Medical Simulations For Training Combatants in Medical Aid

To ensure that each soldier sailor or airman is well trained in administering basic first aid, their basic military training includes ‘medical first aid training’. In addition, few selected soldiers are trained as ‘Battle Field Nursing Assistants’ (BFNAs). The special skill sets of BFNAs include administering critical first aid to control blood loss, administering of morphine injections to injured, carrying out Cardiopulmonary resuscitation (CPR), application of splints to immobilise broken limbs, to clear the respiratory passage for smooth breathing, handling of ‘seizures’, preparing the casualty for transportation to next level of medical aid etc. As can be seen, these are critical skills when correctly applied contribute in saving precious lives. In medical emergencies, the lifesaving ‘golden hour’ (also known as golden time) is well recognized, which refers to a time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death.

Though ideally, the Indian army would desire to train all its combatants in the skills required by these BFNAs, but due to lack of time and resources, it has not been practical to implement it. The special training for BFNAs is carried out by field formations, as part of their Annual training curriculum. But, their training hours are also constraint by the availability of instructors, training aids and allied resources. Further, diversion of such resources for BFNA training is always at the cost of their core purpose of employment. To that extent, medical simulations provide unique opportunity to impart significant improvement in the training of BFNAs who shall, more often than not, be the first responders to a crisis situation.

Medical simulation itself is a branch of simulation technology. It can involve simulated human patients, educational documents with detailed simulated animations, casualty assessment in military situations, and emergency response. Its main purpose is to train medical professionals to reduce accidents during medical assistance, prescription, general practice and surgery. The advanced simulators enhance the simulation training because they make it much easier to reflect real life situations. In certain countries, disaster response is made easier and conducted by better trained individuals due to the rapid availability of simulators in schools, hospitals, military facilities, and research labs.

Globally, armies are looking at cyber anatomy wherein a virtual human body is being brought into for medical training. From massive leg injuries to artificial bullet holes, war-wound simulations have become "makeup science" and such realistic simulations are being prepared and used for training of combatants. The use of silicon-based ‘simulated wounds’ in training for combat first aid is the latest in this field. The potential BFNAs can be trained to connect the lifelike human limbs and body wounds to devices that simulate blood flow, and then attach them to mannequins for realistic battlefield exercises. Such simulations are realistic and command the full attention of the soldiers being trained. Much of this training is scenario based and while preparing the simulations, once a specific battle field scenario is set up, the trainees are sent in to treat the "wounded." Most of these scenarios emphasise the need to diagnose and stabilise a casualty within the first 10 minutes after an injury. These simulations are so programmed that if the mannequin doesn't receive proper treatment in given time, it replicates the symptoms of a real casualty, and its vital conditions rapidly deteriorate. The training on these realistic, blood-pulsing "props" is said to have helped later in reducing the shock experienced by combatants or BFNAs in the field and thus has improved their decision-making and treatment skills during the stress of actual combat.

In fact, in the US Army, PEO STRI is one of the prime movers in assisting in the development of medical simulation technologies. It has already fielded a total of 18 medical simulation training centres, with a number of additional centres to come in the coming years. They provide 40 hours training for the combat life saver, which is given to almost all soldiers. The idea first came in 2005 and already, they claim to have documented evidence that medical simulation has saved an estimated 1,000 lives.

The British Battlefield Advanced Trauma Life Support (BATLS) course had been an essential part of the pre-mission training for almost a decade, when full-fledged simulations were integrated with the course in 2006. Earlier they made use of the more basic manikins, but the instructors were experiencing that the advanced simulators help in enhancing the training as these simulators make it much easier to portray real life situations and to perform team training. When using the simulator lab, it is quite easy to create complex scenarios by combining medical challenges with issues concerning command and control, safety and communications. The new wireless simulators make it easier to extend the use of the simulators and perform in situ training outdoors and inside vehicles. The alerted team is given the context of an immediate incident and then introduced to the simulator that will be acting as their patient during the upcoming scenario. The instructor is located in the control room, adjacent to the simulation lab. From here, the instructor is able to dynamically control the simulator's vital and physical signs and tailor the level of difficulty according to how the scenario plays out in the next room. A microphone placed inside the manikin allows the instructor to give the patient simulator a voice, and the one-way mirror to observe the ongoing action. The simulation scenarios are all videotaped and applied during subsequent structured debriefings where discussions on areas of improvement are discussed in a nonjudgmental fashion.

In the same way, in Finland, the Centre for Military Medicine, established in 2006, provides medical training for military personnel with particular emphasis on management of typical military first response emergencies on the battlefield and multifarious disasters. Here too, a simulation studio with a control room enables the training team to recreate various types of emergency situations. By adjusting the lighting, applying smoke and the sound of explosions, soldiers experience an augmented realistic feel of the staged battles, where a patient’s injury may vary from a gunshot wound to a fragment injury. The training sessions are recorded by wireless microphones and cameras and stored on a DVD. The content can be analyzed during personalized debriefings which can take place right after each scenario. Thus, efficient use of resources, enhanced communication skills and activities under pressure in a disciplined, productive manner can be taught to the trainees.

Equally, in our army, a simulation hub can be created in each military station, where such simulations can be installed with permanently placed pool of control instructional staff and thus the medical training of each combatant on simulations can be institutionalized. Injuries like gunshot, fragment, blast, mine, fire, pressure, or victim of a chemical / biological weapons etc can be simulated as part of various combat scenarios. Topics of the pre-planned scenarios can be revealed to the trainee before start, but the development of scenario can be controlled by the instructor in the control room. It may call for initial investment of funds but same will prove cost effective in the long run as it will go a long way in imparting realistic training in medical aid to all combatants. Since training on these simulations can be conducted repeatedly, almost all combatants can benefit. Also, suitable upgradation cadres for selected personnel can be planned. Moreover, by creating such simulation hubs, the trained medical professionals can be released from their erstwhile training duties and thus medical personnel can be optimally utilised in their core responsibility.

The author is a Senior Fellow at CLAWS.

Views expressed are personal