FORT CAVAZOS, Texas –
Currently, the U.S. Army does not have high-fidelity female simulators for tactical combat casualty care training. That may soon change pending the results of an operational field test of a severe trauma female simulator conducted by the U.S. Army Medical Evaluation Training Activity on behalf of the Army Program Executive Office for Simulation, Training and Instrumentation.
MTEAC organized different trauma lanes over three days from April 3-5, 2024, to test the use of the trauma female simulators. This test provided the test players, comprised of 68W combat medics, flight paramedics (68WF2), combat lifesavers and credentialed Army medical providers, various scenarios to treat battlefield injuries.
Included were amputations, penetrating chest trauma, shrapnel wounds, burns and heat causalities. The test was conducted at the Medical Simulation Training Center at Fort Cavazos, Texas, with support from the 36th Engineer Brigade, 89th Military Police Brigade, 1st Air Cavalry Brigade and 1st Medical Brigade at Fort Cavazos, TX and the 1st Stryker Brigade Combat Team (SBCT), 4th Infantry Division, at Fort Carson, Colorado.
If fielded, the female trauma simulators will provide Army medics and medical providers with increasingly realistic training, filling a current capability gap.
According to the Department of Defense, in 2022, women made up 17.5% of the active duty force, and 21.4% of the National Guard and reserves, numbers that are raising each year.
Most soldiers, including female soldiers, have not trained on even the basic female medical manikins. More training and familiarly with female simulators is needed as women increasingly participate in combat roles.
Capt. Dallas Carranza, a physician assistant with the 581st Area Support Medical Company, 1st Medical Brigade, thought it was amazing to get training on the new simulators. She liked the realism and their ability to breath on their own.
“The female soldier population makes up a large part of the overall Army population,” Caranza said. “It’s important for medical personnel to get hands on training with female mannequins”.
She could not recall ever having trained on a female simulator.
The anatomically accurate trauma female simulators have life-like soft tissue and skin with advanced physiology and integrated patient monitoring. They are full body, wireless and tether-less training devices, two-way communication capability via a headset controlled with a tablet, that enables simulated breathing, arterial and venous hemorrhaging, humeral and sternal intraosseous access, mid-clavicular, axillary needle decompression, and chest tube insertion.
Each has two liquid reservoirs: a 1.5-liter reservoir for hemorrhage control and a 50-milliliter one for urinary output. The simulators are 5 feet 4 inches tall and weigh 135 pounds, the average height and weight of female soldiers across the DOD, with African American, Hispanic, and Caucasian skin tones.
Dr. Jerry Higman, deputy product manager medical simulation at PEO STRI, is the lead for the severe trauma female simulators.
“There's an assumption that everybody in the battlefield would be 6 foot 280 pounds without taking into consideration that people come in different sizes and sexes,” Higman said. “We found that the medical equipment used to support the soldier out on the battle space during critical care needs to be properly sized for a range of individuals from smaller females to the larger of males.
“For example, the tubes for the nasopharyngeal airway that are currently fielded now fit males, but we have found in our evaluations that they do not fit smaller females. The simulators that we developed and tested are based on say the average female across the DOD,” Higman said.
In 2013, the then-Secretary of Defense lifted the ban on women in the military serving in combat. Beginning in 2016, women have the equal right to choose any military occupational specialty, including ground combat units, that were previously unauthorized.
“We absolutely need this capability out there,” Higman said. “We strongly believe this will saves lives. Teaching males how to tend to female wounds and teaching females to treat other females.”
Higman also described what is sometimes referred to as male hesitancy in treating females on the battlefield.
“There is no female trauma simulator that are provided to the Army for tactical combat causality care,” he said. “What we’ve seen in some cases is that the males will delay in cutting off the female underwear, or not do it at all. They will not make the patient fully trauma naked and can miss seeing wounds.”
Incorporating female simulators into medical training is expected to help resolve this issue.
The first part of the severe trauma female simulator operational test began in January 2024 when a MTEAC team went to the Fort Cavazos MSTC for training and familiarization.
Joseph Day, instructor operator at the MSTC, described the preparation for the current test working with the simulators.
“It was a learning experience for us when they brought in the vendor and gave us a three-day class on the simulator,” Day said. “We ran through the common tasks that soldiers perform while training on mannequins. The focus is that everybody is a patient, it doesn’t matter what their sex is. Anatomically it is an accurate simulator and easy to operate. For us as operators, the more familiar we get, just like with our older models, we become more proficient on how to troubleshoot.”
Describing working with PEO STRi and MTEAC, Day liked that as an end use operator he was asked for his input in developing and testing the simulator.
“I’ve been doing this for 18 years here at this medical simulation training center and 39 years in medicine. Out of all that, this the first time a contracting element has come in and asked for opinions before they purchase. I think that speaks volumes because we are the end users for that device, and we have a lot of opinions, and we know what works and doesn’t work. Plus, it saves money down the road if you pick a good trainer that is viable and meets all our needs.”
Largely constructed as a self-help project by the MSTC staff Fort Cavazos, the realism of the facility proved to be the idea location for the MTEAC test. Inside the building designed to look like a village in a rural country a decommissioned UH-1 Huey helicopter is placed on top of a sand covered floor. Off to each side rooms provide areas for medics to train in conditions they would encounter in deployed locations.
Possible fielding of the severe trauma female simulators will proceed after MTEAC provides PEO STRi with a comprehensive test report with objective data, observations and feedback from the test players and operators.
That report will be analyzed and forwarded to the U.S. Army Medical Center of Excellence Directorate of Simulation, the accrediting office for review and determination of the severe trauma female simulators.
If accredited, the PEO STRi plan is to initially provide one simulator, that will include training and supplies, at each of the 25 Army MSTC locations.
Aligned under the U.S. Army Medical Center of Excellence, USAMTEAC’s mission is a unique one in that it is the sole independent operational test and evaluation agency for medical related materiel and medical information management/information technology products.
USAMTEAC is charged with the mission of directly supporting the U.S. Army in the Department of Defense’s acquisition process. Residing on Joint Base San Antonio-Fort Sam Houston, Texas, the base that serves as the Army’s bastion of medical excellence, USAMTEAC is a small unit of approximately two dozen military and civilian personnel tasked with the mission of helping to ensure that medical personnel are equipped with suitable and effective equipment.