In the context of tactical medicine, a mass casualty (MASCAL) event is defined as a situation where the number and severity of casualties exceed the available medical resources. MASCAL events can result from a wide range of scenarios that pose significant challenges for military healthcare providers. Examples include: large-scale accidents, terrorist attacks, or natural disasters. These events strain resources, require rapid triage and decision-making, and can have long-term physical and psychological effects on patients and healthcare providers. This article by Remy Roe will explore how MSTCs use hybrid simulation to prepare military healthcare providers for the unique challenges of MASCAL events.
The Power of Hybrid Simulation for Austere Environment Training
In the face of MASCAL events, the United States Army must be prepared to provide rapid and effective medical care under extreme pressure. To ensure that military healthcare professionals are ready for these high-stakes situations, the Army has established Medical Simulation Training Centers (MSTCs). One of the most powerful tools in the MSTC arsenal is hybrid simulation, where high-fidelity manikins are used in conjunction with live actors to create realistic training scenarios.
Hybrid simulation is a technique that leverages the strengths of both high-fidelity manikins and live actors to create immersive, realistic experiences. In MASCAL scenarios, manikins are typically used to simulate complex trauma cases that require advanced medical interventions, such as intubation, chest tube insertion, or damage control surgery. The use of manikins allows trainees to practice their skills in a safe, controlled environment. However, manikins alone cannot fully capture the emotional and psychological challenges of MASCAL events.
Through the incorporation of actors into the simulation, MSTCs create a more authentic and emotionally charged environment that develops trainees’ ability to manage stress, communicate effectively, and make critical decisions under pressure. In army based clinical simulation, actors can play the roles of not only patients, but also fellow healthcare providers. Through interactions with simulated colleagues, trainees learn to communicate clearly, delegate tasks effectively, and work together to prioritize patient care in a dynamic and high-pressure environment. These skills are critical in real-world MASCAL situations, where every second counts and every decision can mean the difference between life and death.
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Realistic Portrayal of Traumatic Injuries
A key advantage of the use of actors in MASCAL simulations is the ability to realistically portray a wide range of traumatic injuries. From compound fractures, to burns and amputations, actors can be outfitted with special effects makeup and prosthetics that closely mimic the appearance and behavior of real-world injuries. This level of realism prepares military healthcare providers to manage the often-gruesome realities of combat medicine. In some cases, MSTCs hire actors with real-life amputations to participate in healthcare simulation. These individuals foster a unique level of authenticity and can draw upon their own experiences to inform their performances. Through interactions with these actors, trainees gain a deeper comprehension of the physical, emotional, and psychological challenges faced by patients.
Stress Inoculation and Emotional Management
Actors in MASCAL simulations prepare trainees to manage the emotional and psychological stresses of these high-intensity events. Actors can be coached to exhibit a range of emotional responses, from shock and disbelief, to anger and despair. The purpose of an actor’s behavior is not just to serve as a stressor in a scenario, but rather to mirror the reactions of real patients and family members in crisis situations. The immersion of trainees in these emotionally charged scenarios, enables MSTCs to teach the resilience, empathy, and emotional intelligence needed to provide compassionate, patient-centered care in the face of chaos and tragedy.
However, repeated exposure to high stress, emotionally charged situations can take a toll on military healthcare providers. They face an increased risk of burnout, compassion fatigue, and post-traumatic stress disorder (PTSD) due to the intense nature of their work. To mitigate these risks, MSTCs incorporate debriefing as an essential component of the training process. After each clinical simulation, participants have the opportunity to discuss their experiences and process their emotions. These debriefs promote long-term psychological wellness amongst military healthcare providers, and help to build the mental and emotional stamina required to perform at their best when lives are on the line.
Interprofessional Communication and Teamwork
MASCAL events require seamless coordination and communication among multiple healthcare disciplines, from triage and transport, to surgery and critical care. MSTCs use hybrid simulation to foster the development of these essential interprofessional skills through scenarios that demand effective teamwork and collaboration. A common occurrence in these scenarios is for a combat medic, flight paramedic, and surgeon who have never met before to work together in a healthcare simulation exercise that can last entire days in length. One example of such an exercise is the Delayed Evacuation Casualty Management (DECM) course.
DECM is a two-week long course that culminates in a 36-hour MASCAL clinical simulation. DECM also exposes combat medics to lesser-known MASCAL variables, like patient and team management across language and cultural barriers. Through these immersive experiences, military healthcare providers develop the interprofessional skills and cultural competencies needed to provide optimal care in diverse environments.
Hybrid simulations like DECM help break down silos between specialties, promote a shared awareness of roles and responsibilities, and foster a culture of mutual respect and trust. For example, a combat medic may gain a deeper appreciation for the challenges faced by a surgeon in the operating room, while a surgeon may better understand the critical role of a medic in pre-hospital environments. Joint training in realistic scenarios enables military healthcare providers to learn how to leverage each other’s strengths, communicate effectively, and make collaborative decisions in high-pressure situations.
Conclusion: Hybrid Simulation Creates Powerful Outcomes
The use of hybrid simulation in the U.S. Army Medical Simulation Training Centers represents a significant advancement in the preparation of military healthcare professionals for mass casualty events. The combination of the technical realism of high-fidelity manikins with the emotional authenticity of live actors, MSTCs create immersive experiences that closely mirror the challenges and complexities of real-world MASCAL situations. Through these MASCAL clinical simulation, military healthcare providers develop the clinical skills, emotional resilience, and interprofessional collaboration needed to save lives in the face of unthinkable tragedy. As the nature of warfare continues to evolve, the importance of hybrid simulation will only continue to grow.
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