The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study
Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions,...
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Published in | The journal of trauma and acute care surgery Vol. 79; no. 5; p. 741 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
01.11.2015
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Subjects | |
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Abstract | Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings.
An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the "Cut Suit") was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon.
There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004).
Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures. |
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AbstractList | Hemorrhage is the leading cause of preventable posttraumatic death. Many such deaths may be potentially salvageable with remote damage-control surgical interventions. As recent innovations in information technology enable remote specialist support to point-of-care providers, advanced interventions, such as remote damage-control surgery, may be possible in remote settings.
An anatomically realistic perfused surgical training mannequin with intrinsic fluid loss measurements (the "Cut Suit") was used to study perihepatic packing with massive liver hemorrhage. The primary outcome was loss of simulated blood (water) during six stages, namely, incision, retraction, direction, identification, packing, and postpacking. Six fully credentialed surgeons performed the same task as 12 military medical technicians who were randomized to remotely telementored (RTM) (n = 7) or unmentored (UTM) (n=5) real-time guidance by a trauma surgeon.
There were no significant differences in fluid loss between the surgeons and the UTM group or between the UTM and RTM groups. However, when comparing the RTM group with the surgeons, there was significantly more total fluid loss (p = 0.001) and greater loss during the identification (p = 0.002), retraction (p = 0.035), direction (p = 0.014), and packing(p = 0.022) stages. There were no significant differences in fluid loss after packing between the groups despite differences in the number of sponges used; RTM group used more sponges than the surgeons and significantly more than the UTM group (p = 0.048). However, mentoring significantly increased self-assessed nonsurgeon procedural confidence (p = 0.004).
Perihepatic packing of an exsanguinating liver hemorrhage model was readily performed by military medical technicians after a focused briefing. While real-time telementoring did not improve fluid loss, it significantly increased nonsurgeon procedural confidence, which may augment the feasibility of the concept by allowing them to undertake psychologically daunting procedures. |
Author | Tien, Homer Brien, Susan Roberts, Derek J McKee, Jessica Lynn Ball, Chad G Keillor, Jocelyn Kirkpatrick, Andrew W Lavell, Kit Wright Beatty, Heather E Wong, Jonathan LaPorta, Anthony T Beckett, Andrew |
Author_xml | – sequence: 1 givenname: Andrew W surname: Kirkpatrick fullname: Kirkpatrick, Andrew W organization: From the Canadian Forces Health Services (A.W.K., H.T., J.W., A.B.); Departments of Surgery (A.W.K., D.J.R., C.G.B.), Critical Care Medicine (A.W.K.), and Community Health Sciences (D.J.R.), and Regional Trauma Services (A.W.K., C.G.B.), Foothills Medical Centre; and Innovative Trauma Care (J.L.M.), Edmonton, Calgary, Alberta; Sunnybrook Health Sciences Centre (H.T.), Toronto; and Royal College of Physicians and Surgeons (S.B.); and Flight Research Laboratory (J.K., H.E.W.B.), National Research Council of Canada, Ottawa, Ontario, Canada; Rocky Vista University, Parker, Colorado (A.T.L.); and Strategic Operations (K.L.), San Diego, California – sequence: 2 givenname: Homer surname: Tien fullname: Tien, Homer – sequence: 3 givenname: Anthony T surname: LaPorta fullname: LaPorta, Anthony T – sequence: 4 givenname: Kit surname: Lavell fullname: Lavell, Kit – sequence: 5 givenname: Jocelyn surname: Keillor fullname: Keillor, Jocelyn – sequence: 6 givenname: Heather E surname: Wright Beatty fullname: Wright Beatty, Heather E – sequence: 7 givenname: Jessica Lynn surname: McKee fullname: McKee, Jessica Lynn – sequence: 8 givenname: Susan surname: Brien fullname: Brien, Susan – sequence: 9 givenname: Derek J surname: Roberts fullname: Roberts, Derek J – sequence: 10 givenname: Jonathan surname: Wong fullname: Wong, Jonathan – sequence: 11 givenname: Chad G surname: Ball fullname: Ball, Chad G – sequence: 12 givenname: Andrew surname: Beckett fullname: Beckett, Andrew |
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SubjectTerms | Abdominal Injuries - surgery Canada Clinical Competence Emergencies Emergency Medical Services Emergency Medical Technicians - education Female First Aid Gastrointestinal Hemorrhage - surgery Humans Laparotomy - education Laparotomy - methods Male Manikins Mentors Military Personnel Pilot Projects Telemedicine - methods |
Title | The marriage of surgical simulation and telementoring for damage-control surgical training of operational first responders: A pilot study |
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