Graduate Education Office, Enlisted to Medical Degree Preparatory Program, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Department of System Biology, George Mason University, Fairfax, VA 20120, USA.
Mil Med. 2024 Aug 30;189(9-10):e2192-e2199. doi: 10.1093/milmed/usae162.
Providing resilient Damage Control Resuscitation capabilities as close to the point of injury as possible is paramount to reducing mortality and improving patient outcomes for our nation's warfighters. Emergency Fresh Whole Blood Transfusions (EFWBT) play a critical role in supporting this capability, especially in future large-scale combat operations against peer adversaries with expected large patient volumes, restrictive operating environments, and unreliable logistical supply lines. Although there are service-specific training programs for whole blood transfusion, there is currently no dedicated EFWBT training for future military medical officers. To address this gap, we developed, implemented, and evaluated a training program to enhance EFWBT proficiency in third-year military medical students at the F. Edward Hebert School of Medicine at the USU.
After reviewing both the 75th Ranger Regiment Ranger O-Low Titer program and the Marine Corps' Valkyrie program, along with the relevant Joint Trauma System Clinical Practice Guidelines, we created a streamlined and abbreviated training curriculum. The training consisted of both online preparatory materials as well as a 2-hour in-person training that included didactic and experiential learning components. Participants were 165 active duty third-year medical students at USU. Participants were assessed using a pre- and post-assessment self-reported questionnaire on their confidence in the practical application and administrative oversight requirements of an EFWBT program. Participants' performance was also assessed using a pre/post knowledge assessment consisting of 10 multiple choice questions identified as critical to understanding of the academic principles of EFWBT along with the baseline questionnaire.
Differences in the mean scores of the pre- and post-assessment self-reported questionnaire (increased from 2.32 to 3.95) were statistically significant (P < .001). Similarly, there was a statistically significant improvement in student test scores, with the mean score increasing by approximately 3 points or 30%. There was no significant difference in student confidence assessment or test scores based on branch of service. Students who had previously deployed did not show a statistically significant difference in scores compared to students who had not previously deployed.
Our results suggest that the implementation of streamlined EFWBT training into the undergraduate medical education of future military medical officers offers an efficient way to improve their baseline proficiency in EFWBTs. Future research is needed to assess the impact of this training on real-world applications in forward-deployed environments.
尽可能在靠近受伤点的地方提供有弹性的损伤控制复苏能力，对于降低我国作战人员的死亡率和改善患者预后至关重要。紧急新鲜全血输注（EFWBT）在支持这一能力方面发挥着关键作用，尤其是在未来针对具有预期大量患者量、限制操作环境和不可靠后勤供应线的同等对手的大规模作战行动中。虽然有专门针对全血输注的服务特定培训计划，但目前没有针对未来军事医务人员的专门 EFWBT 培训。为了解决这一差距，我们在美国 USU 的 F. Edward Hebert 医学院开发、实施和评估了一项培训计划，以提高三年级军事医学生的 EFWBT 熟练度。
在审查了第 75 游骑兵团游骑兵低滴度计划和海军陆战队 Valkyrie 计划以及相关的联合创伤系统临床实践指南之后，我们创建了一个简化和精简的培训课程。培训包括在线预备材料以及 2 小时的面对面培训，包括理论学习和实践学习部分。参与者是 USU 的 165 名现役三年级医学生。参与者使用预评估和后评估自我报告问卷评估他们对 EFWBT 计划的实际应用和行政监督要求的信心。参与者的表现也通过预/后知识评估进行评估，该评估包括 10 个多项选择题，这些问题是理解 EFWBT 的学术原理的关键，以及基线问卷。
预评估和后评估自我报告问卷的平均分数差异（从 2.32 增加到 3.95）具有统计学意义（P <.001）。同样，学生考试成绩也有统计学意义的提高，平均分数提高了约 3 分或 30%。根据服务分支，学生的信心评估或考试成绩没有显著差异。以前部署过的学生与以前没有部署过的学生相比，分数没有统计学上的显著差异。
我们的结果表明，将简化的 EFWBT 培训纳入未来军事医务人员的本科医学教育中，是提高他们在 EFWBT 方面基本熟练度的一种有效方法。需要进一步研究来评估这种培训对前部署环境中实际应用的影响。
