[ The Real McCoy Online Home ]                                                                                                                      January 9, 2009
Mobilization

Soldiers train on mannequins 
to improve medical skills

By Tom Michele, The Real McCoy Contributor

Emergency Care Simulators (ECS) bite the bullet at Fort McCoy so Soldiers don’t have to.

Photo: Sgt. Maj. Robert Bennett (right) treats a leg wound on a mannequin. Bennett of the 370th Medical Group of Columbia, Ohio, was at McCoy working on a site survey for an upcoming medical exercise. Combat Medic Instructor James Jeleniowski watches Bennett’s training. (Photo by Tom Michele)
Sgt. Maj. Robert Bennett (right) treats a leg wound on a mannequin. Bennett of the 370th Medical Group of Columbia, Ohio, was at McCoy working on a site survey for an upcoming medical exercise. Combat Medic Instructor James Jeleniowski watches Bennett’s training. (Photo by Tom Michele)

The ECS provides an anatomically correct, feature-rich mannequin, which allows for the physical demonstration of various clinical signs including bleeding, breathing, blinking eyes and convulsions. 

ECS can be programmed to live or die, explicitly through the actions of the combat medic trainees trying to keep ECS alive. This, in turn, helps combat medics learn to provide proper care to Soldiers injured on the battlefield. ECS can be programmed to have an arm or leg blown off from an improvised explosive device (IED) from a simulated action on a battlefield. ECS can virtually depict a bullet, blast, fire or any variety of injuries as it lays on the ground on a training range or floor of a classroom structure at Fort McCoy.

Indoors or outdoors, day or night, summer or winter, combat medic students are called to care for the wounded Soldier … or simulated wounded warrior.

Cory Lamoreaux, Medical Simulation Training Center (MSTC) site manager at Fort McCoy, said ECS is the "new kid on the block" at Fort McCoy. "He," and sometimes "she," is helping in big ways to save the lives of U.S. Soldiers on the battlefield.

The new kid bleeds, blinks, cries, screams, has a pulse in the neck, arms, legs and feet, and it breathes, all according to how it is treated by Soldiers racing to save its life.

ECS breathes, as its chest raises and relaxes, very much like a "human." Or ECS doesn’t breathe, due to injuries. The student medic is responsible to instantly initiate life-saving rescue procedures, such as cardiopulmonary resuscitation (CPR), to get ECS breathing again, but more so to treat combat wounds. ECS has a dozen or so electronic sensors attached to the inside of its body and connected to and controlled by a set of computers in a control room 20 feet away from the battlefield site.

The human physiology models at the core of the ECS provide appropriate responses to treatment interventions, including airway and oxygenation management, fluid administration, defibrillation and the administration of drugs.


"This simulation training with these new ECS (Emergency Care Simulators) is most important for Soldiers because the ECS bleed and breathe and react to treatment from the student medic."

Cory Lamoreaux,
Medical Simulation Training Center
Site Manager

Together, these systems deliver a realistic and objective training ground for trainees to practice and perfect patient care without risk to real patients.

The training focuses on the most common causes of preventable death in combat: extremity hemorrhages, collapsed lungs due to a punctured chest (tension pneumothorax) and air entering the chest cavity and blocked airways. Each ECS has different injuries, so the necessary care and treatment varies. The virtual patients live or die based on the care provided by the Soldiers doing the training.

Trainees apply tourniquets to severed limbs and treat blocked airways by inserting a tube in the patient’s nose and down the throat to ensure an open airway. Soldiers learn to recognize signs and symptoms and then to render life-saving care, including treating for shock, applying splints and administering saline and intravenous infusions.

Lamoreaux, said, "This simulation training with these new ECS is most important for Soldiers because the ECS bleed and breathe and react to treatment from the student medic. ECS are the next best thing to working with a real, live person. Simulation training is one of the fastest-growing fields in medical technology."

"The importance of all of this is that it is our job to prepare Soldiers for combat, so they will save lives on the battlefield," Lamoreaux said. "Most casualties that are going to die, die before they get to the first doctor. Ninety percent of life-saving in combat is done by combat medics."

The MSTC concept was developed to focus on the treatment that warfighters provide in the "platinum 10 minutes" immediately after a Soldier is wounded. The Army has worked to improve upon the civilian sector’s concept of the "golden hour" of trauma where the best way to guarantee survivability is to get the most critical care to a patient within the first hour of injury. The Army has recast that concept as the "platinum 10 minutes."

"The scope of practice for an Army combat medic is greater than a civilian emergency medical technician," Lamoreaux said. "A combat medic has more things to do and a greater and higher level of responsibility."

The MSTC mission statement reads, "To train Soldiers to have the fullest ability and confidence to provide the highest standard medical care in all aspects of combat trauma management during any mission in any environmental and physical conditions." Lamoreaux added, "MSTC’s mission is primarily to teach and validate combat medics to be confident that they will reduce preventable combat deaths."

MSTC conducts training for the 68W combat medics and combat life-saving classes for all Army military occupational specialties. MSTC is separate from their brethren at Regional Training Site-Medical (RTS-Medical) that conducts numerous other medical classes.

Photo: Maj. Dennis Klatt uses his stethoscope to listen to the breathing sounds made by a medical mannequin at the Regional Training Site-Medical Clinical Skills Lab at Fort McCoy. (Photo by Tom Michele)
Maj. Dennis Klatt uses his stethoscope to listen to the breathing sounds made by a medical mannequin at the Regional Training Site-Medical Clinical Skills Lab at Fort McCoy. (Photo by Tom Michele)

"The training we provide is so the combat medic will provide critical treatment at the point of injury, that being on the battlefield," Lamoreaux said. "That increases the survivability of the wounded Soldier. This much more modern training is shown in the 90 percent survivability rate of combat-injured Soldiers. That is compared with just fewer than 70 percent in World War II and about 75 percent in Korea and Vietnam."

"Training with a high-fidelity patient simulator in a realistic environment is going to increase confidence and ability when medics go to work under fire," Lamoreaux said. "United States military medicine, from the 68W combat medic, to nurses and surgeons at frontline hospitals, is arguably the best in the world. But replicating confusion of combat, where even the coolest heads can lose their bearings, is difficult."

ECS has been in service with the Army since 2005. The set at McCoy is the first at the Wisconsin installation and was delivered in time for the MSTC opening.

Lamoreaux knows something about what he is teaching. As a master sergeant serving as a medic with the 160th Special Operations Aviation Regiment in Afghanistan, he was aboard a Chinook helicopter transporting U.S. Army Rangers that was shot down by enemy forces March 3, 2002. For his actions under direct enemy fire, he was instrumental in the survival of his comrades and subsequently was awarded the Silver Star Medal.

Lamoreaux’s staff includes Maj. Dennis Klatt, a registered nurse, who serves as a senior supervisor, and a noncommissioned officer-in-charge, three instructors and an administrative assistant. Klatt’s role is split between his MSTC duty and being a clinical coordinator at RTS-Medical.

Advances in the medical equipment Soldiers’ carry with them has contributed to the Soldiers’ ability to help themselves and others. The medical kits now include equipment to ensure continued breathing for those with chest wounds, various bandages and a new tourniquet that can be applied with one hand.

Keeping breathing passages open and stemming blood loss has led to increases in survivability. The Army is sending new medical products to theater operations, such as Combat Gauze and WoundStat as additional methods of reducing blood loss.

The ECS mannequin has a brother mannequin in the medical simulation training arena at Fort McCoy, according to Klatt. That brother is Sim-Man Mannequin and there are a family of them at RTS-Medical. A combat support hospital (CSH or "cash") situation is set up with five individual hospital patient bays in one of the regular barracks buildings in the 1100 block at McCoy.

"Sim-Man is similar to ECS," Klatt said, "It’s just used differently for different missions. These medical simulators have come a long way in recent years." Each Sim-Man "patient" has different injuries and is on a cot with close to all of the medical tools and supplies surrounding each of them, just like at a CSH. Student medical personnel rush in to care for the patients that also have some of the electronic sensors to read how the student is caring for them and reacting accordingly, either continuing to live, or to die.

Sim-Man also has the capability of having intravenous injections administered. The needle is inserted into specifically soft areas on the body. 

Sim-Man also is connected to a computer that includes readouts of vital body signs, such as pulse, oxygen level, and respirations.

Although ECS and Sim-Man are very similar in both their capabilities and realism, the MSTC uses the ECS for pre-hospital and combat scene environments while RTS-Medical uses the Sim-Man for a clinically based hospital environment.

"There are procedures and protocols that have to be followed in treating wounds and medical conditions," Klatt said. "It is very similar to putting together a bicycle or desk. If you skip a step the bike may fall apart or a patient may stop breathing if the medic fails to check an airway."

"In simulation, we can make that mannequin stop breathing so that the medic knows that he missed that step," Klatt continued. "We also have the capability to view the scenario on video, so that a thorough after-action-review can be conducted. It can be very difficult to train these medical procedures when using notional scenarios. The computerized mannequins give us the ability to have the patient react by controlling the breathing, heart rate and blood pressure. It is as realistic as possible to an actual battlefield or combat support hospital situation. "

"We are absolutely committed to saving every Soldier wounded in action; this is what motivates us and guides our training," Klatt said. "If a Soldier on the battlefield knows that there is a well-trained and competent medic only a few meters away, they can feel confident in accomplishing their mission at hand."

(Michele is a public affairs specialist for Eagle Systems and Services Inc., contractor for CONUS Support Base Services.)

 

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