Naval casualty management training using human patient simulators

Introduction: Extended-evacuation in austere environments is characterized by the lack of resources to facilitate medical evacuation in the 'Golden Hour' from moment of injury. This may require the primary caregiver, often a relatively inexperienced general physician or EMT, to administer extended medical care in the field.
Objectives: We describe the Shipboard and Underwater Casualty Care and Sedation Simulation (SUCCeSS) program in the Israeli Navy, intended to train caregivers for extended prehospital intensive casualty care using high fidelity life-size simulation mannequins set up onboard corvettes or submarines during manoeuvers, in maximally realistic conditions.
Methods: Twenty two general physicians and EMTs in 12 teams were enrolled in the program in the years 2011-2013. Two hour long training sessions were headed by senior surgeons and anesthesiologists using flexible scripts enabling the mannequin operators to react to caregivers' actions and their consequences. Trainee evaluation was performed by the preceptors using semi-structured forms taking into account critical treatment decisions and the effects of actions taken. Trainees also completed self-report CRM questionnaires before and after the sessions.
Results: Success of the trainees correlated with an evaluation score above 72%. The mean overall CRM score for team leaders post exercise was 74.64%, an improvement of 10% over pre-exercise scores (p<0.0001).
Conclusion: Caregiver self-perceived competence and self-sufficiency in treating casualties at sea was improved via high fidelity simulation in theatre using realistic naval casualty care situations. We discuss the the emergent concept of the extended evacuation environment.

This abstract was presented at the Innovative Solutions in Remote Healthcare - 'Rethinking Remote' conference, 23-24 May 2016, Inverness, Scotland.