Pre-deployment Training Research Articles

Fire at Sea: A 70-year Review of Fire-Related Mass Casualty Events on U.S. Aircraft Carriers.

A major fire at sea is among the most devastating events that can occur while a U.S. Navy combatant vessel is underway. Since World War II, no attack on a large U.S. Navy capital ship has occurred during combat operations. However, increasing global tensions raise the threat of future peer adversary naval combat, and shipboard medical caregivers must be prepared for mass casualty events in the deployed maritime environment. To better prepare modern naval caregivers for this possibility, we reviewed mass casualty events from major fires aboard large U.S. Navy aircraft carriers from 1950 through 2020 to summarize available objective data and identify lessons learned. Underway fires from any cause aboard U.S. Navy aircraft carriers and large amphibious assault ships causing more than 10 casualties (injuries + deaths) were reviewed from 1950 through 2020 using available open access sources including literature review, the Naval Safety Command mishap database, and U.S. Navy Judge Advocate Manual reports. Of 246 fires identified, 27 met inclusion criteria resulting in 1,634 casualties with a combined crew mortality of 23% of those injured. In the 16 events with at least 1 death, 2.0% of the total crew was injured with a combined mortality of 28%. All mishaps occurred while underway during routine training or combat operations; none were caused by an enemy combatant attack. Those events affecting more than 5% of the crew were particularly devastating resulting in a mortality rate of 29% of 1,056 total casualties. Given that main medical spaces may be damaged or destroyed during major fires from any cause, identified lessons learned included the need for (1) distributed medical supplies, (2) flexible medical treatment locations throughout the ship, (3) specific training to prepare non-physician caregivers and non-medical first responders to provide burn and hemorrhagic shock resuscitation, airway management, and prolonged care at or near the point of injury, and (4) the prolonged holding capability of critically ill burned and injured patients if evacuation off the ships is unavailable. Shipboard fires underway pose a significant threat to crew safety with a mortality of nearly a quarter of those injured. These fire mass casualty events immediately overwhelm shipboard medical capabilities requiring a complex response from all hands beginning with non-medical first responders. Notably, all events occurred outside of direct enemy combat, potentially underestimating the impact and number of casualties of a shipboard fire during naval combat. Advances in peer weaponry and the threat of future conflict emphasize the need for pre-deployment burn care training for all shipboard medical caregivers as well as advanced airway and resuscitation training for non-physician caregivers. This review underscores the profound impact of shipboard fires on crew safety, highlighting the critical need for enhanced preparedness and response strategies to prepare for fire-related mishaps during routine operations and naval combat.

Troops Preparation Policy On A World Peace Mission

Indonesia’s involvement in peacekeeping missions has long been a key part of its foreign policy, contributing to world peace as outlined in Republic of Indonesia Law Number 37 of 1999 concerning Foreign Relations. This study aims to analyze the government's policy implementation regarding troop preparation for world peace missions, particularly in relation to Indonesia's role as a Troops Contributing Country (TCC) to the United Nations (UN). The research utilizes a qualitative descriptive approach to understand the intricacies of the troop preparation process through George Edward III's policy implementation model, which emphasizes the importance of disposition, communication, resources, and bureaucracy. Data were collected through document analysis, interviews, and observation of relevant practices in Indonesian military operations. The findings highlight that the personnel selection process for peacekeeping missions is highly structured, requiring compliance with rigorous standards set by both the Indonesian government and the UN. The pre-deployment training, supervised by the TNI (Indonesian National Army) Headquarters, ensures that selected personnel are adequately prepared for their assignments. This comprehensive preparation includes mental and physical readiness, as well as the necessary technical and language skills. The results also emphasize the importance of strong inter-agency coordination, particularly between the Ministry of Defense and the Ministry of Foreign Affairs, to ensure the success of these missions. Furthermore, the study reveals that budgetary and resource constraints remain significant challenges in sustaining peacekeeping operations. In conclusion, Indonesia's contribution to global peacekeeping missions underscores the nation's commitment

Self-care strategies used by disaster responders after the 2023 earthquake in Turkey and Syria: a mixed methods study

BackgroundDisaster responders are exposed to several physical and mental health risks. This study aimed to describe self-care strategies used by disaster responders after the earthquake in Syria and eastern Turkey in February 2023.MethodsA study specific web-based questionnaire survey was used to collect quantitative and qualitative data according to a convergent mixed methods approach. Data from 252 disaster responders responding to the earthquakes in Turkey and Syria were analyzed using both descriptive and analytical statistics and summative content analysis of free-text answers. Data were collected in March to July, 2023.ResultsThe most used self-care strategies included resting, social support from colleagues in the field, extra intake of food or drink, and intake of medicines. The recovery strategies varied due to previous disaster response experience, indicating that supportive self-care strategies can be developed or learned.ConclusionGiven the extreme conditions and limited possibilities of external support, sufficient self-care is an essential competence among disaster responders. Self-care strategies can be both external processed such as intake of medicines, social support from others, and internal processes such as personal reflection. Providing oneself with self-care activities seems to be a skill developed with increasing experience supported by pre-deployment training. Therefore, to enhance resilience, self-care strategies should be encompassed in pre-disaster response training.

Psychological Impact of Covid-19 Pandemic on Health Care Workers of a Field Hospital in UN Peacekeeping Mission

Background: The Covid-19 pandemic has significantly affected the healthcare system worldwide as well as the psychological state of all. The objective of the current study was to assess the psychological conditions of the healthcare workers in Enhanced Level 1+ Hospital, Bouar, Central African Republic (CAR). This assessment can help in the guideline development and implication psychological interventions which in turn can improve the quality of life, working environment and decision-making capabilities of health care workers during widespread pandemic. Methods: This descriptive cross-sectional study was conducted on 40 medical personnel working in Enhanced Level 1+ Hospital, Bouar, Central African Republic. The study was performed from June 2022 to August 2022. Assessment of psychological status of military healthcare providers was done by analyzing the results derived from the Mental health survey, Perceived Stress Scale (PSS-10), Generalized Anxiety Disorder scale (GAD-7) and Patient Health Questionnaire (PHQ-9). Hospital records were analyzed to assess the changes in workload. Results: The working hour increased significantly from Pre Covid to Post Covid period (1920±34.1 hours/week to 2120±67.3 hours/week) although the number of weekly patients in OPD and Emergency decreased slightly from 51.9 to 40.6. Elevated mental stress was observed during outbreak (average PSS-10 score in June 22 was 20.4 which reduced to 9.7 in August). The same pattern was observed in case of GAD-7 score (15.6 to 10.8) and PHQ-9 score (12.4 to 6.1). The percentage of concerns regarding Covid19 was high during the outbreak, 37/40 (92.5%), which decreased after wards to 18/40 (45%). Conclusion: The UN field hospitals are inadequate to support mass outbreak like COVID 19 in the context of both staff and medical supplies. During Covid 19 outbreak, sharp rise of workload and difficulties in restocking of essential medical items played a vital role in the mental state of the medical professionals. The field hospitals in UN peacekeeping missions require intensive effort especially on disaster and epidemic management during pre-deployment training. Moreover, reconsidering distribution of human resources in field hospitals is also required. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 35-42

Improving the Safety of UN Peacekeepers through Data-Driven Training

Abstract Peace operations personnel are often targeted while on mission by armed groups and individual actors seeking to cause harm. This paper outlines recent events driving force-protection concerns, analyzes trends in peacekeeper fatalities, and proposes steps for improving force-protection research and training in the future. Among our recommendations are continued efforts to monitor and evaluate the experiences of peacekeeping personnel, including but not limited to violent incidents on mission that result in fatalities to peacekeepers or civilians. With that, broadening access to anonymized incident data from the field would facilitate both research and training teams and ultimately allow troop contributing countries (tcc s) to better target the specific needs of their deployed units. Our recommendations are built upon a decade of experience providing pre-deployment force protection training to tcc s through the Identifying Threats in Peacekeeping Environments program. The best way to help personnel stay safe on mission is through an understanding of current trends in the field; improving access to incident data would dramatically help stakeholders understand the points of impact for peacekeeper safety so they can ultimately help deployed personnel stay safe.

Training for a mass casualty incident: Conception, development, and implementation of a crew-resource management course for forward surgical teams.

Since 2021, the predeployment training of French FSTs has included a simulation-based curriculum consisting of organizational and human factors. The purpose of this article is to describe the development of a crew-resource management (CRM) training course dedicated for the forward surgical teams (FSTs) of the French Military Health Service. The approach was based on three steps: (1) establishment of a conceptual framework of FSTs deployment; (2) development of an aircrew-like CRM training combining lectures, laboratory exercises, and situational training exercises to consider four fundamental "nontechnical" (cognitive and social) skills for effective and safe combat casualty care: (a) leadership, (b) decision-making, (c) coordination, and (d) situational awareness; (3) Implementation of teamwork evaluation tools. A multidisciplinary team designed a conceptual framework for FST preparedness, 24 French FSTs completed a high-quality training that takes into account both technical and nontechnical skills to maintain quality of combat care during mass-casualty incidents, FSTs' CRM skills were assessed using an audio/video recording of a simulated mass-casualty incident.

Ethical Dilemmas Faced by Military Health Personnel During High-Intensity Conflict: The Crucial Issue of Triage.

Russia's invasion of Ukraine has triggered the biggest conflict in Europe since the Second World War. It has forced countries to prepare for engagement on a massive scale, namely, a high-intensity war between nation states. A potential massive influx of wounded personnel risks saturating logistical supply chains and requires changes to not only medical care but also a paradigm shift. In this context, the principle of distributive justice is key. The aim is to save as many lives as possible through triage, which consists in "doing the greatest good for the greatest number." This idea is fundamental, as an emergency that has passed is no longer an emergency. However, international texts and treaties not only underline that the sole criterion for triage is clinical severity, but they also fail to take into account the patient's status (civilian, friend, and foe). In a high-intensity warfare situation, these texts, and the medical-surgical triage criteria they provide are insufficient, as caregivers may be required to make decisions based on the status of the patient. The need to make such choices could cause psychological suffering among military caregivers, as individuals are recurrently faced with difficult ethical dilemmas. One way to prevent this happening is to provide predeployment training in wartime medical ethics. The latter would include both instruction in international humanitarian law and practical simulations of clinical situations where the person is faced with an ethical dilemma.

Needs assessment of police pre-deployment training for dispatch experts in international development cooperation of policing

PurposeThis study identifies the policing pre-deployment training content for Korean experts based on needs assessments. Korean policing is at an excellent level to transfer knowledge and skills. Pre-deployment training should be designed systematically and training of trainers approaches should be implemented.Design/methodology/approachThis study used T-tests, Borich needs assessments, and Locus for Focus model analyses to determine the priorities of needs for pre-deployment training in policing. A survey of 116 experienced experts was conducted, with 87 responding (75%).FindingsThe study identified 26 factors that deployed law enforcement professionals want to learn from pre-deployment training. These factors were categorized into three areas: research, training design and methods and understanding of partner countries and international development cooperation. The nine highest priorities for training needs were related to understanding the status and conditions of police training in the country to which policing experts are deployed.Research limitations/implicationsThis study was limited to Korean policing experts. And the study did not evaluate the validity of the training curriculum or indicators.Practical implicationsTechnical assistance in international policing development cooperation aims to train future trainers who can train local police. This study found that limited learner information and poor communication skills can lead to ineffective technical assistance.Originality/valueThis study highlights the importance of knowledge transfer and effective pre-deployment training for policing. The findings can be used to improve training programs and police human resource development.

European military surgical teams in combat theater: A survey study on deployment preparation and experience

IntroductionAdequate (predeployment) training of the nowadays highly specialized Western military surgical teams is vital to ensure a broad range of surgical skills to treat combat casualties. This survey study aimed to assess the self-perceived preparedness, training needs, deployment experience, and post-deployment impact of surgical teams deployed with the Danish, Dutch, or Finnish Armed Forces. Study findings may facilitate a customized predeployment training. MethodsA questionnaire was distributed among Danish, Dutch, and Finnish military surgical teams deployed between January 2013 and December 2020 (N = 142). The primary endpoint of self-perceived preparedness ratings, and data on the training needs, deployment experiences, and post-deployment impacts were compared between professions and nations. ResultsThe respondents comprised 35 surgeons, 25 anesthesiologists, and 39 supporting staff members, with a response rate of 69.7 % (99/142). Self-perceived deployment preparedness was rated with a median of 4.0 (IQR 4.0–4.0; scale: 1 [very unprepared]–5 [more than sufficient]). No differences were found among professions and nations. Skills that surgeons rated below average (median <6.0; scale: 1 [low]–10 [high]) included tropical disease management and maxillofacial, neurological, gynecological, ophthalmic, and nerve repair surgery. The deployment caseload was most often reported as <1 case per week (41/99, 41.4 %). The need for professional psychological help was rated at a median of 1.0 (IQR 1.0–1.0; scale: 1 [not at all]–5 [very much]). ConclusionsMilitary surgical teams report overall adequate preparedness for deployment. Challenges remain for establishing broadly skilled teams because of a low deployment caseload and ongoing primary specializations. Additional training and exposure were indicated for several specialism-specific skill areas. The need for specific training should be addressed through customized predeployment programs.

Civilian Protection in Theory and Practice

ABSTRACT This article introduces a Special Issue on the Protection of Civilians (PoC) efforts in United Nations (UN) peacekeeping operations. The UN Security Council adopted Resolution 1265 in February 1999, laying the basis for PoC becoming a fundamental part of UN peacekeeping. On the 25th anniversary of this resolution, it’s time to reflect on the various advances, achievements and challenges facing the UN’s PoC agenda. This introduction to the Special Issue outlines the UN’s three-tiered PoC approach: dialogue and engagement, physical protection, and creating a protective environment. Building on this foundation, the Special Issue explores diverse topics, including pre-deployment training, unarmed peacekeeping, host-state consent, military and police roles in protection, the use of force by troops, civilian protection sites in South Sudan, and the unintended effects of peacekeeping missions. Each article contributes insights across the three PoC tiers bringing together cutting edge insights from leading academics and practitioners in the field.

Participation of the Ministry of Internal Affairs of the Russian Federation in Enhancing African Police Personnel Peacekeeping Capacity

The peacekeeping became actual agenda of international relations due to increased number of internal conflicts with mass human rights violations in different regions of the world including Africa. The problems of ensuring peace and security have become priority for United Nations (UN) and regional organizations involved in constant search of conflict resolution best practices. Peacekeeping actors admitted the key role of law-enforcement agencies, and first of all the police, in ensuring security in conflict or post-conflict reconstruction. Therefore, the UN actively developing the strategy of police methods usage in peacekeeping operations. Because of this process, the number of member states contributing police contingents to the UN including formed police units increased. Joint activity of police officers from different countries with different education, professional experience and specialization requires high-quality training of candidates for peacekeeping operations. The purpose of this article is to analyze the needs of African police officers in professional development and the capabilities of the Ministry of Internal Affairs of the Russian Federation in training of African police officers for the UN peacekeeping operations. The study is based on insights from non-participant observation, interviews and analyses of the UN official documents, policies and training materials. Actual Russian and foreign scientific publications were used. Results confirmed that Russian Federation has many years of experience in African policemen training for the UN peacekeeping operations. The promising areas of Russian Federation participation in the development of the peacekeeping potential of African police, along with the provision of standardized pre-deployment training based on the UN certified programs, can be training in the crime investigation methodology and the training of special police units of the UN member states.

Retention Schemes for Cross-Cultural Missionaries: Enhancing Long-Term Commitment and Effectiveness

This paper aims to provide a comprehensive review and analysis of academic journal publications relevant to retention schemes for cross-cultural missionaries. Retention refers to the ability to sustain missionaries' commitment and engagement in the field. It encompasses strategies aimed at reducing attrition rates and fostering missionaries' long-term effectiveness. Several studies have delved into this topic and provided valuable insights regarding strategies that can positively influence retention. However, this paper seeks to uncover the retention schemes that might serve as a panacea for cross-cultural missionary attrition. The study investigates and identifies effective strategies and interventions that can contribute to the long-term engagement and effectiveness of cross-cultural missionaries in their various places of assignment. By examining a range of scholarly articles, this paper has provided an overview of various retention schemes, including pre-deployment training and cultural orientation; continuous learning and professional development opportunities; personal, spiritual, emotional, and psychological support; adequate financial support and benefits; family care and support; mentorship and supervision; and regular field evaluations and feedback. This paper sheds light on key retention schemes for cross-cultural missionaries and offers evidence-based approaches to address them. Thereafter, it states the importance of the retention of cross-cultural missionaries.

Medics, Mercenaries and Miscreants — A review of Canadian Medical Assistance Teams' EMT Type 1 response to the conflict in Ukraine

Introduction:On February 24, 2022, Russia invaded Ukraine, resulting in Europe’s largest refugee crisis since World War II. More than six million Ukrainians fled the country—half of these to Poland—and one-third of the population was internally displaced.Border points became bottlenecks where fatalities were reported—people risked their lives in long queues and subzero temperatures.Method:This presentation focuses on experiential information obtained during a 17-week deployment of EMT Type 1 both at border points (fixed) and in northwestern Ukraine (mobile). Quantitative and qualitative data were obtained after deployment by online survey with 75 medical, logistical and interpreter volunteers.Results:Initial teams experienced extremely fluid demands and numerous challenges with security, team adherence to COVID-19 protocols, behavioral issues with less experienced volunteers, and collaboration with novel governmental and non-governmental partners to achieve objectives.Conclusion:1. Deployment to a conflict setting requires adherence to the Incident Command System, with daily security briefings and structured handover between teams at the beginning of each deployment.2. Strict adherence to well-defined protocols for the prevention and management of emerging infectious risks such as COVID-19 is necessary, along with contingency plans to isolate infected team members.3. There is a need for standardized pre-deployment vetting, training and orientation of all volunteers—particularly team leaders.4. Identification of international partners should start pre-deployment and remain a continuous process during deployment.

Nurses' Perception of Humanitarian Training Post-deployment on Plans to Redeploy

Introduction:Pre-deployment training for nurses ensures readiness.Method:A quantitative descriptive research methodology was used to conduct an anonymous survey distributed to all registered nurses deployed in 2017 to Hurricane Maria with a hospital-supported team and a federal team. The project sought to improve the pre-deployment preparation experience of nurses to positively impact nurses' willingness to redeploy. The survey was administered for ten days in January 2021.Results:This quantitative descriptive study sought to understand nurses’ perceptions of their readiness for deployment during a disaster response. Thirty-nine surveys were distributed with a 46% response rate (n = 18).Gender was not related to agreement with the role variable (p = 0.070). Marital status was significantly related to role (p = 0.015), as was age (p = 0.022). Single individuals and individuals &gt;50 yo were more likely to agree that they understood their role during the disaster.Gender was not related to agreement with the preparedness variable (p = 0.465), nor was marital status (p = 0.067). Age was significantly related to perceptions of preparedness (p = 0.004). Individuals &gt;50 yo were more likely to respond that they were prepared for their deployment.Gender was not related to perceptions of knowledge of providing clinical care during a disaster (p = 0.235), nor was marital status (p = 0.627) or age (p = 0.674).Conclusion:The results suggest that single nurses &gt; 50 yo with more years of nursing experience who have previously deployed may understand the role better and feel more prepared to deploy.However, their responses do not indicate that they feel more knowledgeable about the type of nursing care they are expected to provide in a disaster response.

Updating the Military Unique Curriculum for a Ready Medical Force.

Previous conflicts have demonstrated the impact of physician readiness on early battlefield mortality rates. To prepare for the lethal nature of today's threat environment and the rapid speed with which conflict develops, our medical force needs to sustain a high level of readiness in order to be ready to "fight tonight." Previous approaches that have relied on on-the-job training, just-in-time predeployment training, or follow-on courses after residency are unlikely to satisfy these readiness requirements. Sustaining the successes in battlefield care achieved in Iraq and Afghanistan requires the introduction of effective combat casualty care earlier and more often in physician training. This needs assessment seeks to better understand the requirements, challenges, and opportunities to include the Military Unique Curriculum (MUC) during graduate medical education. This needs assessment used a multifaceted methodology. First, a literature review was performed to assess how Military Unique Curricula have evolved since their initial conception in 1988. Next, to determine their current state, a needs-based assessment survey was designed for trainees and program directors (PDs), each consisting of 18 questions with a mixture of multiple choice, ranking, Likert scale, and free-text questions. Cognitive interviewing and expert review were employed to refine the survey before distribution. The Housestaff Survey was administered using an online format and deployed to Internal Medicine trainees at the Walter Reed National Military Medical Center (WRNMMC). The Program Director Survey was sent to all Army and Navy Internal Medicine Program Directors. This project was deemed to not meet the definition of research in accordance with 32 Code of Federal Regulation 219.102 and Department of Defense Instruction 3216.02 and was therefore registered with the WRNMMC Quality Management Division. Out of 64 Walter Reed Internal Medicine trainees who received the survey, 32 responses were received. Seven of nine PDs completed their survey. Only 12.5% of trainees felt significantly confident that they would be adequately prepared for a combat deployment upon graduation from residency with the current curriculum. Similarly, only 14.29% of PDs felt that no additional training was needed. A majority of trainees were not satisfied with the amount of training being received on any MUC topic. When incorporating additional training on MUC topics, respondents largely agreed that simulation and small group exercises were the most effective modalities to employ, with greater than 50% of both trainees and PDs rating these as most or second most preferred among seven options. Additionally, there was a consensus that training should be integrated into the existing curriculum/rotations as much as possible. Current Military Unique Curricula do not meet the expected requirements of future battlefields. Several solutions to incorporate more robust military unique training without creating any significant additional time burdens for trainees do exist. Despite the limitation of these results being limited to a single institution, this needs assessment provides a starting point for improvement to help ensure that we limit the impact of any "peacetime effect."

Physical and psychological challenges faced by military, medical and public safety personnel relief workers supporting natural disaster operations: a systematic review

Natural disasters, including floods, earthquakes, and hurricanes, result in devastating consequences at the individual and community levels. To date, much of the research reflecting the consequences of natural disasters focuses heavily on victims, with little attention paid to the personnel responding to such disasters. We conducted a systematic review of the challenges faced by military, medical and public safety personnel supporting natural disaster relief operations. Specifically, we report on the current evidence reflecting challenges faced, as well as positive outcomes experienced by military, medical and public safety personnel following deployment to natural disasters. The review included 382 studies. A large proportion of the studies documented experiences of medical workers, followed by volunteers from humanitarian organizations and military personnel. The most frequently reported challenges across the studies were structural (i.e., interactions with the infrastructure or structural institutions), followed by resource limitations, psychological, physical, and social challenges. Over 60% of the articles reviewed documented positive or transformative outcomes following engagement in relief work (e.g., the provision of additional resources, support, and training), as well as self-growth and fulfillment. The current results emphasize the importance of pre-deployment training to better prepare relief workers to manage expected challenges, as well as post-deployment supportive services to mitigate adverse outcomes and support relief workers’ well-being.

A Deeper Dive Into Combat Medic Training.

The recent article by Knisely etal. provides a comprehensive review and summary of recent literature describing simulation techniques, training strategies, and technologies to teach medics combat casualty care skills. Some of the results reported by Knisely etal. align with the findings of our team's work, and these findings may be helpful to military leadership with their ongoing efforts to maintain medical readiness. Accordingly, we provide some additional contextual understanding to the results of Knisely etal. in this commentary. Our team recently published two papers describing the results of a large survey that examined Army medic pre-deployment training. Combining the findings of Knisely etal. along with some of the contextual information from our work, we provide some recommendations for improving and optimizing the pre-deployment training paradigm for medics.

A narrative review of damage control resuscitation for paediatric trauma patients in Iraq and Afghanistan from 2001 to 2016

Introduction Requirement for blood transfusion in the injured paediatric civilian population is rare. Therefore, a substantial evidence base underpinning damage control resuscitation (DCR) in paediatric patients is lacking. Published outcome data originating from Iraq and Afghanistan offer a unique opportunity to study large cohorts of children who received DCR. It is hoped that by collating the data, this review will inform pre-deployment medical training and support the development of paediatric specific DCR guidelines, which can be used in all trauma environments. Methodology A comprehensive search of the literature was conducted using online databases, grey literature searching and screening of reference lists. Papers discussing blood product, crystalloid or tranexamic acid (TXA) administration in paediatric patients injured in Iraq and Afghanistan from 2001to present were included. Results Eighteen papers were included – all were retrospective studies of data from military trauma databases. Most children that received massive transfusion were male (73.4%), injured in Afghanistan (69.9%) by explosives (60.4%) with a median age of 9 years. A definition of paediatric massive transfusion of 40 ml/kg of all blood products within 24 h was developed. Massive transfusion rates were high (15.7% of children). Whole blood administration occurred in 4% of patients requiring blood transfusions. Low crystalloid volumes in combination with balanced blood product ratios were associated with improved survival, along with the use of whole blood and TXA. Conclusion The review offers insight into the paediatric population likely to require DCR and the optimal DCR strategies to be used in their management.

Leveling the Battlefield: Development of a Pre-Deployment Vascular Access Curriculum for the Nonsurgical Provider.

Timely vascular access is critical, as hemorrhage is the number one cause of death on the battlefield. Anecdotal evidence in the Military Health System identified an operationally relevant procedural skills gap in vascular access, and data exist in civilian literature showing high rates of iatrogenic injuries when lack of robust procedural opportunity exists. Multiple pre-deployment training courses are available for surgical providers, but no comprehensive pre-deployment vascular access training exists for non-surgical providers. This mixed-method review aimed to find relevant, operationally focused, vascular access training publications. A literature review was done to identify both relevant military clinical practice guidelines (CPGs) and full text articles. Reviewers also investigated available pre-deployment trainings for both surgeons and non-surgeons in which course administrators were contacted and details regarding the courses were described. We identified seven full-text articles and four CPGs. Two existing surgical training programs and Army, Navy, and Air Force pre-deployment training standards for non-surgeons were evaluated. A cost-effective and accessible pre-deployment curriculum utilizing reviewed literature in a "learn, do, perfect" structure is suggested, building on pre-existing structures while incorporating remotely accessible didactics, hands-on practice with portable simulation models, and live-feedback training.

Do Urban City Trauma Centers Suffice as Pre-Deployment Training and Post-Deployment Skills Retaining Centers?

Do Urban City Trauma Centers Suffice as Pre-Deployment Training and Post-Deployment Skills Retaining Centers?