Spc. Andrew Amm, 89th Military Police Brigade, performs a simulated intravenous line insertion on the first female medical manikin developed for the U.S. Army. (U.S. Army photo by Shawn Davis, Fort Cavazos Public Affairs)
Spc. Andrew Amm, 89th Military Police Brigade, performs a simulated intravenous line insertion on the first female medical manikin developed for the U.S. Army. (U.S. Army photo by Shawn Davis, Fort Cavazos Public Affairs) (Photo Credit: U.S. Army) VIEW ORIGINAL

FORT CAVAZOS, Texas — Prosthetic body parts of a medical manikin are unpackaged from large trunk cases and assembled on a stretcher on the morning of Jan. 9 in the Fort Cavazos Medical Simulation Training Center, as combat medics from III Armored Corps and the U.S. Army Medical Test and Evaluation Activity agency familiarize themselves with the new female manikins to be used for training female combat casualty care in the Army.

The new equipment training will give Soldiers a planned three days to learn the capabilities and functions of the first female manikin made for the U.S. Army before fielding them for operational testing starting April 2 at Fort Cavazos.

The female manikins are built to scale and are based on anatomical data of the average female Soldier. Assembled with plug and play functionality, they use components such as artificial blood pumps and high fidelity animatronics that simulate living responses to pain and trauma. Their specialized sensors can measure care as delicate as inserting an intravenous line under battlefield conditions and feedback is provided by the connected software that measure a combat medic’s actions by the second, where any hesitation in care can be catastrophic for the casualty.

It’s a crucial component for maintaining Army readiness and has the attention of Army-wide MSTC manager Col. Gustov Mareno, Directorate of Simulation. “Our sisters in arms go to war with us and they run the same risk as any other Soldier on the battlefield,” Mareno said. “We have to be ready to give the best medical care possible to all Soldiers.

“I’ve been in the medical field for many, many years and it takes time to break your mental barriers when to comes to exposing a female to do trauma stabilization, because our training focuses on exposing the entire body to look at these injuries so we don’t miss anything,” he added. “There’s a little hesitancy at the beginning when you don’t have the experience or if the environment isn’t private enough, and these are the hurdles that we have to get past so that we can give the best medical care possible to our sisters in arms.”

Hesitancy and slower performance by male medics when performing Tactical Combat Casualty Care, or TC3, for wounded female Soldiers is a well-documented phenomenon, and it isn’t the only challenge being addressed by the four immediate agencies involved with this training. Soldiers are learning to adapt standard issue equipment often fitted for the male anatomy to their physically smaller female sisters in arms. It’s a refreshing change in approach to former Army combat medic and lead instructor operator, Crystal Kepler.

“This manikin is the most realistic that we’ve encountered for female anatomy,” Kepler said. “Currently, we’re working on chest tubes — some of our instructors are saying that the intercostal space, the space between the ribs, is too small. She (the manikin) is built comparatively to my size as a female.

“I think we get complacent with larger manikins,” she added. “For older female manikins, they placed the female genitalia on top of a male sized manikin — breasts, genitalia, things of that nature and it gives you a false sense of security when performing interventions on male sized manikins versus one based off the median female size.”

The manikin serves not only as a way for Soldiers to train to provide more accurate care for female casualties, but as a wider push by the U.S. Army to advance TC3 training to incorporate real world data from ongoing conflicts across the world.

“In future wars, we may not have air superiority, so we hone in on our medics having the ability to sustain a casualty, keep them alive and treat them for a longer period of time,“ Kepler said. “Previously, our medics would train for about a 30 minute assessment, get them out of combat, treat and sustain them and then pass to a tactical evacuation platform.”

Now, she continued, the Army is training combat medics to sustain casualties for longer periods of time with the equipment commonly found in combat vehicles and kit. The manikin, with its capability to work in both simulated combat environments and clinical settings with advanced sensors and ruggedness, provides a more efficient and immersive approach to training, disembarking from the prior method of using different manikins based on their level sophistication and corresponding fragility across different training environments.

While developmental testing has happened at other Army installations, operational testing will be exclusive to Fort Cavazos. The operational testing will occur April 2-5 and will be the final step before the accreditation of the series to be implemented Army wide.

Fort Cavazos and III Armored Corps are well positioned to host the first wide scale operational test for the female manikin, said Dr. Jerry Higman, deputy product manager of Medical Simulation, as it holds the largest MSTC and the support structure of combat medics, instructor operators and environment necessary to facilitate a productive operational test of the new models.

Higman represents the Program Executive Office Simulation, Training and Instrumentation and is joined by members of MTEAC, U.S. Army Training and Doctrine Command Proponent Office – Virtual & Gaming and the Directorate of Simulation. Their goal is to address the disproportionate rates of preventable battlefield deaths for female casualties in combat.

“We’ve discovered that the lack of the training with the female physiology can explain why females are dying on the battlefield at a higher per capita rate than males,” Higman said.

The rates of female service member deaths compared to male service member have been measured by the National Institute of Health at 2.5% higher in Operation Iraqi Freedom and 18.9% higher in Operation Enduring Freedom.

“This is why we’re doing what we’re trying to do with the female manikins,” Higman said, “We want to do it right, we want to make sure that we’re giving the Soldier the right training solution with all the issues understood prior to doing any fielding. At this point in time across the Army, there have been no female manikins fielded, only males, so this is huge.”