Dive Medicine and Rescue course enhances military medical readiness
Readiness is the cornerstone of military effectiveness. It is seen as the main line of effort for the Department of Defense. For 24 students in the Uniformed Services University (USU) Dive Medicine and Rescue course, readiness means the ability to perform complex medical tasks, while overcoming emotional fears and stress, in an aquatic setting.
“The military medical providers must understand conventional medicine, but also how to take those skills and use them in the austere environment,” said Dr. Matthew Welder, USU Assistant Professor and Course Director. “The austere environment can become the primary enemy for the provider. Therefore they must train for clinical, operational, physical and emotional readiness to ensure they are a functional member of the Ready Medical Force.”
The two-week course, conducted at the Special Forces Underwater Operations School in Key West, Florida, combines a mixture of nearly 90 hours of classroom, pool and open water training designed to provide the students with a full understanding of the medical issues and responses associated with military water operations. This onsite training is in addition to the basic scuba, nitrox, advanced, and dive stress and rescue eLearning modules that must be completed prior to arriving at the course. Starting with a basic swim evaluation, the course culminates with the application of their skills during a complex high angle rescue onto a US Coast Guard Cutter.
“Unique to this course is all of the didactic lectures students receive on the medical issues that can result from diving mistakes,” said Lt. Col. (Dr.) Michael Arnett, Resident, Occupational and Environmental Medicine, Walter Reed National Military Medical Center.
Arnett, who is one of the course instructors, feels that the greatest challenge in instructing is getting to the students to quit relying on their primal instincts, which do not prepare them for diving or underwater operations, and get them to listen to the instructors about what they should be doing while underwater.
“Because of the large instructor:student ratio, it is easy to observe which students quickly incorporate the feedback of their instructors and which ones do not,” added Arnett. “As a senior medical educator, my experience suggests that the students who quickly incorporate feedback and change behavior in the diving environment would exhibit the same behavior in the clinical setting. Conversely, students who seem to have difficulty incorporating or ignoring feedback on improving their diving techniques would also exhibit that same behavior in the clinical setting.”
The training is designed to introduce the students to a variety of complex and intense diving and rescue scenarios which require them to apply the skills learned in order to be successful. They are taught the dive medical concepts during classroom lectures, by expert instructors in their fields, then apply and perfect those concepts and techniques in the confined water setting, before moving into the open water for the final evaluations.
“The growth of these students is exponential by the end of the course,” added Welder. “They are able to perform gross and fine motor skill tasks under stress in an environment that is trying to kill them.”
Welder notes that the student’s greatest challenge is overcoming emotional fear while maintaining their own safety and simultaneously performing complex medical tasks during scenario based simulation.
The instructors aren’t the only ones who see the growth, the students, ranging from medical personnel assigned to USU, the FBI, NASA and US Army Ranger units, recognized the increased knowledge, skills and ability gained during the course.
“I gained a significant amount of confidence in my abilities to rescue and treat casualties of diving,” said Navy Student Nurse Anesthetist Lieutenant Jeffrey D. Henderson. “I recognized the value of being able to get out of my head, avoid panic, and use drills to gain control of chaotic situations.”
Additionally, Henderson added that the course provided a lifelong memory of applying valuable gas laws and complications of diving, which built confidence in treating diving associated casualties.
“I visually saw how Boyle’s law applies to gas consumption during our deeper dives, which I will remember permanently,” stated Henderson.
Fellow Navy, Student Nurse Anesthetists, and USU students, Lieutenants Paul Kuhn and Taylor Brocuglio agree that the practical application of skills learned was one of the most valuable aspects of the training.
“The ability to apply past experience like the gas laws and neurological exams, and see them come to life while caring for an injured diver, allowed me to gain comfort in something that I make have to apply when working with divers or aviators,“ added Brocuglio.
Kuhn stressed that as a phase one student registered nurse anesthetist, the application of gas laws and the ability to quickly recognize differential diagnoses such as AGE (atrial gas embolism) and DCS (decompression sickness) were extremely valuable skills learned during the course. He continued to highlight that from a rescue standpoint, learning and understating how to transport a patient, removing them from the water and even surfacing with them, are skills that he might need to use in the future.
While gaining insight into the application and diagnosis of the medical aspects of diving is a critical component of the training, another key readiness aspect is learning how to use special rescue equipment and recovery techniques.
“The most valuable part of this course from a rescue standpoint was learning how to use the Skedco and stokes litter,” said Navy Student Nurse Anesthetist Lieutenant Caroline Mosher. “I had never used the Skedco before and I didn't even know you could use it in the water, but by the end of the two weeks I felt pretty good about it.”
The fact that the students are inexperienced in the operational applications of their profession and equipment is the hole this training aims to fill from a readiness perspective.
“There remains a substantial gap between the military medicine establishment that conducts 99% of the training in the tertiary-care/academic environment and the operational community of the military,” said Arnett. “Anything that moves medical learning outside of the medical treatment facility and into the operational setting closes that gap and creates medical personnel who better understand the needs of the operational community and are better able to meet those needs. This training supports the development of military clinician readiness.”
Mosher agrees and added, “This training teaches people how to provide care in a totally unfamiliar environment, which will happen all the time in the operational setting. You also get the experience of learning a new skill very quickly. In the Navy, we are often expected to become proficient in all kinds of things with very limited time. This training was great practice for that scenario.”
According to Welder, readiness is a lifelong journey and USU is where it all starts.
“Readiness is a continuum and constant exposure to readiness training is essential for competency, proficiency and currency,” he stated. “We must study skills degradation and ensure that we are building and expanding operational readiness courses that ensure battlefield medical success. I am confident that students attending this course will perform at a higher level than those who have only worked in a hospital setting.”
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