Page 91 - JSOM Summer 2023

wounded participants; (2) the time to evacuate the CCP; and TABLE 1 Standard 20-Item Scale Using French Forward Combat
(3) the emotional response of the study participants. Casualty Care Clinical Benchmarks
Secondary Actions/
Concern Critical Actions Pretransfer Assessment
Methods
Massive Tourniquet* Reassess
Study Design and Setting Bleeding Hemostatic Administer tranexamic
The traditional training to prepare military postgraduate stu- acid
dents for MCIs was a combination of didactic lectures (Phase Pelvic stabilization —
1), laboratory exercises (Phase 2), and STX (Phase 3). Phase Airway Subluxation Appropriate recovery
1 lectures included reviews of FFCCC practices based on the position
acronym MARCHE for the detection of care priorities and Cricothyroidotomy* —
implementation of lifesaving interventions, rapid triage tech- Respiration Needle exsufflation* Chest tube insertion
niques (simple triage and rapid treatment [START]), and 9-line Oxygenation —
MEDEVAC requests (2 hours). Phase 2 was dedicated to MCI Circulation IV vascular filling —
management practice with two scenarios. In this case-control
study, the study group experienced SG training, whereas the Titrated adrenaline —
control group was trained with text-based simulations. Phase Head/ Neurological evaluation Pain assessment &
3 was clinical: throughout a 3-day, full-scale exercise, military Hypothermia administer analgesic
students were assessed during MCI STX in the French Army Prevention of Immobilization/traction
Trauma Training Center (Centre de Formation Opérationnelle hypothermia
Santé [CEFOS], Camp La Valbonne). Trainees, who act as Evacuation Patient handoff report Administer antibiotics
prehospital physicians and are assisted by two medics, must 9-line Message request —
be able to care for five casualties arriving simultaneously in a for MEDEVAC
CCP. They had to sort the victims, ensure that the first acts of *Lifesaving intervention
damage control were undertaken, and order evacuations. Vic- IV, Intravenous; MEDEVAC, medical evacuation
tims were played by briefed and disguised soldiers (Figure 1).
Scenario variations during STX were obtained by randomly briefed on the background (e.g., weapon attack, bombing),
choosing each of the five cases from a box of 14 standard cases and was continuously informed of casualty arrival and
(Supplementary material, Table 1). evacuation possibility.
2) Tactical-sensory-motoric immersion: the player had to
Population evaluate each case, extracted from military and civilian
The inclusion criteria for participants in this prospective study French databases (FHMS Registry, Traumabase), to decide
were defined as postgraduate students of the FMHS Academy upon corrective actions. Walking from casualty to casualty,
(Ecole du Val de Grace), Paris, France, aged >18 years, in an the trainee perceived some visual-based cues and selected
initial combat care training program and prepared to partici- lifesaving interventions and corrective actions. Procedures
pate in the entire three-phase triage course. Students who did were simulated respecting the recommendations. Physiolog-
not meet the inclusion criteria were excluded. Each participant ical status was noted to the trainee during an examination
consented to this study. of each virtually wounded patient (e.g., bleeding, radial/
femoral pulse, respiratory rate, consciousness) and pro-
Intervention gressed by considering blood loss in accordance with the
The study group experienced TRAUMASIMS in Phase 2. Advanced Trauma Life Support classification of hypovole-
All components were incorporated into the design of this mic shock. Appropriate actions improved the virtual-case
first- person game to provide an immersive virtual reality physiological status.
experience: 10–12 3) Strategic-cognitive immersion: the trainee had to catego-
rize, organize, and order evacuation of the CCP.
1) Narrative-emotional immersion: the trainee was assigned 4) Spatial immersion: designed for the player to experience
the role of a prehospital physician facing an MCI, was a perceptually convincing simulated world. The CCP took

FIGURE 1 Experimental design of the TRIAGE study.

CONTROL GROUP (2h)
• Text-based simulation
• 4 cases

Performance
LARGE SCALE
LECTURE (2h) Stress Stress SIMULATION (2h) assessment
Theoretical mesure mesure • Real-life simulation • Triage
knowledge Time 1 Time 2 • 5-wounded Mascal • Evacuation
• Stress mesure

SG GROUP (2h)
• TraumaSims
• 2 scenarii

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