Description:
OBJECTIVE: To develop a simulation-based training system to assist teaching and training the use of intraosseous (IO) devices in the humeral head to administer fluid to patients at point of injury. DESCRIPTION: Over the past few years, the British Medical Emergency Response Team (MERT) and US Air Force Search and Rescue Unit (aka, PEDRO) have been administering fluids to patients at point of injury and enroute through the use of intraosseous (IO) devices in the humeral head. The MERT includes an Emergency Medicine residency trained physician. The PEDRO includes pararescue trained medical providers who are afforded the opportunity to train on cadavers prior to deployment. The US Army Center for Predeployment Medicine (CPDM) at Fort Sam Houston, TX provides predeployment medical training to providers of all levels as mandated by Surgeon General Executive Order 096-09. CPDM currently does not have an adequate shoulder training model to train on the humeral head intraosseous device. Consequently, the shoulder IO device has not been placed in the US Army Medical Equipment Sets (MES) to avoid issuing a life-saving medical device without proper training. It is cost prohibitive to use cadavers for the number of students attending CPDM each year. It is not logistically feasible to train all providers in Emergency Medicine. As a result of not having an adequate training model to train our deploying providers, the US Army is currently behind the power curve on treating combat wounded service members on the modern battlefield in regards to the use of the humeral head IO. Research conducted under this effort should focus in the development and evaluation of a low cost simulation-based shoulder training capability for placement of intraosseous device in the humeral head. The system should: - Support established training objectives. - Provide a capability to judge proficiency performance. - Support practice of both cognitive and psychomotor skills. - Simulate entire torso from sternal notch to just below umbilicus with complete bilateral upper extremities. - Allow for proper positioning of the affected upper extremity prior to insertion of the device. - Afford training on both left and right humeral heads. - Have flexible upper extremities, including elbow, to allow positioning of the hand over the umbilicus to ensure proper position for device insertion. - Allow for improper positioning of the extremity by the student, affording an opportunity for remedial training. - Include palpable anatomical landmarks to determine proper insertion site of device. - Include injectable simulated bone to confirm placement and flow. - Have replaceable humeral head simulated bones. PHASE I: Conduct a six month effort to analyze the scientific, technical, and commercial merit and feasibility of using a low-cost medical simulator for training medical Army personnel of all levels in Army Combat Training Schools. Proposed work will include research into feasibility of developing the capability and describing the overall concept. We seek innovative and novel ideas for exploration of concepts to provide this training environment. Identify innovative technologies being considered, technical risks of the approach, costs, benefits, and notional schedule associated with development and demonstration of the prototype. The simulator solution must be hands-on, low-cost, and realistic for use in the current training Program of Instruction (POI) at the US Army Center for Pre-Deployment Medicine (CPDM) at Fort Sam Houston, Texas. PHASE II: Develop and demonstrate a prototype system from the recommended solution in Phase I. Provide realistic and meaningful interaction for hands-on treatment. The prototype should provide immediate student feedback without the aid of an on-site instructor. Evaluation of the proposed system is required. Data from these studies will need to be provided, analyzed, and presented in a final report. PHASE III DUAL USE APPLICATIONS: This system could be used in a broad range of military and civilian medical training applications. Demonstrate the application of this system to civilian hospitals, paramedics, and other military medical personnel. REFERENCES: 1. Carness, J.M., Russell, J.L., Lima, R.M., Navarro, L.H., & Kramer, G.C. (2012). Fluid resuscitation using the intraosseous route: Infusion with lactated ringer"s and hetastarch. Military Medicine, 177(2), 222-228. 2. Harcke, H.T., Crawley, G., Mabry, R., & Mazuchowski, E. (2011). Placement of tibial infusion devices. Military Medicine, 177(7), 824-827. 3. Hock, M.E., Chan, Y.H., Oh, J.J., & Ngo, A.S. (2009). An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO. American Journal of Emergency Medicine, 27, 8-15 4. Paxton, J.H., Knuth, T.E., & Klausner, H.A. (2009). Proximal humerus intraosseous infusion: A preferred emergency venous access. The Journal of Trauma Injury, Infection, and Critical Care, 67(3), 606-611. 5. Sarkar, D., & Philbeck, T. (2009). The use of multiple intraosseous catheters in combat casualty resuscitation. Military Medicine, 174(2), 106-108.
