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Simulation Center offers realistic training for critical care air transport team

  • Published
  • By Bernard S. Little
  • Walter Reed National Military Medical Center Public Affairs staff writer
BETHESDA, Md. --  On an Air Force medical evacuation aircraft, two critically injured Soldiers are being transported from Bagram Airfield, Afghanistan, to Landstuhl Regional Medical Center, Germany, under the care of a Critical Care Air Transport Team .

A CCATT is a flying three-person critical care unit responsible for caring for the most severely injured and ill patients, while flying them from lower levels of medical care to higher levels of care. This includes flying patients from small forward operating base hospitals to larger medical facilities in theater, flying patients out of theater to Landstuhl, or flying patients from Landstuhl to the United States.

The above scenario was part of CCATT Simulation Day hosted by the 779th Medical Group at Walter Reed National Military Medical Center Dec. 11.

"We had a short time to mission plan, request supplies, and talk to the doctor at Afghanistan to see what changes had happened since [the] last update," Air Force Capt. Andrew Ray Severns said about the simulated flight from Bagram to Landstuhl. "At that point, we were to board the plane and start caring for the patients, responding to any needs that may arise," added the critical care nurse, part of the three-person CCATT which also included emergency medicine physician Air Force Capt. (Dr.) Katherine Ellis and respiratory therapist Air Force Staff Sgt. Jamie Bucher. The three are members of the 779 MDG headquartered at Joint Base Andrews, Md.

During the flight, Ellis, Severns and Bucher responded to various critical care needs of the patients, including treating head, lung and leg injuries, pressure monitoring, cardiac concerns, IV requirements, and ventilation and breathing challenges.

Members of the 779th MDG are part of the National Capital Region Medical Directorate enhanced Multi-Service Market, along with WRNMMC, Fort Belvoir Community Hospital and other military treatment facilities in the NCR providing care to more than 500,000 beneficiaries throughout the region, including at Malcolm Grow Medical Clinics and Surgery Center at JBA.

Air Force Lt. Col. Martin Harssema, staff anesthesiologist/CCATT program director, explained the importance of the CCATT training at WRNMMC, during which physicians, nurses and respiratory therapists were able to hone their critical care skills on life-like manikins using virtual reality machines and equipment in the high-tech, state-of-the-art simulation center at Walter Reed Bethesda.

"We have learned through the years in medical education that simply reading about patient care isn't enough," Harssema explained.  "In the same way that pilots do ground school and simulators before flying, the medical profession is beginning to adopt similar techniques. 

"Patient simulation is still in a relative infancy in the medical community, but a growing field," Harssema continued.  "The significance of our specific training is three-fold: first, to reinforce the fundamentals of patient management in critical care with a focus on life-threatening scenarios; second, to better prepare our personnel for success at the Center for Sustainment of Trauma and Readiness Skills course in Cincinnati, the critical validation course of each deployer's clinical abilities that formally vets them as mission-ready; and three, to provide hands-on training with the highest degree of realism, [including] manikin function, equipment, even sound/environmental control, so as to ready our personnel to provide the best clinical care possible to our wounded warriors while deployed."

Twenty-five critical care medical personnel participated in the recent CCATT Simulation Day training at WRNMMC, Harssema said. "The feedback has been overwhelmingly positive.  On this particular training, the majority of attendees ranked the simulation, learning and instructors as 'excellent.' Those who have attended the CSTARS course after our last simulator training said it was a remarkable leap forward in preparing them for CSTARS simulations and deployment.  We are constantly assessing our feedback in this new endeavor to better the experience with each subsequent course."

Severns added, "Sustainment/readiness trainings do not attempt to familiarize [personnel] to what is a normal CCATT mission. Rather, they test ability and familiarize us with handling the worst case scenario."

Harssema agreed, explaining, "As with all training, I think the mantra is 'hope for the best, prepare for the worst.' The training we do is effective in recreating the environment -- dim light, ambient aircraft sound, and provides hands-on with the same equipment and gear that will be used during CCATT.  It additionally gives folks a first-look at team dynamics in a constrained, high-pressure environment and teaches them not only how to expect others to act, but gives them a mirror to look at how they themselves will act in such an environment.

"In reality, most CCATT missions go off without much of a hitch... and that is because extensive care is taken to field only highly-prepared and clinically astute teams, and only fly patients who have been clinically vetted at multiple levels as being capable to sustain the flight environment," Harssema continued. "Overall, I think our training compares closely to actual CCATT - and that continues to be the goal."

Ellis, who works in the MGMCSC Emergent Care Center, said she enjoyed the CCATT training at Walter Reed. "I feel like more familiarity with the CCAT equipment and supplies, is always better, and the training was a great opportunity to get my hands on the equipment and to re-familiarize myself with the bag sets. The CCATT 'patients' we were treating in the simulator were much sicker and more complex than the patients I see in my regular job in the MGMCSC ECC, so it was also a great opportunity to brush up on my critical care skills. I enjoyed working in the team environment in the simulator, and I also enjoyed getting the chance to meet other CCATT personnel from Andrews."

According to Lt. Gen. (Dr.) Thomas W. Travis, the Air Force surgeon general, since the 9/11 terrorist attacks, the Air Force has logged more than 194,000 patient movements, and CCATTs transported over 9,000 critically injured or ill patients. He added the efforts of CCATTs have contributed to greater survivability of war wounds among U.S. troops in Afghanistan and Iraq.

Air Force officials also note during the Vietnam War, it took an average of 45 days to return patients to the states and 75 percent of wounded warriors survived. The Air Force's CCATT capability allows service members to be transported from the point of injury to a stateside hospital in less than three days and 98 percent survive their injuries. CCATT teams also support peacetime movement of critically ill beneficiaries of the military health care system, as well as humanitarian assistance such as airplane crashes and natural disasters.