Training and Assessing Critical Airway, Breathing and Hemorrhage Control Procedures for Trauma Care: Live Tissue versus Synthetic Models

Abstract

Introduction

Optimal teaching and assessment methods and models for emergency airway, breathing and hemorrhage interventions are not currently known. The University of Minnesota Combat Casualty Training consortium (UMN CCTC) was formed to explore the strengths and weaknesses of synthetic training models (STMs) versus Live tissue (LT) models. In this study, we compare the effectiveness of best in class STMs versus an anesthetized caprine (goat) model for training and assessing 7 procedures: Junctional hemorrhage control, Tourniquet (TQ) placement, Chest seal, Needle thoracostomy (NCD), Nasopharyngeal airway (NPA), Tube thoracostomy, and Cricothyrotomy (Cric).

Methods

Army combat medics were randomized to one of four groups: 1) Live tissue trained – live tissue tested (LT-LT), 2) live tissue trained – synthetic training model tested (LT-STM), 3) synthetic training model trained – live tissue tested (STM-LT), 4) synthetic training model trained – synthetic training model tested (STM-STM). Participants trained in small groups for 3-4 hours and were evaluated individually. LT-LT was the “control” to which other groups were compared, as this is the current military pre-deployment standard. The mean procedural scores (PS) were compared using a pairwise t-test with a Dunnett's correction. Logistic regression was used to compare critical fails (CF) and skipped tasks.

Results

There were 559 subjects included. Junctional hemorrhage control revealed no difference in CFs, but LT tested subjects (LT-LT and STM-LT) skipped this task more than STM tested subjects (LT-STM and STM-STM) (p<0.05), and STM-STM had higher PS than LT-LT (p<0.001). For TQ, both STM tested groups (LT-STM and STM-STM) had more CFs than LT-LT (p<0.001) and LT-STM had lower PS than LT-LT (p<0.05). No differences were seen for chest seal. For NCD, LT-STM had greater CFs than LT-LT (p=0.001), and lower PSs (p=0.001). There was no difference in CFs for NPA, but all groups had worse PS versus LT-LT (p<0.05). For Cric, we were underpowered; STM-LT trended towards more CFs (p=0.08), and STM-STM had higher PSs than LT-LT (p<0.01). Tube thoracostomy revealed STM-LT had higher CFs than LT-LT (p<0.05), but LT-STM had lower PS (p<0.05). An interaction effect (making the subjects who trained and tested on different models more likely to CF) was only found for Tourniquet, chest seal and Cric, however, of these 3 procedures, only TQ demonstrated any significant difference in CF rates.

Conclusion

Training on STM or LT did not demonstrate a difference in subsequent performance for 5 of 7 procedures (junctional hemorrhage, TQ, chest seal, NPA and NCD). Until synthetic training models are developed with improved anthropomorphic and tissue fidelity, there may still be a role for LT for training tube thoracostomy and potentially cricothyrotomy. For assessment, our STM appears more challenging for TQ and potentially for NCD than LT. For junctional hemorrhage, the increased “skips” with LT may be explained by the differences in anatomic fidelity. While these results begin to uncover the effects of training and assessing these procedures on various models, further study is needed to ascertain how well performance on an STM or LT model translates to the human model.

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