I get asked on occasion “Why did I get started in simulation?”  My answer is grounded in an observation from Iraq.  I am in the Vermont Air National Guard.  In 2006 and again in 2007 I deployed to Balad,Iraq.  I was assigned to the Air Force Theater Hospital in Balad, about 60 minutes northeast of Baghdad.  This was the military major medical center for all of Iraq.

Balad was the place where all aeromedical transport out of Iraq started. So every wounded or sick American being evacuated back to the States came through Balad.  In 2007, at the height of “the surge”, it was a busy place.  Based in Balad was an Army aviation company responsible for medevac, or in-country transport of casualties.  They flew the UH-60 or “Blackhawk” helicopter.  These guys were amazing and flew to other cities and military hospitals but also flew to the front lines to pick up wounded soldiers, sometimes taking fire themselves.  I was there as a flight surgeon and flew often with the medevac choppers.

The medevac unit in Balad when I started in July had been there 11 months.  When they dropped off patients in our emergency room (“room” being a fancy name for “tent”), the patients had superb care.  Injured limbs had properly applied tourniquets. Bandages were in place.  One or two intravenous lines were started.  They knew the patients’ histories, how and where they were injured, and what drugs were administered.  These guys were good – they had almost a full year of experience – and plenty of patients to transport during that time.  Having performed their job over 12 months, their well-deserved return home came up as their replacements rotated in.

Initial flights had mixed crews over a few days but the “new guys” were rapidly thrown into the fray.  Unfortunately, it was obvious.  The “deer-in-the-headlights look” was evident.  The new crew seemed to just pick up patients and got them here as fast as possible.  Patient histories were not clear, intravenous lines were not in place (thankfully tourniquets were) and the level of expertise was just not there.  It was so obvious in the first week.  Well, those guys got better quickly.

Okay, so what’s this got to do with clinical simulation?  (Doc’s a little distracted, eh?  Ask him what time it is and he tells you how to make a clock…) Well, it seemed to me it would have been nice to get those Blackhawk medics practice before we threw them into the fray, right?  Why weren’t they trained on simulators?  All the procedures they needed to do could be replicated on simulators before they arrived so they could have felt more comfortable about the patients they were taking care of in the field (I am told they do have training now prior to these deployments).

So, I started thinking about simulators and how we could apply training on simulators for our students, residents, and Air National Guard personnel.  If you see our Clinical Simulation Laboratory or are lucky enough to win our “Doc for a Day” event (“like” us on Facebook and then make sure you enter!), you’ll understand things got a little out of hand and we went a little further than “thinking about simulators…”

Michael A. Ricci, MD, is Clinical Director of Simulation and a vascular surgeon at the UVM Medical Center.

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