Prolonged Field Care Training: CAESAR vs METIMan HPSN World, Sarasota, Fl, USA, April 29 th 2014 Dr. Burkhard Milde

Prolonged Field Care Training:CAESAR vs METIMan

HPSN World, Sarasota, Fl, USA, April 29th 2014

Dr. Burkhard Milde

HPSN World 2014 Sarasota– Dr. Burkhard Milde

Dr. med. Burkhard Milde

Adjacent Faculty Member CAE Healthcare

Until 2006 German Army Flight Surgeon

– Human Factors- / CRM-Instructor

– Simulators / new helicopters (Tiger/ NH90)

Family Med, Occupational Health, Aerospace Med., Emergency Med.

postdoc: Management of Healthcare organisations

A little about me


Simulation and competence

Know

Know how

Show

DoSimulationsophisticationincreases

Speed of learning, multiple objectives

Wilford & Doyle 2006


Why use simulation in prolonged field care training?

Knowledge about protocols,

physiology , pharmacology etc..

Attitude communication,

empathy leadership etc..

Skills undertaking assessment,

clinical procedures etc..


CAESAR vs. METIMan


Simulator features - overview


• HPL: Human Performance and Limitations-

• HF: Human Factors

• CRM: Crew Ressource Management

• Personal Safety

• Patientsafety

Force protection=

Protection of running projects/ processes

©B. Milde, 2012

Human Factors / Crew Resource Management


Quality of process

Quality of infrastructure

Quality of result

in complex situations

Simulationand CRM improve :

©B. Milde, 2012

CAESAR vs METIMan


Simulation is established for training of

– Skills

– Tactical/ Operational training

– New techniques/ standards/ material

– Crew Ressource Management (CRM)

CAESAR vs METIMan


PHTLS-PFC- EVAC – D C Surgery- MedEvac

The care given by unprofessional unexpirenced first providers/ life savers after lifesaving procedures before evacution is available due to

a lack of transportation capacity

Envronment conditions (weather, political situation)

Austere distant conditions

CAESAR vs METIMan: Prolonged Field Care


PHTLS-PFC- EVAC – D C Surgery- MedEvac

Humanitarian help at desaster sites (earthquakes, tzunamis, volcanoerruptions)

War zones

Mass casualty desasters (industrial explosions)

Distant austere working sites (oil plattforms, ships, mines, construction sites, forrests … )



PHTLS is established successfully

Gap of „Prolonged Field Care“:

PHTLS-PFC- EVAC – Damage Controll Surgery


Arch Surg 2011, 146:1350-1358


Prolonged Field Care is

a process of „Theragnostic“

(therapy/ diagnostic)

-from (well trained) reaction to proactive caretaking (unexperienced)

CAESAR vs MM:Prolonged Field Care: Intro

HPSN World 2014 Sarasota– Dr. Burkhard Milde©B. Milde, 2012

Pain as a challenge/ Responder must manage up to 24 hrs allone, PHTLS Skills are well trained

How about PFC Pain-management?

Operator´s condition? Tired, Injured, Shock, …Support (Telemed, radio, teammembers,…)

Casulty conditions: Ventilated?

Shock?

State of consciousness

Prolonged Field Care: Scenario 1 Pain


Why pain-management?

Pain is most feared

Will cause problems during PFC– Choice of drug (morphine- derivate/ Ketarolat)– Dosage– Application (p.o., i.m., i.v., i.o., dermal)– Alternatives (local anesthesia?)

Prolonged Field Care: Scenario 1 Pain- Intro


Pain as a clinical „sign and symptom“:

Arrousal, conscioussness (GCS)

Blood-pressure

Hyperventilation



– Scientific Initiative for Developing a training tool/ simulator for TCCC by the US DoD: Development of CAESAR by CAE

– 09/ 2012 change to MÜSE- Software taking over METI

Caesar™ vs METIMan: History Simulators

©B. Milde, 2013


CAESAR







Orientation to the mannequin

21

HPSN World 2014 Sarasota– Dr. Burkhard Milde 22

CAESAR – Simulator Features


METIMan- Simulator features


CAESAR vs METIMan: MÜSE® -Software

©B. Milde, 2012


Prolonged Field Care: Scenario 2 TBI- Intro


Prolonged Field Care is

the process of „Theragnostic“

(therapy/ diagnostic)

proactive caretaking



Blast related/ TBI as a challenge: (N Eng J Med 2011, 364, 2091-2100)

CFR must manage up to 24 hrs allone

PHTLS Skills are well trained

How about PFC TBI-management/- prevention?

Casulty Conditions: Ventilated?

Shock?

State of consciousness

Prolonged Field Care: Scenario 2 TBI


Why focuss on TBI?

Will cause problems/ may be influenced during PFC

– Choice of drug (morphine- derivate/ Ketarolat)– Dosage– Application (p.o., i.m., i.v., i.o.)– Alternatives

Documentation

©B. Milde, 2012



Limitations:NO clinical simulator!NO CPR simulator!NO real fire simulation! (firefighters due to high temperatures)

Defined objectives realistic?Limited NVG (Night vision goggles) applications (due to eyes and tablet-pc)?

©B. Milde, 2012

CAESAR vs METIMan: Limitations to CAESAR


Limitations:• Clinical simulator! Not ruged, limited outdoor

application • CPR simulator!• NO real fire simulation! (firefighters due to high

temperatures)• Experienced clinical trainer and• Technical support neccessary

Defined objectives realistic?

CAESAR vs METIMan: Limitations to METIMan


Limitations to Caesar and METIMan

Wifi-dependable (problem in narrow vehicles and rooms


Caesar vs METIMan- Core: Safety

ARS for Needle Decompression (14 gauge x 3.25 in.) www.narescue.com

• Entspricht nicht der TRBA 250 (stichsichere Systeme)

• Vorteil: Mehrfach verwendbar im Training!

• Vorteil: durch CAE Healthcare für Caesar zugelassen


Caesar vs METIMan: equipment limitations

EZ-IO Sternal Manual Needle Set Larynxmasken bis Gr. 3 !!!


CAESAR vs. METIMan: outlook


CAESAR vs. METIMan: outlook

Artificial tissue-applications ( compare to „surgical cut suit“)

Vimedex integration

Combination of MM features and Caesars ruggedness „CaesarMan?“


CAESAR vs .METIMann: Technical support


CAESAR vs METIMAnn: Prolongedd Field Care – Results:

• Chose your simulator depending on the issues• Objectives• Learners• Surroundings• Materials• Tech support

• Booth simulators are a perfect mix


Questions?Discussion

Documents

Prolonged Field Care Training: CAESAR vs METIMan HPSN World, Sarasota, Fl, USA, April 29 th 2014 Dr. Burkhard Milde