Simulated reality prepares first responders

  • Published
  • By Air Force Staff Sgt. Robert Barnett
  • 673d Air Base Wing Public Affairs
JOINT BASE ELMENDORF-RICHARDSON, Alaska --  "Move it!" the on-scene commander yelled. "This is bad; it's real bad!"

The medical response team rushed in while the commander continued shouting, "Someone was hit with an IED and it's bad! We need you to save his life!"

A door was thrown open, giving them access to the victim.

The simulated carnage caused responders to briefly hesitate, "Whoa..."

A figure was lying on the ground, uniform in shreds and soaked in blood. There were multiple burn marks on the victim's face mixed with sweat and tears, and debris all around, but what stood out more was the lower torso. The legs appeared to have been blown off, leaving bloody stumps with bone, muscle and tissue sticking out, blood oozing across the floor. Somehow, the stumps were still kicking. If the sight of the simulation wasn't enough, the sound of the victim screaming in pain, panic and desperation prevented any attempt at verbal communication. The high-tech manikin looked like the real thing from the blood, down to the moving parts, even though nobody had actually been hurt and no real damage caused.

These types of scenarios are common enough on the battlefield that they demand the medical response teams, or first responders, be capable of quickly taking action and providing life-saving measures. Clear the victim's airway, keep them breathing and stop the bleeding. Treat for shock. Dress and bandage the wounds. Perhaps the most important: get them out of harm's way, as much as possible.

In the above case, the 673d Air Base Wing medical team at Joint Base Elmendorf-Richardson did what they were trained to do. Once the final step was taken to ensure the patient's survival, the scenario ended. The figure on the floor stopped kicking and screaming and the blood stopped flowing. Will Enfinger, an instructor at the 673d Medical Group Simulation Center, stepped into the room and began debriefing, discussing the actions taken by the team. Debriefing may be the most important aspect of a simulation; it allows time for the instructor and students to go over everything.

Their approach to training is to remove instructors from the direct simulation environment, said Gardner. With technology allowing the patient to respond appropriately, the instructor can later provide valuable debriefing and feedback and the students are able to look back at their performance by analyzing the videos of the scenarios within the lab.

Enfinger knows what happened during the scenario and has a documented record of the entire scene action-by-action. He watched from a control room. Multiple vantage points record the events, a webcam in the ceiling that is synced with the main computer. The main vantage point is the two-way mirror, through which instructors can control the patient remotely, using a Wi-Fi network.

The patient is a manikin called Multiple Amputation Trauma Trainer, or MATT, is a life-size simulator with thrashing legs and bleeding used to train combat medics to properly identify and treat severe blast injuries. The primary manikin, however, is Laerdal SimMan3G, a wireless, high-fidelity, patient simulator, complete with a microphone in its ear, a speaker for talking and speakers in its chest to replicate heart and lung sounds. The eyes blink, dilate and cry.

With a few keystrokes and clicks on a laptop, the instructor can adjust the realistic human-looking "patient's" heart rate, breathing, sweat, tears, fake blood or just about any other detail to simulate signs and symptoms a real human victim would display.

"We want our healthcare team to have experienced various high-risk situations in a safe and controlled environment so they are better prepared to face the real thing for the first time," said Gavin Gardner, an Air Force medic for nine years and ICF International simulation coordinator for the 673d Medical Group. "We make simulations as real as they can possibly be without actually hurting anyone or causing real damage."

SimMan sweats and cries because people cry, Gardner explained. It has a pulse in multiple locations because people do. It bleeds because people bleed, and when someone puts a tourniquet on its leg stumps correctly, that bleeding will stop, he said. Some models even have hair in places people do, keeping things real.

"When I was in the Navy, a simulated situation usually meant pretending to see something that wasn't there," said Will Enfinger, a Navy hospital corpsman for seven years and ICF International simulation operator. "You had to look up at your inspector to get information like vitals, or to see how the victim responds to treatment. But the way we're able to train today, when we put SimMan in front of you, now the manikin is able to do everything and respond like a real patient would."

The goal is to familiarize first responders, to let them make the mistakes in the training environment, according to Gardner.

"If we have one department that mostly deals with heart attacks all the time, and another that deals with seizures regularly, we can give them scenarios where they get to treat those other things," Enfinger said. "And we're capable of more than just medical group training. We provide scenarios for wing training exercises on the flight line, and more."

The Simulation Center also provides training on locations to include the intensive care unit, the operating room and other hospital locations. They also provide simulation support for classes in advanced cardiac life support, pediatric advanced life support, self-Aid and buddy care, Mock Code Blue and more. Their training is also supported for exercises at the Alaska Veterans Affairs clinic, 673d Security Forces, JBER Fire and Rescue and various Army units around the joint base. The MATT is provided by the U.S. Army of Alaska surgeon's office.

They trained 673d Security Forces personnel for the Ability To Survive and Operate rodeo in Joint Base Lewis-McChord, Wash., in July. "We've even done zombies," Enfinger said.
The 673d Simulation Center mentors sites at Randolph Air Force Base, Texas, Camp Bullis, Texas, Wright-Patterson Air Force Base, Ohio, Travis Air Force Base, Calif., Keesler Air Force Base, Miss., Nellis Air Force Base, Nevada and Luke Air Force Base, Ariz. They also mentor sites across the Pacific Air Forces, including Hawaii, Guam, Japan and Korea, as well as other sites in Alaska.

They are the only tier-one simulation center in the Pacific Air Forces for the Air Force Medical Modeling and Simulation Training program used by many of the sites they mentor.

"The Simulation Center is available to enhance training needs," Gardner said. "The AFMMAST mission is to integrate simulation into every aspect of training. We are eager to hear units' training ideas and would like to develop a way to incorporate simulation into units' specific platform."

For more information, contact Gavin Gardner at 580-5652 or gavin.gardner@elmendorf.af.mil