Combat & Casualty Care

Q2 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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Page 17 of 39 16 | Combat & Casualty Care | Summer 2016 Virtual Training Clinical Evaluation U.S. Navy Trauma Training Center (NTTC), a branch of Navy Medicine (NAVMED), exemplifes modern military medical training. By Jeffrey Ricks, Commander, NTTC T he mission of Navy Trauma Training Center (NTTC) is to provide advanced trauma training for application across the range of military operations. Military medicine must be capable of providing exceptional care whether injuries occur during combat, humanitarian assistance, peacekeeping, or training missions. Casualties can present to a tent in the desert, on board a ship at sea, or evacuated by air to a military treatment facility. Partnered with Los Angeles County + University of Southern California Medical Center (LAC+USC), NTTC uses lectures, simulation and exposure to high-acuity civilian trauma while guiding military personnel to adapt trauma care principles for limited resource environments. The concept for what is now NTTC began 20 years ago because of the need to develop and maintain trauma skills in military medical personnel during peacetime. Clinical experiences were limited as few military hospitals saw a large volume of trauma patients. In addition, standardized courses like Advanced Trauma Life Support were effective at introducing trauma management concepts, but they were not comprehensive or necessarily as applicable to complex combat injury patterns seen in prior armed conf licts. In response to this need, the U.S. Navy joined forces with LAC+USC. Navy physicians, nurses and enlisted corpsmen were assigned to NTTC to provide classroom instruction on trauma care principles for application in limited resource environments; LAC+USC provided support and valuable clinical experiences. Simulation Benefits Much has changed since the inception of NTTC. Primarily, the nation has not seen an extended period of peace. With repeated deployments of medical personnel to combat zones, critical trauma skills development and maintenance has become even more important. The learning curve associated with trauma care should be climbed prior to deploying to theaters of operation. It's too late to wait until you're on the battlefield to learn the basics. The ability to train personnel has improved with advances in simulation technology as well. High fidelity mannequins are more easily programmed, can better simulate exam findings, and provide feedback. Task trainers can help with procedural skills without putting a live patient at risk of injury. Simulation provides an opportunity to present students with standardized patients and improve consistency in learning objectives between classes. Because of these advances, NTTC has expanded the simulation program. Learning objectives drive the development of simulation scenarios, and time is compressed to maximize the number of simulation experiences. With a total of 50 simulation scenarios throughout the three-week course, NTTC uses high-fidelity mannequins and task trainers to reinforce trauma concepts presented in lectures and experienced in the clinical spaces. Simulation evolutions are paired with lecture topics, and each progressively builds in complexity with particular focus on the learning objectives from the preceding classroom lesson. Expected physiologic changes to the injuries and responses to interventions are programmed to progress four times faster than in real time. On the first day, following the lecture on initial patient evaluation, each student must perform a primary and secondary survey in five minutes, with minimal equipment, space and additional personnel. The final simulation requires a team approach to successfully care for casualties reinforcing the key objectives and clinical experiences. Required Learning The focus of simulation is practicing the management of patients with fewer resources than encountered in a trauma center. Less emphasis is placed on specific environmental factors that may inf luence care. For example, it is more important for the students to learn the signs of a tension pneumothorax and when to appropriately intervene rather than what to do if kneeling in the dirt versus standing on a casualty receive ship. Critical thinking and decision making are as important as teamwork and Medical Simulation FOR TRAUMA CARE NTTC rotators participate in the Final Simulation of the course. The fnal simulation incorporates all aspects of didactics, simulations and clinical experiences the rotators learned during their three weeks of training. (LCDR Tony Torres, NTTC)

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