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Medical training in hyperreality

JOINT BASE SAN ANTONIO-RANDOLPH, Texas (AFNS) -- Have you ever wondered what it would be like if film makers added smell and other senses to your explosive, action-packed movie watching experience? This idea is probably not far from reality and most likely will make motion pictures even more dynamic.

The Air Force Medical Modeling and Simulation Training, or AFMMAST, is improving medical training is by adding hyperreality and high fidelity through the use of the Tactical Combat Casualty Care Cut Suit.

The AFMMAST website describes the cut suit as a learning tool that provides the most realistic way to simulate the look, feel and smell effects of severe traumatic situations on a live human. It allows medical providers a safe training environment to perform real procedures -- from the point of injury to treatment en route, and transition of care to surgical intervention.

Senior Master Sgt. Juan Rodriguez, the AFMMAST program manager, said the cut suit gives medical providers a training platform to focus on the three primary causes of death on the battlefield: uncontrollable hemorrhaging, airway compromise, and tension pneumothorax (an abnormal collection of air or gas in the space that separates the lung from the chest wall).

In a field environment, a live actor wearing the cut suit will appear to be bleeding and can vocalize his pain and discomfort. The cut suit can also be used on a high fidelity mannequin. This cut suit mannequin combination will provide the users with the physical appearance of the injury as well as the ability to monitor physiologic symptoms of traumatic shock, like cardiac arrest, weak pulse, rapid or weak breathing, all of which can be tweaked and adjusted on a wireless computer monitor system.

"Simulation is just a tool to use during medical training and can be used with a huge variety of learning objectives," said Ruben Garza, the AFMMAST Program deputy chief/administrator.

"The training that AFMMAST supports spans the continuum from combat mission preparation to basic training of Airmen to do the work required of their Air Force medical specialty," he said. “Some sites have minimal training requirements and equipment, and others, such as large hospitals have robust requirements that necessitate full-time staff, dedicated space and large amounts of equipment.”

Tony Garcia, a simulation operator at the Medical Research Training Center at Camp Bullis, Texas, said training can also be conducted in the Wide-Area Virtual Environment, or WAVE. The WAVE is an immersive 3-D environment that includes, smoke, noise and an interactive background complete with avatars.

"In some scenarios, the actual smell of cutting into the gastrointestinal tract can be added to the training simulators." he said. "But, they usually don't go that far, because it depends on the specific curriculum and scenarios the instructors request from AFMMAST."

The amount of training an Airman needs is determined by the mission and where they are in their career. Some Airmen are maintenance level, which means they are fully competent and not scheduled to deploy. But there is also the ramp up level where Airmen are preparing to deploy, and the novice level, where they are learning the basics of how to be a medic, nurse or physician.

"In any case, the advantages of virtual training allow the learner to practice critical skills repeatedly, in a safe environment, at a variety of locations, simultaneously," Garcia said.

These virtual environments are also cost effective if planned appropriately, Rodriguez said.

"The program can be used by many people without costly set-up or resources," he said. "The skin and the organs on the cut suit are repairable. The organs can be changed out by the user and the skin can be repaired with special silicone-based glue."

When asked what he hopes to see in future medical training models, Rodriguez said it would be smart for developers to address the full spectrum of a disease or injury.

"None of the simulation methods actually replicate real practice fully, so currently, a blend or variety of methods is used to meet training requirements," he said.

"Hyperrealistic training is immersion of the learner in the situation," Rodriguez reiterated. "It is intended to put the learner in a situation where cognitive, affective, and psychomotor skills can be tested, trained and practiced."

"With this advanced technology, when trainees are presented with a real-life scenario, their motor memory will take over and will get them through the initial shock," Rodriguez said. “It improves their training experience, helps them complete the mission, but most importantly, save lives.”