Medical simulators provide realistic training for casualty treatment
CAMP FOSTER, Okinawa — The noise inside the KC-135 is almost unbearable. The floor vibrates; the crew is bathed in a cool, blue light.
A heart monitor blips with metronome-like cadence as the patient, lying on a bench, complains of abdominal pains. Tears stream down the patient’s face and his eyes blink rapidly.
“He’s restless, irritated. We’re at cruise (altitude). So let’s have someone go ahead and take some vital signs,” said Air Force Master Sgt. Alex Rojas, a training supervisor. “Someone start dropping an [nasogastric] tube. What questions are you going to start asking so you can rule out what could potentially be going on?”
“When did the pain onset? Location, radiation, tenderness, and does he have a fever?” Senior Airman Justin Shane said as he pressed gently on the various quadrants of the patient’s stomach.
Rojas suggested it might be gas in the abdomen.
“Get him up, see if that helps,” Shane said.
The crew from Kadena Air Base’s 18th Aeromedical Evacuation Squadron may have been in the familiar surroundings of a large steel bird, but this time, they weren’t at 32,000 feet soaring over the Pacific, shuttling stabilized patients to the States.
They were in the belly of the 18th Aeromedical Evacuation Training and Sustainment Center’s new KC-135 Cargo Compartment Trainer, a one-of-a-kind simulator built by Air Force Maj. Susan “Moses” Parda-Watters.
The trainer was certified in March, so the squadron’s crews are now able to maintain their in-flight certifications in burns, cardiac, respiratory, psychiatric, pediatric and trauma emergencies without leaving the ground.
Coupled with a 3rd Marine Division Tactical Medical Simulation Center at Camp Hansen that specializes in point-of-injury care, U.S. military units on Okinawa are becoming more self-sufficient. Servicemembers are no longer required, for the most part, to leave the island to receive critical medical training.
“This is to scale, not to height, but to width, so this is the actual space that we work in,” Parda-Watters, sounding like a proud parent, said as she watched the crew operate in the simulator. “There is no right or wrong in this environment right now. This is where you make your mistakes, you trip, you fall and you learn. That’s the whole intent.”
Using a laptop from outside the simulator, the 16-year Air Force veteran can remotely control the medical scenario. The faux plane — built largely from discarded materials at no cost to the U.S. military, yet valued at about a half-million dollars — has been operational since September.
She also set up a myriad of clinical training stations, from burns to pediatric care, all designed to give airmen the basic skills needed to enter the simulator where they would be asked to take aerospace physiology into account, where altitude, barometric pressure, vibrations, humidity and oxygen are all factors in patient care and can lead to complications.
“When you take a patient up to altitude, everything expands,” Parda-Watters said. “Everything gets bigger, air gets bigger. If you have gas and a stomach ache, it could be a problem. Hypoxia is a big issue.”
The airmen must be well versed in oxygen calculations and must bring enough with them for lengthy flights. They go over their checklist, attend a crew brief and go through patient preparation, placement and roles and responsibilities on the aircraft just as they normally would. Then they enter the simulator with a five-man crew, two nurses and three technicians.
“For us medics, it gives us the edge over somebody who doesn’t have this training,” Shane said. “It’s good practice for the real world, and you can use it for other things too outside of the hospital.”
Closer to the action
The simulator is part of the military’s effort to make training as realistic as possible and more accessible, especially for mass casualty events, when every minute can mean the difference between survival and death. Having simulators like the KC-135 cargo compartment means crews can get as much training as they want and prepare for any contingency.
On the other side of the island, Lance Cpl. Cody Porche ran laps around the building that housed the 3rd Marine Division Tactical Medical Simulation Center on Camp Hansen. After his heart rate was up, he was directed toward the center.
Porche stormed through the door, rifle at the ready, from daylight into darkness, followed by a partial squad of fellow heavy equipment operators from the 9th Engineer Support Battalion.
Porche found chaos among fish mongers and carpet stalls, meant to simulate a late-night mass casualty incident — like a bomb blast — in a Middle Eastern or Afghan market. Strobe lights flashed, smoke was thick in the air and loud music blared from maxed-out speakers.
Casualties were scattered throughout. Blood pooled around lifeless bodies.
The Marines were not only tasked with locating them in the debris, but also rendering aid, tourniquets and, in some cases, a tracheotomy.
But there was a curveball.
The instructors placed psychiatric patients in their midst. So while the Marines rendered aid, they had to fend off people intent on disrupting them and stealing their weapons or equipment.
“Wes kept yelling, 'He’s not breathing. He’s not breathing.’ I was trying to hold you down and get him a needle at the same time,” Porche said to the psychiatric patient after the exercise.
“It could have gone a lot better. There was a lot of chaos. We could have communicated better, but it was our first time ever doing this.”
On the next run through, Porche was the psychiatric patient. He found himself hogtied so his fellow Marines could focus on their response. He shrieked, adding to the madness.
“[We could do this in a real world scenario now] as long as we kept our communications up,” said Lance Cpl. Geoff Blake. “It’s all about communications and working with the team.”
Hansen’s center is run under the watchful eye of former Navy corpsman Mark Kane and former special forces medic Joseph Groves. Their simulator supports the entire 3rd Marine Expeditionary Force and features stations, a written test and the nightmarish marketplace, which could be turned into a Korean marketplace with a moment’s notice should the need for Middle Eastern scenarios no longer be needed.
They have seen around 4,000 servicemembers come through since the simulator was set up five years ago.
“I want them to be comfortable with the gear they’ve been issued,” Kane said. “Our theme is to eliminate preventable death on the battlefield.”
The work focuses on the treatments needed to save a patient’s life so they can be evacuated from the battlefield, which could mean in a vehicle or, in most cases, a medevac helicopter.
Medical evacuations are generally the Army’s mission, the Air Force’s Parda-Watters said. But it’s up to any military unit, like the 9th Engineer Support Battalion, to know the basics of point-of-injury care. The patient will be transported to a hospital. When a flight surgeon determines a patient is stable enough to fly at altitude, the 18th Aeromedical Evacuation Squadron can transport them to the U.S.
“When you went up to Hansen, you did point-of-injury and stabilization,” Parda-Watters said. “That’s how we tie in. Aeromedical Evacuation flies stabilized patients. So our skills require us to know pediatric to geriatric and everything that encompasses that.”
Both Parda-Watters and Kane agreed that the medical response at U.S. military installations on Okinawa had improved vastly by having the simulators.
“It’s a win-win for everybody,” Kane added. “It benefits the overall mission of casualty care.”