Combat & Casualty Care

Q1 2016

Military Magazines in the United States and Canada, Covering Combat and Casualty Care, first responders, rescue and medical products programs and news\Tactical Defense Media

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tacticaldefensemedia.com 16 | Combat & Casualty Care | Spring 2016 High Fidelity Simulation Tech Military feld surgeons are preparing for combat surgery through the use of "Hands-in-the-Body" high fdelity simulation technology. By D. Michael Navin, CEO and Robert F. Buckman III, VP, Operative Experience Inc. A ll deployed military physicians, regardless of specialty, are expected to provide combat casualty care. Many of these physicians, even some trained general surgeons, have received little training in trauma surgery during their medical education and residency. What would be most beneficial would be a training system that could rapidly bring general and subspecialist surgeons already lacking solid trauma experience to the point of competency in the performance of open, major, surgery. TATRC The Medical Modeling & Simulation (MM&S) team at the Telemedicine and Advanced Technology Research Center (TATRC), U.S. Army Medical Research and Materiel Command (USAMRMC), recognized this need. Seeking to improve trauma training effectiveness, the MM&S team proposed a number of forward-looking research topics, one of which was entitled "Rapid Trauma Skills Training", to the Small Business Innovative Research (SBIR) program. The SBIR topic was approved, the government solicited research proposals; many were submitted. Operative Experience Inc (OEI) was one of the two companies selected. TATRC provided government oversight during Phases 1 and 2. Based on successful performance, a second Phase 2 award was made. Management oversight has been transferred to the Congressionally Directed Medical Research Program (CDMRP), in response to a reorganization directed by the USAMRMC. OEI stated they have undertaken a long-term project to develop training systems that can meet these needs. OEI has produced unique, high-fidelity physical models of a variety of combat injuries as well as multimedia training modules to rapidly teach more than 20 critical trauma procedures and skills. The training systems developed by the company have been suitable for the education of trauma providers at various roles of care. These include a suite of five combat casualty simulators with wounds consistent with an IED detonation, high velocity gunshot wounds, trans-facial gunshot wounds, traumatic amputations, burns, blasts, and fractures. The point-of-injury simulators are currently used by the USMC at Camp Pendleton as well as the U.S. Department of State. Surgical training simulators include a craniotomy simulator for training in the relief of a subdural hematoma, a two-incision four-compartment fasciotomy of the lower extremity, above and below knee amputations, and proximal control, extensile exposure, and shunting of the femoral artery. The company's approach has been to create physical models of relevant surgical anatomy, including the derangements caused by combat-relevant wounds. The models are made of materials that can be subjected to all the maneuvers of major surgical operations using standard instruments such as those in deployed instrument sets. Within these models, artificial organs, muscles, skin, bones, fascia, blood vessels and other tissues are accurately represented. The all-important dissection planes, which allow the safe surgical approach to deep structures, are incorporated. OEI stated the resulting physical simulators are the first in the world that permit the demonstration and practice of major, "hands-in-the-body" surgical operations for combat wounds without the need for live tissue or cadavers. The artificial tissues of the simulators can be cut, retracted, dissected, stapled and sutured using standard surgical instruments, but unlike real tissues, the artificial tissues are stable and are not subject to dehydration or decay. Each simulator serves as the basis for a curriculum-based multimedia educational module consisting of a systematic demonstration of surgical anatomy as well as trauma operative management tactics and techniques. "The idea of using real surgical instruments, both to learn and rehearse surgical procedure(s) on a manikin with synthetic tissues is intriguing, but it is extremely important to validate how well this approach actually improves training effectiveness," said Harvey Magee, Lab Manager, TATRC's Medical Modeling & Simulation Innovation Center. Medical Procedure Training OEI's most recent project enables the teaching of emergency resuscitative thoracotomy and other combat-relevant thoracic surgery techniques. These low-frequency, high-stakes procedures represent extreme resources of the surgeon facing a casualty with imminent or actual cardiac arrest due to blood loss. The simulator enables VIRTUAL INCISION, REAL-WORLD PRECISION OEI simulator demonstrating surgical exploration of the thigh for a gunshot wound transacting the superfcial femoral artery and vein. (Operative Experience, Inc.)

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