Squads to test training to improve combat casualty care

Soldiers wounded in combat may have a better chance of surviving if the Army gives its warriors better, more realistic point-of-injury training to help their wounded battle buddies, say officials with the Army's Squad Overmatch Study.

Training to respond immediately to combat injuries can be vital, as about 80 percent of the initial treatment in combat situations is done by the wounded soldier himself or the soldier next to him, rather than their medic, they say.

A team is working on ways to improve immediate care for soldiers at the point of injury so they stand a better chance of surviving until they get to the next level of care, and ultimately to the hospital. The team includes scientists, medical simulation experts, psychologists, engineers and advisers.

This fall, six squads — four Army and two Marine Corps — will take part in a joint effort to improve tactical combat casualty care, or TC3, at the squad level, a move officials say can help fill a gap in tactical training.

The TC3 effort is complementary to the Squad Overmatch Study, which is looking at ways to make combat training more relevant and realistic, and make soldiers more resilient to traumatic situations.

During combat simulations for the Squad Overmatch Study, when soldiers were wounded they were taken to a collection area, their buddies would secure the area, call in support, "and that was it, the exercise stopped," said Rob Wolf, Squad Overmatch Study project director at the Army's Program Executive Office for Simulation, Training and Instrumentation, or PEO STRI.

"We realized there was a hole in tactical combat casualty care. The exercise should not stop," he told Army Times.

In Army combat casualty training, "predominantly the focus has been on the medic," Wolf said. "This effort analyzes pushing training in a combined arms environment down to the squad level with treatment at the self, buddy and combat lifesaver level."

The team is shaping future requirements, both from the perspective of integrated training strategy, which would fall under Army Training and Doctrine Command, and from the perspective of developing and using technology, which PEO STRI would be involved in, Wolf said.

Tactical Combat Casualty Care is team decision-making under extreme stress, team members say. TC3 providers and squad leaders need unit-level training to handle both tactical and medical requirements in realistic scenarios.

"Soldiers in combat, dealing with casualties, must balance three extremely complex life-and-death situations: the threat, the casualties and accomplishing the mission," said Col. (Dr.) Dan Irizarry, clinical adviser to the Joint Project Office for Medical Modeling and Simulation. "This study, the first study of its kind, will evaluate training techniques and technologies to help soldiers, squads and leaders successfully manage all three challenging situations."

While the Army's first-responder training does give individuals tactical medical skills through medical simulation training centers, using mannequins that can simulate bleeding and dying, there is no collective training that tests and certifies squads in doing tactical medical treatment, officials said.

Squad involvement is important, team members say, not only for coordinating on-the-spot medical treatment but also for how the squad's soldiers can handle what's happening to their buddies..

Improving the squad members' performance in tactical medical situations "may also increase individual and squad resilience when dealing with emotional problems that may result from a fellow Soldier's death," the team states in a document about the study. "It may also improve the squad's ability to recover from losses and return to critical tactical-decision making faster."

The training the squads will go through this fall will include gaming, virtual environments and practice with tools with the potential to save soldier's lives, Wolf said.

They will train on tourniquets, chest decompression needles and nasal airway equipment with digital instrumentation to supplement the MILES gear, short for Multiple Integrated Laser Engagement System.

The devices would be automatically associated with digital real-time casualty assessment algorithms for the wounded soldier or civilian, Wolf said, potentially allowing them to survive to the next level of care.

Upgraded MILES gear will help support instrumentation of the medical equipment, Wolf said.

"New architecture for our MILES is an open environment, much like a desktop environment," Wolf said. "We're going to build the instrumentation for the medical systems so they will plug and play in that architecture and be part of the same environment."

Squads will each have three days of training so the team can collect data on how to improve squad training across the Army. The soldiers and Marines will experience a graduated increase in stress during the training scenarios.

After-action reports will be done in the same three-day period to give troops the best chance at retaining their impressions.

The Walter Reed Army Institute of Research is on the team and will provide input on scenarios based on TC3 "so we can make it even more stressful for the soldiers and get realistic data," Wolf said.

The plan is to have training that applies to responders in multiple services: combat medics, Navy corpsmen and TC3 first responders.

The TC3 project is supported by Army Medical Command and the Defense Health Agency. MEDCOM agreed to approve two years of work on it, then in the third year the team will look at trying to integrate it into the Army training strategy, Wolf said.

The team includes scientists, psychologists, engineers, medical simulation experts and advisors.

Other organizations involved:  Naval Air Warfare Center Training Systems Division, the Army Research Laboratory, The MITRE Corporation, Maneuver Center of Excellence, the Federal Law Enforcement Training Center, the Office of Naval Research, Marine Corps Program Manager Training Systems, University of Southern California Institute for Creative Technologies, Army Training and Doctrine Command and Army Special Operations Command.

The intent is to measure how both individual and squad performance improves in managing tactical medical scenarios and how resilient the troops become.

The training is designed around techniques developed in the 75th Ranger Regiment., Irizarry said, with tactical medicine subject matter experts to guide the study team, among them retired Col. (Dr.) Russ Kotwal, who was involved in the study "Eliminating Preventable Death on the Battlefield," which documented the 75th's training efforts to save lives in combat.

The TC3 study will incorporate "Ranger-developed training concepts, advanced training technology, real-time data capture and innovative after-action reviews," Irizarry said.

When the study ends, "I would like to be able to tell a commander that if he invests a defined amount of training time enhanced by this suite of training devices, he can expect his squad's tactical medical performance to increase," he said, "similar to when we send soldiers to a marksmanship range."

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