Strategic Operations - News


A collection of news and press items featuring Strategic Operations, Inc.


Transforming Tactical Combat Casualty Care to Civilian Providers via Medical Simulation

Posted January 23, 2020 (From HealthySimulation.com January 9, 2020 - Original Article)

Today’s emergency casualty care builds on lessons learned in the wars in Afghanistan and Iraq and active shooter and mass casualty tragedies in the civilian world. Lessons learned from tactical combat are crucial for the civilian space to understand and train for in today’s world. This information transfer has lead to unique government supported initiatives and innovative training products which are crucial for healthcare simulation programs to understand and incorporate. Here below, Strategic Operations’ Kit Lavell reviews the latest developments in education, training and medical simulation technologies designed to save lives in our contemporary world.

Tactical Combat Casualty Care (TCCC) guidelines were developed more than twenty years ago but matured during the wars in Afghanistan and Iraq. TCCC is based on Care Under Fire, Tactical Field Care, and Tactical Evacuation Care to address the three most preventable causes of death on the battlefield (and as discussed below, also on highways, in industrial accidents and active shooter and mass casualty tragedies): hemorrhage; tension pneumothorax; and airway obstruction (Butler, 2017). The TCCC skills have been proven safe and effective, and even somebody without medical training can perform them.

Massive hemorrhage is controlled with tourniquets, hemostatic dressings, junctional devices, and pressure dressings. The airway is managed by the rapid and aggressive opening of the airway to include cricothyroidotomy for difficult airways. Respiration and breathing are managed by the assessment for tension pneumothorax and the aggressive use of occlusive dressings and needle decompression devices to relieve tension and improve breathing.

As TCCC was applied in Afghanistan and Iraq in Role 1 Care (immediate and at a battlefield Medical Treatment Facility), the survival rate for a preventable death wounded, i.e., someone who was not killed outright, was about 95%. A preventable death is someone who has died from massive extremity hemorrhage, a tension pneumothorax, and/or airway obstruction. This was a significant increase over previous wars and resulted from TCCC being applied in the “Golden Hour” before being evacuated to Role 2 Care for surgery.

Over the last decade or more, TCCC techniques have filtered down to civilian trauma treatment and training, especially the use of tourniquets, hemostatic dressings, junctional devices, and pressure dressings. On October 6, 2015, the White House unveiled its “Stop the Bleed” campaign to encourage bystanders to act as immediate responders. Collaborating with the Departments of Homeland Security and Health and Human Services, FEMA, the private sector, nonprofits, and the medical community, the “Stop the Bleed” initiative aims at raising awareness of life-saving techniques and providing public access to tools for bleeding control already used by EMS and the military.

Additionally, this campaign is a culmination of partnerships between the National Security Council at the White House, American Heart Association, American Red Cross, American College of Surgeons (ACS), Hartford Consensus, National Association of Emergency Medical Technicians (NAEMT) and others. “Stop the Bleed” campaign’s goal is to train millions of Americans over the next decade.

Since its release date, June 25, 2019, the 2nd edition of the (NAEMT) Tactical Emergency Casualty Care (TECC) course teaches EMS practitioners on all levels how to respond to and care for patients in a civilian tactical environment. TECC is a set of best practice treatment guidelines for trauma care in high-threat prehospital settings. The guidelines are built from lessons learned by the U.S. and allied military forces in Iraq and Afghanistan and were brought to the civilian sector via the Committee on Tactical Combat Casualty Care (Co-TCCC).

Train for TCCC with Nasco’s Rescue Randy

Nasco Healthcare recently introduced the Casualty Care Rescue Randy, an affordable, rugged, field-deployable, full-body manikin designed for enhanced realistic training on TECC procedures, powered by Strategic Operations Hyper-Realistic technology. The Casualty Care Rescue Randy is designed for use by civilian EMS, EMT, Law Enforcement and other civilian and military medical first responders.

The manikin has articulated joints, mimics a human body’s weight distribution, holds three to four liters of simulated blood, has a foot-operated pump (an electronic pumping system is optional) to deliver blood to femoral, brachial, inguinal and carotid wounds, and allows for treatment interventions using extremity and junctional tourniquets, wound packing and pressure bandages. Airway management is accomplished with Nasopharyngeal, Oropharyngeal, and Cricothyroidotomy. Tension pneumothorax with Needle Decompression at the 4th/5th intercostal space in the anterior axillary line and at the 2nd/3rd intercostal space in the mid-clavicular line. A penetrating chest wound allows for an occlusive dressing to be applied.

The Casualty Care Rescue Randy’s skin is user repairable, and unlike other manikins, it does not have a “target” that “guides” the provider where to place the needle. The provider must visually locate and properly palpate to determine correct placement. Casualty Care Rescue Randy comes with simulated blood, repairable neck skins, repairable tracheas, and a repair kit. There is a tremendous need for realistic, user-repairable manikins to teach first responders proper tactical medicine techniques – that are affordable – and rugged enough to be used in the field.

“We use Casualty Care Rescue Randy manikins in the classroom and field portions of our NAEMT and POST-certified tactical medicine courses,” says Wyatt Sabo, Medical Training Program Manager at Strategic Operations in San Diego. “First responders can practice life-like training solutions for real-life situations.”

Expansion of Specialized Training for TCCC from the DHA

Last summer, the Assistant Secretary of Defense for Health Affairs chartered a working group of members of the Defense Health Agency (DHA) and other military services responsible for developing a structured Tactical Combat Casualty Care (TCCC) curriculum for all service members (ASM). TCCC ASM was released on August 1st and will be the first level of four-tiered standardized TCCC curricula to be completed. The TCCC ASM course follows the MARCH algorithm and covers five lifesaving skills (rapid casualty assessment, tourniquet application, hemostatic dressing, pressure dressing, and airway maneuvers) over 6 hours that will serve both as the minimum standard of care for all service members and act as the foundation for the four-tiered TCCC program (Remley, 2019).

The second tier, Combat Lifesaver (CLS), was released on December 31, 2019 and follows MARCH PAWS, which helps familiarize TCCC concepts and lifesaving skills to render medical aid to a trauma casualty. The course provides information through a short lecture followed by interactive, hands-on training and formal evaluation. The CLS TCCC Course encompasses tactical trauma assessment, bleeding control interventions, airway and respiratory management techniques, and proper lift, drag, and carry methods. The course also covers the prevention and treatment of shock, burns, eye injuries, splints, pain management, critical communication, and medical documentation practices. Upon completion of this 40-hour course, students will be qualified at a TCCC basic level.

They are based on the MARCH PAWS algorithm:

M – Massive bleeding

A – Airway

R – Respiration

C – Circulation

H – Hypothermia/Head


Pain

Antibiotics

Wounds

Splint

Strategic Operations is an authorized NAEMT Training Center that hosts numerous medical training courses; LEFR, TECC, TCCC, and TMT. The Law Enforcement First Response (LEFR) is a course that teaches first responders and allied professionals the primary medical care interventions, which can save an injured person’s life until conventional EMS arrives. The TECC 2nd edition course delivered by STOPS is certified by the ACS and is consistent with the most current guidelines established by C-TECC.

The 40-hour Tactical Medicine Technician (TMT) course prepares SWAT medics and Rescue Task Force (RTF) deployments to mass casualty and active shooter situations. Strategic Operations uses the crawl, walk, run teaching methodology that takes the students from the repetitive practice of core TACMED skills and progress through the full hyper-realistic stress inoculation scenarios using the Casualty Care Rescue Randy.

References:

Butler, F. K. (2017). Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20. Military Medicine, 182(3/4), e1563–e1568.

Feldman, R. (2019). Committee for Tactical Emergency Casualty Care.

Remley, M. (2019). Changes Coming to TCCC Training. Infantry 108(2), 47-49.

Stop the Bleed – Campaign – AEMS.

Tactical Combat Casualty Care Guidelines (2019). Committee on Tactical Combat Casualty Care (CoTCCC).

Tactical emergency casualty care (TECC): Course manual (2nd ed.). (2020). Burlington, MA: Jones & Bartlett Learning.


A hyper-realistic active shooter and mass casualty simulation helps to prepare for the real event

Posted January 20, 2020

Dozens of first responders took place in a simulated active shooter and mass casualty event on Saturday in Kearny Mesa. Local firefighters, paramedics, and police participated in the event to teach educators and clinicians how to conduct similar scenarios for crisis training across the country. The training exercise was for attendees of the International Meeting on Simulation in Healthcare conference (IMSH 2020) taking place in San Diego. The San Diego conference included healthcare educators and clinicians from across the world.

The event took place on the backlot of the former Stu Segall Productions TV studio. The simulation included hyper-realistic explosions and actors portraying active shooters, bombers and point of injury casualties.

The event also included a new "Cut Suit®," a training suit that can be worn by people to simulate actual surgical procedures.

"Paramedics will perform life-saving procedures on people wearing the Cut Suit at the point of injury," said STOPS Executive Vice President Kit Lavell. "And doctors will perform surgery on live humans in the operating room. Of course, they will be wearing Cut Suits."

Watch the video on CBS8 Website



8th Annual Intensive Surgical and Trauma Skills Course (ISTSC)

Posted June 6, 2019

A unique emergency room in San Diego was inundated all week recently with trauma casualties and very sick people requiring surgery, and second year medical students performed surgeries. The trauma resulted from overturned cars, active shooters and improvised explosive devices. Real firefighters, paramedics, and police were the first responders at the scene.

All this occurred at Strategic Operations on the back lot of Stu Segall Productions TV/film studio and the ER and operating rooms are simulation labs constructed for a very unique – one of a kind in the nation – Intensive Surgical & Trauma Skills Course (ISTSC). Forty-two surgeries were performed on live humans – wearing Strategic Operations’ human-worn simulators called “Cut Suits®,” the only hyper-realistic open surgical simulators in the world.

Read More about the 8th Annual Intensive Surgical and Trauma Skills Course (ISTSC)


Mass Casuality Exercise - Medicine Hat, Alberta, Canada

Posted June 6, 2019

(ST/OPS Canada ) conducted a Mass Causality exercise in partnership with the City of Medicine Hat, Alberta, Canada. These full scale emergency exercises prepare police, fire, and EMS to respond to a major crisis.

Chat News Today Canada reported on this unique and vital exercise.

Read More and Watch Video


Realistic Trauma Training Hones Surgical Teams

Posted December 18, 2018 (From Proceedings - December 2018 issue)

With up-to-date intensive curriculum in an immersive environment, simulations can improve medical readiness and patient outcomes.

Read More (PDF)


Damage-Control Medicine

Posted December 18, 2018 (From Seapower Magazine, December 2018 issue)

Immersive Training Prepares Medical Personnel for Future En-Route Care, Evacuation Scenarios

Read More (PDF)


Strategic Operations in the News - Simulated Attack Response - FOX 5 San Diego Coverage

Posted May 11, 2018

On 29 April through 4 May 2018 students from Rocky Vista University College of Osteopathic Medicine (RVUCOM) military medicine track will be joined by students from the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine and the College of Osteopathic Medicine of the Pacific (COMP) at Western University of Health Sciences.


Strategic Operations in the News - Intensive Surgical Skills and Trauma Week - KUSI San Diego Coverage

Posted May 11, 2018

On 29 April through 4 May 2018 students from Rocky Vista University College of Osteopathic Medicine (RVUCOM) military medicine track will be joined by students from the Kansas City University of Medicine and Biosciences College of Osteopathic Medicine and the College of Osteopathic Medicine of the Pacific (COMP) at Western University of Health Sciences.


Intensive Surgical & Trauma Skills Week (ISTSC) at Strategic Operations May 1-4, 2018

Posted May 8, 2018 (From Medical Training Magazine May 1, 2018

A unique emergency room in San Diego, California will be inundated with trauma casualties and very sick people requiring surgery May 1-4, and second year medical students will be those performing surgeries. The simulated trauma scenarios will result from overturned cars, active shooters, a high-rise fire and improvised explosive devices. Real firefighters, paramedics and police will be the first responders at the scene.

Read More


The Seventh Annual Hyper-Realistic® Intensive Surgical & Trauma Skills Week (ISTSC) will be conducted at Strategic Operations April 29 to May 4, 2018

Posted April 26, 2018 (Press Release)

Second Year Medical Students Immersed in Week-Long Series of Life or Death Scenarios Involving Overturned Cars, Active Shooters and IEDs

SAN DIEGO — April 29, 2018 — A unique emergency room in San Diego will be inundated all week with trauma casualties and very sick people requiring surgery, and second year medical students will be those performing surgeries.

The trauma will result from overturned cars, active shooters, a high-rise fire, and improvised explosive devices. Real firefighters, paramedics, and police will be the first responders at the scene. All this will occur at Strategic Operations (STOPS) on the back lot of Stu Segall Productions TV/film studio and the ER and operating rooms are simulation labs constructed for a very unique – one of a kind in the nation – Intensive Surgical & Trauma Skills Course (ISTSC).

From 29 April to May 4, Rocky Vista University College of Osteopathic Medicine (RVUCOM) in Parker, Colorado, Kansas City University of Medicine and Biosciences (KCUMB) and the College of Osteopathic Medicine of the Pacific (COMP) at Western University of Health Sciences will conduct the ISTSC at STOPS’ Simulation Lab. Overhead catwalks and video camera systems enable live viewing and after action review. Forty-five live-action, Hyper-Realistic® simulations of both medical and surgical problems will be created, immersing the participants from point of injury all the way through the ER and OR.

Thirty-five surgeries will be performed on live humans – wearing Strategic Operations’ simulators called “Cut Suits®.”

Thirty-six second-year medical students, many teaching faculty and visiting surgeons and physicians, as well as surgical and ER residents and staff from Balboa Naval Hospital and local hospitals will participate.

“Medical students commonly state that they do not truly understand or recognize a textbook description of a disease or a syndrome until they experience the clinically applicable version of it,” said Strategic Operations Executive Vice President Kit Lavell. “In efforts to reduce the gaps in knowledge and technical skills prior to starting third-year clinical clerkships as well as improve competencies and confidence, this week-long ISTSC mimics a General Surgery rotation.

Lavell said the ISTSC will utilize the “Cut-Suit®,” a human worn surgical simulator, stress-immersion, and other educational modalities in an effort to better prepare medical students for their third-year surgical and emergency medicine rotations. RVUCOM was the first medical school to incorporate the “Cut-Suit®” into medical student education, and when integrated into an ISTSC, it can provide that hands-on experience prior to clinical clerkships by presenting real-life scenarios to medical students in a flexible, safe, efficient and cost-conscious manner.

Rocky Vista University (RVU) is a health sciences university located in Parker, Colorado. RVU’s College of Osteopathic Medicine (RVUCOM) was founded in 2006 and opened its doors in August of 2008, enrolling students in its four year program of study leading to the Doctor of Osteopathic Medicine (D.O.) degree. The University is located in a 145,000-square-foot contemporary facility on twenty acres, housing the latest in classroom, lecture, laboratory and audiovisual equipment, with additional instruction conducted at numerous teaching hospitals throughout the state of Colorado. Rocky Vista University provides quality healthcare education while inspiring students to serve with compassion, integrity and excellence. For more information, visit www.rvu.edu or call 720-875-2804.

Kansas City University of Medicine and Biosciences graduates more physicians annually than any other medical school in Missouri. Active in the Kansas City medical community since 1916, KCUMB is one of the oldest and largest of the nation’s 29 colleges of osteopathic medicine. KCUMB is known as a leader in osteopathic medical education, with an educational environment that emphasizes both academic excellence and the education of caring physicians who place their patients’ needs above all else. For more information, visit http://www.kcumb.edu/about/ or call 816-654-7000.

The College of Osteopathic Medicine of the Pacific (COMP) was established in 1977 in Pomona, California as a direct and important response to a critical shortage of primary care physicians in the western United States. COMP remained as the only osteopathic medical school west of the Rocky Mountains for 18 years. In 1996, COMP was restructured into Western University of Health Sciences (WesternU), which is one of the largest graduate schools for the health professions in California. In 2011, WesternU expanded and opened COMP-Northwest in Lebanon, Oregon to provide medical education to the Pacific Northwest. After 40 years, they have graduated over 5,294 physicians with the majority choosing a career in primary care medicine. For more information, please visit www.westernu.edu or call (909)623-6116 for the Pomona campus or (541)259-0200 for the Lebanon campus.

About Strategic Operations

Strategic Operations Inc., on the lot of Stu Segall Productions, a full-service TV / movie studio in San Diego, Calif., provides “Hyper-Realistic®” training services and products for military, law enforcement and other organizations responsible for homeland security. The company employs state-of-the-art Hollywood battlefield special effects, combat wound effects, medical simulation systems like the “Cut Suit®,” role players, subject matter experts, and training scenarios to create training environments that are the most unique in the industry. Over the last 15 years Strategic Operations has provided Hyper-Realistic® training support to more than 850,000 military – and civilian first responders – in the U.S. and Canada. For more information, visit www.strategic-operations.com. To Follow ISSC week go to “Contact Us” Make sure to enter your e-mail and paste ISTSC_4-29-2018 in the remarks section of the web form. 

 * * *