Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training.
BACKGROUND
Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills.


METHODS
The pilot study evaluated 10 three-person military resuscitation teams from community hospitals that participated in a 28-day rotation at a civilian trauma center. Each team consisted of physicians, nurses, and medics. Using the HPS, teams were evaluated on arrival and again on completion of the rotation. In addition, the 10 trauma teams were compared with 5 expert teams composed of experienced trauma surgeons and nurses. Two standardized trauma scenarios were used, representing a severely injured patient with multiple injuries and with an Injury Severity Score of 41 (probability of survival, 50%). Performance was measured using a unique human performance assessment tool that included five scored and eight timed tasks generally accepted as critical to the initial assessment and treatment of a trauma patient. Scored tasks included airway, breathing, circulation, and disability assessments as well as overall organizational skills and a total score. The nonparametric Wilcoxon test was used to compare the military teams' scores for scenarios 1 and 2, and the comparison of the military teams' final scores with the expert teams. A value of p < 0.05 was considered significant.


RESULTS
The 10 military teams demonstrated significant improvement in four of the five scored (p < or = 0.05) and six of the eight timed (p < or = 0.05) tasks during the final scenario. This improvement reflects the teams' cumulative didactic and clinical experience during the 28-day trauma refresher course as well as some degree of simulator familiarization. Improved final scores reflected efficient and coordinated team efforts. The military teams' initial scores were worse than the expert group in all categories, but their final scores were only lower than the expert groups in 2 of 13 measurements (p < or = 0.05).


CONCLUSIONS
No studies have validated the use of the HPS as an effective teaching or evaluation tool in the complex field of trauma resuscitation. These pilot data demonstrate the ability to evaluate trauma team performance in a reproducible fashion. In addition, we were able to document a significant improvement in team performance after a 28-day trauma refresher course, with scores approaching those of the expert teams.
Holcomb
John B
JB
Joint Trauma Training Center, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. john.b.holcomb@uth.tmc.edu
Dumire
Russell D
RD
Crommett
John W
JW
Stamateris
Connie E
CE
Fagert
Matthew A
MA
Cleveland
Jim A
JA
Dorlac
Gina R
GR
Dorlac
Warren C
WC
Bonar
James P
JP
Hira
Kenji
K
Aoki
Noriaki
N
Mattox
Kenneth L
KL
D003198:Computer Simulation; D006801:Humans; D008889:Military Personnel / Q000193:education; D010348:Patient Care Team; D012151:Resuscitation / Q000193:education*; D014947:Wounds and Injuries / Q000628:therapy*