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 26 | Combat & Casualty Care | Spring 2016 Virtual Prep Reality Training By Col. (Dr.) Shad Deering, Professor and Chair of OBG and Dr. Joe Lopreiato, Medical Director, Val G. Hemming Simulation Center, Uniformed Services University of the Health Sciences T he Val G. Hemming Simulation Center was established within the School of Medicine at the Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, in 1999. Initially, the center used simulated patients (SPs) to act as patients for medical and nursing students to interview and examine in order to practice and get feedback on their skills in history taking, physical examination and communications skills. SPs assessed student performance and gave feedback to USU medical and nursing students. Over time, other capabilities were added, specifically the use of anatomic manikins and task trainers to allow students to practice procedures such as IV insertion, lumbar puncture and inserting chest tubes in trauma patients. At the same time, the center introduced the use of high complexity human patient simulators that allowed students to respond and get feedback on emergencies such as cardiac arrest, seizures and intubation – procedures that cannot be performed on SPs. These methodologies filled a gap between cognitive knowledge of understanding what to do and being able to actually demonstrate skills in specific high-risk tasks. Mixed Methods Trauma Simulation In 2003, the Center began working to create an immersive virtual environment in which computers create the setting while trainees attend to casualties. The center has continued to develop this ground- breaking technology and in the past few years has moved it from concept to reality. The Wide Area Virtual Environment, or WAVE, is the largest virtual reality theater in health care. In this environment, computer-generated graphics create the surrounding reality while teams of learners work on SPs or mannequins. WAVE, which is the size of a basketball court, uses 24 screens to project 3D images of various environments, many of which involve combat-oriented scenarios. Casualties in the form of humans or manikins are inserted within the real-time training scenario to enable medical students to practice building combat-related skills for actions such as hemorrhage control, airway obstruction, IV insertion, and evacuation of the wounded by ground or by air. In accompaniment with the visual virtual combat environment are physical, audio and smell elements that complete the true combat experience, such as simulated ammunition bursts and associated sounds, burning materials, and even weather- related conditions such as heat and light variation. From virtual field to virtual facility, trainees also gain experience treating patients in role 3 facility settings such combat support, f leet surgical, or Air Force EMEDS hospitals. For each scenario offered, all that needs to be swapped out are the live or manikin casualties. This immersive environment can recreate the chaos of war for teams of four-to-six learners at a time, and allows the training and evaluation of both technical skills and teamwork. The Simcenter also employs the use of a hybrid technology where a human dons a wearable ensemble allowing treatment of certain types of combat-related injuries. Treatment may include placement of a tourniquet, a chest tube, or even a surgical airway. Trainees get the added benefit of working on a live individual while performing the procedures, bringing the training level that much closer to real-time combat casualty situations. The hardest part of simulation is not the technology, but in developing reliable and valid tools that measure the performance of individuals and teams in simulation that translate to the real world. It is not as simple as it appears. Clinical skills and decision making are complex human tasks, and the current assessment tools we have are not very precise. We need better performance measures to get the best value out of simulation. The second challenge is proving simulation creates better outcomes for actual patients outside the simulation lab. Drawing a direct line between simulation practice and clinical practice is challenging and a source of ongoing research to tease out how much of the patient improvement was due to simulation training. BRINGING REAL WORLD TO VIRTUAL CARE

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