MEDICAL SIMULATION FOR TRAINING.

Source: The Combat Casualty Care Research Program website, www.usacc.org.

Rationale for Investment
Blast injuries from roadside and car bombs, rocket-propelled grenades and mortars account for more than half the U.S. combat deaths in Iraq and Afghanistan. Many Soldiers are not prepared to treat such injuries and are thus less effective in the use of their medical skills. Currently, patients in the field are represented by actors or expensive, fragile patient simulators that cannot be moved. The actors are easy to move but lack the realism and fidelity needed for training. The patient simulators are great training tools but are not realistic. Simulations today do not look, feel, smell, act or react in clinically accurate ways, and are large, costly and fragile. For maximum effectiveness, Medics must train in realistic environments, on realistic patients that can be moved out of the line of fire, extracted from difficult terrain (i.e. destroyed buildings, vehicles, aircraft) while the patient condition deteriorates. Medics returning from combat have conveyed how the current simulations did not prepare them for the horrific injuries they treated. Realistic simulated trauma will allow warfighters to master their skills and their equipment before entering the battlefield.

Overarching Objective:
The focus of this Program Area is to improve the quality and the availability of medical simulation training for field medical personnel by developing cost-effective physiologically based patient simulators that are deployable, wireless, autonomous, rugged enough to survive in the field, and realistically weighted. These simulations will train associated tactics, techniques and procedures that will enable the Army to field and maintain better trained Medics and Combat Life Savers (CLS), with a resultant decrease in the died by wounds rate, while reducing training costs. This importance and impact of this work is recognized in that it is being done under two of the less than 85 Army Technology Objectives.

Development Strategy:
This joint effort between Research, Development, and Engineering Command and the Medical Research and Materiel Command will evaluate battlefield injuries and conditions against current training methods; research effects of severe trauma injuries onpatients and care givers; design a methodology to support combat medic training with realistic battlefield injuries, including compartmentalized trauma, continuous physiology, transfer of care, and time integrated milestones of care. Use the information gained to complete prototype patient trauma simulations with advances in material sciences, including realistic skin, flesh, blood, bone, fluids and organs, sensor technologies, and advances in simulated fluid loss technologies. The results from this research will train and test Medics on key medical skills in realistic environments with minimal support. The technology will remove the negative training induced by tethering the simulators to a fixed position.
Additionally, various innovative training simulation systems have been developed to enhance Soldier Medic training. The insertion of a chest trauma tube is a critical life-saving measure for the Medic.

Future Direction:
Over the next 2-3 years, complete the prototype simulations so that they will function as stand alone training systems, and as external accessories for patient simulators and actors. The prototypes will then be placed in the current program of instruction to assess training effectiveness at the AMEDD Center and School, the Rascon School of Combat Medicine (Ft Campbell), and the U.S. Army School of Air Medicine (USASAM, Ft Rucker). If time permits, the Joint Trauma Training Center (JMTC, Ft Lewis) and the Joint Readiness Training Center (JRTC, Ft Polk) will evaluate the applicability of the prototypes in their training programs. Based on feedback from the evaluations, a simulation control capability that will enable mass casualty exercises to be managed from a central station will be implemented. The final component will be a distributed computer based refresher and sustainment training system for military Medics and CLS.

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