FORT BRAGG, N.C. -- The U.S. Army is one step closer to increasing the ability of non-surgical medical personnel in remote locations to potentially save the lives of severely injured Soldiers thanks to continuing efforts by the U.S. Army Special Operations Command (USASOC), Womack Army Medical Center and the U.S. Army Medical Research and Materiel Command -- Telemedicine and Advanced Technology Research Center (TATRC).

The USASOC and Womack team hosted the second iteration of the battlefield emergent stabilization skills triad (BESST) demonstration at the Fort Bragg Medical Simulation Training Center in early February 2019. Six students with a non-surgical background participated in two days of classes and hands-on training to help the program's developers formalize the training package and integrate checklists that outline the steps for the medical tasks they trained on and executed.

"In 2017, we built a demonstration for the Army Surgeon General that showed the capability for a non-surgeon to be able to save a life in a remote location using available technology to have a surgeon supervise the procedure, even with an ocean between them," said Lt. Col. Stephen DeLellis, deputy surgeon, USASOC. "That demo is now a fully developed training package, complete with didactic instruction, a training video and procedure-review flip charts."

The students, comprised of two physician assistants, two emergency medicine doctors and two Army special operations medics, learned how to perform two medical tasks that could help save the life of a potentially fatally wounded Soldier: an anterior femoral artery exposure and a 4-compartment fasciotomy. The first task controls life-threatening bleeding and the second releases excessive pressure/swelling in an injured leg.

Helicopters were flying low overhead, adding realism to the event as the students worked with their heads down in the tents where the training was taking place, ignoring everything else around them and focusing only on the manikin in front of them. The students used scalpels to cut into the realistic model and tied off blood vessels with gloved hands, all while wearing augmented reality glasses that allowed a surgeon to observe their actions from the student's point-of-view.

Col. (Dr.) Tyler Harris, an orthopedic surgeon at Womack Army Medical Center, watched the students' progress and communicated with them throughout the procedure. Harris was seated in another room, watching their actions on a laptop computer and providing real-time feedback on what he was seeing to the students who could hear him through their glasses.

While the training provides the students with all the knowledge and tools to perform the procedure on their own, the use of telestration provides a safety net and an additional level of medical oversight to support them when they are caring for actual patients in a remote location.

Harris said that getting training like this available to the force will help increase readiness and the ability to care for Soldiers serving in harm's way.

"The great thing about this training package is that it is scalable to meet the needs of the Army," Harris said. "As many medical personnel that are needed are able to learn each procedure in a day or less. It takes years to bring on new surgeons. This leverages the experienced medical resources units already have -- our non-surgical physicians, brigade doctors and physician assistants -- and allows us to quickly train them to not only meet the needs of the Army, but give them the ability to potentially save the lives of their fellow Soldiers with injuries that could prove fatal without immediate intervention."

Throughout the training, students provided feedback to the team about training modules, classes, the checklist and equipment. They shared what worked and what changes to the program would make it easier for them. Overall, the students said they were glad that training like this was being developed.

"This training was very effective because of the way it was presented," said a participating emergency medicine physician with the Special Operations Medical Detachment. "You got to see it done and then got to do it yourself. There's a lot of repetition and hands-on, you're not just talking it through and hoping for the best."

A Special Forces medical sergeant with 3rd Special Forces Group (Airborne), who also participated in the exercise said, "I think this is a great force multiplier. It's great to get to learn techniques like this, we go places where immediate evacuation to higher care facility isn't always possible. When you're the only medic out there, you want to be able to help someone no matter what."

Experts at the Uniformed Services University of Health Sciences will now review the results of this training and pursue research to clinically validate the process. The goal is to not be able to tell the difference in the results of these skills executed by a surgeon or one of the non-surgeons doing the task. The current expectation is for validation and implementation of the training across the force within the next two years.

The project has been fully supported by Army Medicine as part of its advanced medical technology initiative (AAMTI).