title: Naval casualty management training using human patient simulators.
abstract: BACKGROUND
  Extended-evacuation or austere environments (e.g. naval,immature or depleted combat zones) are characterized by the lack of resources to facilitate medical evacuation in the "Golden Hour" from moment of injury. This may require the primary caregiver, often a relatively inexperienced general physician or EMT, to administer extended medical care in the field. We describe the Shipboard and Underwater Casualty Care and Sedation Simulation (SUCCeSS) program in the Israeli Navy, intended to train caregivers for extended prehospital intensive casualty care using high fidelity life-size simulation mannequins set up onboard corvettes or submarines during maneuvers, in maximally realistic conditions. Twenty two general physicians and EMTs in 12 teams were enrolled in the program in the years 2011-2013. Two to three hour long training sessions were headed by senior surgeons and anesthesiologists using flexible scripts enabling the mannequin operators to react to caregivers' actions and their consequences. Trainee evaluation was performed by the preceptors using semi-structured forms taking into account both critical treatment decisions and observation on the effects of actions taken. Trainees also completed self-report CRM (Crisis Resource Management) questionnaires before and after the sessions.
  
  
  RESULTS
  Success of the trainees correlated with an evaluation score above 72%. The mean overall CRM score for team leaders post exercise was 74.64%, an improvement of 10% over pre-exercise scores (p < 0.0001).
  
  
  CONCLUSIONS
  Caregiver self-perceived competence and self-sufficiency in treating casualties at sea was improved via high fidelity simulation in theatre using realistic naval casualty care situations. We discuss the relative strengths and weaknesses of our training program for the teaching of "NCM", or Naval Casualty Management, as well as the emergent concepts of the military extended evacuation environment.
authors.affiliation: Medical Department, Haifa Naval Base, Israeli Navy, IDF Medical Corp, Heyl Hayam Square, Haifa, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Netzer
authors.affiliation: IDF Medical Corp, Tel Hashomer, Israel.
authors.forename: Aviram
authors.initials: A
authors.lastname: Weiss
authors.affiliation: Department of Anesthesia, Critical Care and Pain Management, Meir Medical Center, Kfar Sava, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Hoppenstein
keywords: Austere environments; Casualty care; Naval medicine; Prehospital; Simulation