Surgical Chloe takes response to new heights

Monday, October 01, 2012

The Army has a saying: "Train as you Fight."

Each year, thousands of members of the Joint Task Force – Civil Support converge on Camp Atterbury, Ind., to give their all during the Vibrant Response training exercise hosted by U.S. Army North, United States Northern Command, the Department of the Army, and other inter-governmental agencies.

For both military and civilian participants, it is the year’s culminating training event, where a large number of military and civilian agencies must work together, to be successful in an exercise that tests the nation’s ability to respond with collective resources, to a chemical, biological, radiological, nuclear and high-yield explosive, or CBRN, disaster.

Surgical Chloe, a full-body surgical simulator, debuted at this year’s Vibrant Response as a training force-multiplier for the Army’s Forward Surgical Team, known as FST.

Chloe allows surgeons and medics to test their competencies in areas such as medical knowledge, patient care, communication and professionalism.

According to the Army medical community, the "golden hour" is the initial hour following severe trauma or injury, when the patient’s chances of survival are greatest.

For the Forward Surgical Team, whose responsibility in a combat environment is to provide that "golden hour" patient stability and hemorrhage control to combat casualties, a leap forward has just been taken into future of combat medical training.

"Vibrant Response is as good as training gets for all of our organizations working together," Lt. Col. Kimberlee Aiello, commander of the 56th Multifunctional Medical Battalion, 62nd Medical Brigade, Joint Base Lewis-McChord, Wash., said.

Adding, "The scenarios are made as realistic as possible, and each year builds on what we’ve learned from the past – so each event keeps getting better."

In the past, FSTs have trained largely with question-and-answer style training scenarios and have used mannequins as well as human role-players as the injured patient.

Chloe takes this training to new heights.

Not only does Chloe blink and speak, but she also bleeds when cut.

When surgery is complete, team members are able to suture their way to a proper closing. Chloe is a multi-layered design of skin, muscle, bone, organs, and everything in between, to provide more realism.

It has several life-like abdominal inserts and uterine assemblies, which allow the teams different surgical options. Real surgical instruments are used to perform surgery in a real operating room environment.

To make things even better, team members are able to keep track of how well they’re doing, with a vital signs monitor that continuously shows Chloe’s progress – or lack thereof.

Cameras and voice recorders are integrated at various points and angles to record all that is said and done. These recordings allow the team to assess their performance during scenarios by watching what they did and hear comments after the fact – an integral part of re-training efforts.

As necessity is the mother of invention, it may be of little surprise that the idea to incorporate the Chloe surgical simulator into the annual Vibrant Response exercise came from an FST member – Maj. Kelly Blair, commander of the 250th FST, 62nd Medical Brigade, and a surgeon at Madigan Healthcare System on Joint Base Lewis-McChord.

"One of the deficits recognized at prior Vibrant Response [after-action reviews] was that FSTs weren’t getting a chance to practice any realistic medical simulation," Blair said.

"Many of them were spending a lot of time setting up tents and tearing them down. I wanted to provide a medical simulation platform to actually train damage control surgery, which we haven’t done in the Army at all in a simulation environment," he added.

From original thought to implementation, Blair’s idea of incorporating the Chloe surgical simulator into the Vibrant Response training, quickly received a string of blessings, which stretched from the local level of the 62nd Medical Brigade, to the U.S. Army North command.

Blair, along with subordinate members of the 250th FST, facilitated this year’s introduction of Chloe.

"Our team’s skills were definitely put to the test," Maj. Joshua Paul, commander, 102nd FST, 56th Multifunctional Medical Battalion, 62nd Medical Brigade, said.

Adding, "A number of our members have combat experience, but they haven’t had the opportunity to train in this most realistic manner, with the constraints that are placed on life saving, immediate, far-forward, resuscitative surgery."

In the Vibrant Response training scenario, an FST would show up in support of civil authorities to a disaster management facility or an area hospital – actually a medical simulation training building at Camp Atterbury – whose resources have been overwhelmed.

As described by Col. Theresa Schneider, commander of the 62nd Medical Brigade, the FST would enter the resource-depleted medical environment and engage with role players, who are saying: "We’re so glad you’re here. We need your help. We don’t have enough medics and surgeons to care for the casualties that have been brought to our facility."

The medics would have to go through all the various casualties, triage them and provide emergency management stabilization, and then surgeons would start doing surgery on the Chloe surgical simulator.

Once finished, they would have to coordinate for evacuation out of the area via ground or air ambulance, and then the mission would be complete for that day.

"I think Chloe is here to stay," Blair said.

Adding, "All the generals and command team members of Army North that have come through have given it the double-thumbs-up. We’ve had an excellent beginning. Next year we want to add a few more simulators, bump up the scenario time limit to give the soldiers more time to practice and add a few more instructors."