Craig Goolsby

The giving back: Battlefield lesson to national preparedness.

I t has been said the only beneficiary of war is medicine, an idiom whose truth depends on the translation of experiences from the management of casualties to a broader civil society. History is replete with examples of lessons from warVin the form of knowledge regarding the commonality of injury and the strategies and devices used to treat itVbeing translated to civilian medicine. On October 6, 2015, the White House National Security Council staff and its Office of Medical Preparedness Policy launched a national campaign called Stop the Bleed (https://www.whitehouse.gov/blog/2015/10/06/stop-bleed) (Fig. 1). This program,which is intended to teach citizens how to save lives from major trauma the same way bystander cardiopulmonary resuscitation saves lives from cardiac arrest, directly translates lessons learned on the battlefields of Iraq and Afghanistan to benefit theAmerican public. The initiative’s aims are to ensure that the general public will know the Stop the Bleed phrase and logo and have access to effective personal and public bleeding control kits that will provide just-in-time training. The Stop the Bleed initiative is the result of 2 years of a federal interagency collaboration to save lives and build resilience by empowering the public to stop life-threatening hemorrhage following unintentional injuries, crashes, acts of violence, or natural disasters. In response to the President’s 2011 National Preparedness Policy, this campaign is similar in many respects to the movement that revolutionized care for those with out-of-hospital cardiac arrest. However, unlike other public education campaigns, Stop the Bleed was born from the study and management of a once-in-a-generation burden of wartime injury. At its foundation and in its implementation, the Stop the Bleed campaign has four principles to consider.

Hybrid Simulation Improves Medical Student Procedural Confidence During EM Clerkship

BACKGROUND Medical students have limited opportunities to perform and learn procedures on live patients. This is particularly concerning at the Uniformed Services University of the Health Sciences (USUHS), where graduates may be assigned to an operational military unit immediately following completion of internship. The authors implemented a new hybrid simulation lab for fourth-year medical students at the Uniformed Services University of the Health Sciences consisting of procedural skills training for seven core emergency medicine skills combined with complex patient cases using high fidelity simulators and standardized patients. OBJECTIVES Measure changes in student procedural skills confidence due to the new hybrid simulation curriculum. METHODS This observational study used anonymous 5-point Likert-anchored questionnaires to measure student confidence at three different times: immediately before hybrid simulation training, immediately after training, and 3 weeks post-training. RESULTS Pretraining student confidence was 3.0 (out of 5) when averaged for all seven procedures. This improved to 4.2 immediately after training, and remained high (4.1) 3 weeks later at the end of the clerkship. Students retained this improved confidence despite performing few procedures on real patients during their clerkships. The training demonstrated statistically significant confidence improvement for all procedures, except bag-valve mask ventilation. CONCLUSIONS Hybrid simulation training improves student confidence with procedural skills during an emergency medicine clerkship.

Hybrid Simulation During Military Medical Student Field Training—A Novel Curriculum

OBJECTIVES Implement a new hybrid simulation curriculum into the Uniformed Services University of the Health Sciences Bushmaster Field Training Exercise for fourth-year medical students. The principal goal was to determine if high-fidelity hybrid simulation could be successfully implemented in a field environment. The secondary goals were to enhance the medical realism of training, allow students to practice crucial combat emergency medical skills and management in stressful field conditions, and develop medical team leadership. METHODS Low-, mid- and high-fidelity simulators were used in combination with standardized patients in a variety of field clinical settings. Students were given multiple opportunities to interact with the hybrid simulations. Student feedback about the simulation training was sought as part of their normal after-course critiques. RESULTS High-fidelity simulation can be successfully implemented in combat-simulated field conditions, and QA feedback indicated very positive perceptions from students. CONCLUSIONS Multiple modality hybrid simulation can be successfully implemented into large-scale military medical field exercises, and appears beneficial for multiple educational goals.

Stop the Bleed Education Consortium: Education program content and delivery recommendations

Following the 2015 White House launch of the Stop the Bleed (STB) campaign various educational programs have emerged to teach hemorrhage control principles to the public. The STB campaign seeks to translate battlefield medicine successes to the civilian sector by empowering the general public to sto

New Wide Area Virtual Environment (WAVE) medical education.

OBJECTIVE Accomplish the first large-scale combat casualty training using multiple-modality hybrid simulation in the Uniformed Services Universitys one-of-a-kind three-dimensional Wide Area Virtual Environment (WAVE). METHODS 91 first-year medical students (MS1) completed a WAVE training session as part of their Combat Medical Skills course. In teams of 6 students, they treated two combat casualties with blast wounds (one a SimMan 3G, and another a standardized patient) during15-minute scenarios in the WAVE. The WAVE is a unique medical simulation environment comprising an 8,000-square-foot virtual space composed of two pods surrounded by circumferential 9 × 12-foot movie screens and a high-fidelity directional sound system. Students completed WAVE quality assurance surveys to describe their impressions. RESULTS 91 MS1s were trained in a 4.5-hour period (including pre- and post-briefs) without technical difficulties during this inaugural training experience. Student survey data indicated a strong desire for more WAVE training in the curriculum (2.9 on a 3-point Leikert scale), and a strong preference for training in the WAVE vs. traditional training methods (4.6 on a 5-point Leikert scale). CONCLUSIONS The novel WAVE platform can be implemented successfully for combat casualty training and represents a significant technological advancement in simulated military medical training.

Brief, Web-based Education Improves Lay Rescuer Application of a Tourniquet to Control Life-threatening Bleeding

The objective was to determine whether brief, Web‐based instruction several weeks prior to tourniquet application improves layperson success compared to utilizing just‐in‐time (JiT) instructions alone.

Innovations for Tomorrow: Summary of the 2016 Disaster Health Education Symposium

In an effort to enhance education, training, and learning in the disaster health community, the National Center for Disaster Medicine and Public Health (NCDMPH) gathered experts from around the nation in Bethesda, Maryland, on September 8, 2016, for the 2016 Disaster Health Education Symposium: Innovations for Tomorrow. This article summarizes key themes presented during the disaster health symposium including innovations in the following areas: training and education that saves lives, practice, teaching, sharing knowledge, and our communities. This summary article provides thematic content for those unable to attend. Please visit http://ncdmph.usuhs.edu/ for more information. (Disaster Med Public Health Preparedness. 2017;11:160-162).

A Retrospective Review of Screening Labs for Medical Clearance in a Military Population

STUDY OBJECTIVE We determine the incidence of clinically significant findings within mandatory screening studies during medical clearance of patients for psychiatric care. METHODS This is a retrospective review of emergency department patients medically cleared for psychiatric care over 11 months. All patients evaluated for behavioral health-related issues are recorded on a daily report which was used to locate subjects. Laboratory studies were reviewed during that visit for the presence of abnormalities. If abnormalities were noted, the individual chart was reviewed. Our primary outcome was the incidence of clinically significant findings that warranted admission to a medical or surgical unit. RESULTS 204 psychiatric patient reports were reviewed. 191 of these patients had screening studies performed. Seven patients were admitted to a nonpsychiatric unit. These admissions were all for elevated ethanol levels. These patients were admitted until their ethanol level decreased, and then transferred to a psychiatric facility. The total screening lab cost during this study period was

Can they stop the bleed? Evaluation of tourniquet application by individuals with varying levels of prior self-reported training

27,893. CONCLUSIONS Routine screening has limited utility in this population and comes at significant cost. Further research should be directed to determine which patients may benefit from screening studies.

Improvised vs commercial tourniquets

BACKGROUND Application of extremity tourniquets is a central tenet of multiple national initiatives to empower laypersons to provide hemorrhage control (HC). However, the efficacy of the general population who self-report prior first-aid (FA) or HC training on individuals ability to control bleeding with a tourniquet remains unknown. Therefore, the objective of this study was to assess the effectiveness of laypeople with self-reported prior FA or HC training to control bleeding with a tourniquet. STUDY DESIGN Employees of a stadium were assessed via simulation in their ability to apply a Combat Application Tourniquet. As a subgroup analysis of a larger study, participants who self-reported: 1) No prior training, 2) FA training only or 2) FA + HC training were compared. Logistic regression adjusting for age, gender, education, willingness-to-assist, and comfort level in HC was performed. RESULTS 317 participants were included. Compared to participants with no prior training (14.4%,n = 16/111), those with FA training only (25.2%,n = 35/139) had a 2.12-higher odds (95%CI:1.07-4.18) of correct tourniquet application while those with FA + HC (35.8%,n = 24/67) had a 3.50-higher odds (95%CI:1.59-7.72) of correct application. Participants with prior FA + HC were more willing-to-assist and comfortable performing HC than those without prior training (p < 0.05). However, reporting being very willing-to-assist [OR0.83,95%CI:0.43-1.60] or very comfortable [OR1.11,95%CI:0.55-2.25] was not associated with correct tourniquet application. CONCLUSION Self-reported prior FA + HC training, while associated with increased likelihood to correctly apply a tourniquet, results in only 1/3 of individuals correctly performing the skill. As work continues in empowering and training laypeople to act as immediate responders, these findings highlight the importance of effective layperson education techniques.