Highly realistic cadaveric trauma simulation of the multiply injured battlefield casualty: an international, multidisciplinary exercise in far-forward surgical management.

Abstract

We designed an ultra-high-fidelity military cadaveric surgical simulation course to train military medical teams for specific battlefield injuries. Our aim was to deliver a highly realistic, immersive simulation training experience, teaching both technical and non-technical skills necessary for the management of war-injuries in the austere environment of a far forward surgical facility. We designed an educational cohort study around the course to measure its learning impact. 25 personnel participated in 15 non-continuous hours of simulation that included 12 patient scenarios. Participants were given previously piloted questionnaires pre- and post-simulation to assess their confidence with managing battlefield injuries by body area, their views on the realism of the simulation, and their perceptions of training benefit. All questions were assessed using a Likert scale of 1-10 (10=best). The response rate for complete questionnaires was 95%. Baseline confidence scores were; abdomen (5.5), pelvis (5.7), chest (6.2), airway (6.3), extremity (7.3). Confidence gains following training were; abdomen (+1.7), pelvis (+ 1.6), chest (+1.6), airway (+1.2), extremity (+0.8). The most realistic aspects of the simulation were; injury replication (9.1), the cadaver as a multiply injured casualty (9.1) and the multidisciplinary team (9.2). The mean ratings for technical and non-technical skill acquisition were 9.1 and 9.0 respectively. Cadaveric simulation was reported to be ideal for learning military medical skills (9.3), and participants strongly recommended that provision should be increased (9.7). We have demonstrated an ability to recreate highly realistic injuries in an ultra-high-fidelity simulation of a multiply injured military casualty. There was a measurable increase in confidence for both technical skills in all major body areas, and non-technical skills. Multinational and multidisciplinary working strongly enhanced learning.