyon, France. Dr Jean Cotte is affiliated with the Intensive Care Unit, Saint Anne Military
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Teaching Hospital, Toulon. Dr Anthony Vacher is affiliated with the French Military Institute of Biomedical Research, Brétigny-sur-Orge, France.
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6 Dr Damien Schlienger is affiliated with the 67th Antenne Médicale, 7th Centre Médical des Armées, French Military Health Service, Annecy,
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France. Dr Jean Philippe Avaro is affiliated with the Department of Thoracic and Vascular Surgery, Saint Anne Military Teaching Hospital,
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Toulon. Dr Bruno de La Villéon is affiliated with the Department of General Surgery, Laveran Military Teaching Hospital, Marseille, France
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