By Terri Bernhardt

Medical simulation is an important component to the engineers and scientists at SFC Paul Ray Smith Simulation and Training Technology Center (STTC) and their years of research and testing is worth noting. STTC is housed under the U.S. Army Research, Development and Engineering Command (RDECOM), which conducts research and development of future training and simulation technologies to enhance the effectiveness of our soldiers. On a regular basis, STTC works with and supports the U.S. Army Research Laboratory (ARL), the U.S. Army Research Institute (ARI), and the University of Central Florida (UCF) Institute for Simulation and Training (IST). This unique, collaborative environment allows for the leveraging of resources to mature and develop new training and other technologies.

MATT, Multiple Amputation Trauma Trainer, Fort Jackson Training Mission
While STTC holds tried and true to their mission and goals, their severe trauma simulation is an area often highlighted, and rightfully so. The STTC conducts research and development in severe trauma simulation technologies to better prepare the soldiers to deal with injuries encountered on the battlefield. Beth Pettitt, Chief of the Army STTC Medical Simulation Branch, stated, “Currently, we have a number of thrust areas we are concentrating on. We are continuing to enhance our training on the use of mannequins and live tissue – making them better – and asking ourselves ‘does this technology simulate the proper look, feel, smell or actions of real trauma? And, does it properly prepare trainees for the horrific injuries they may experience in a combat environment?”

Through the years, the research at the STTC has taken a natural progression from the use of mannequin training to the need for better wounds and training on more realistic-like tissue. The effective training on Multiple Amputee Trauma Trainer (MATT), a graphic trauma simulator that has the ability to do an arterial bleed and to control that bleed through the use of tourniquets, has been extremely useful. The STTC lab houses tables of synthetic wounds for training and although it has been effective, it still isn’t as productive as training on live tissue. “The technology is close, but it still isn’t there – yet.” states Pettitt. Jack Norfleet, Chief Engineer, STTC, spearheads their live tissue training and sits on as many organizations on the forefront of research regarding this sensitive topic. Pettitt emphasized, “The touchy area of using live tissue is being carefully evaluated. We are looking at the whole live tissue replacement, defining and quantifying what makes live tissue use so good for training and how can we duplicate that in simulation systems?”
STTC’s end goal is to find a synthetic tissue system to minimize the use of live tissue and they are driven by taking a closer look at the whole picture. They are putting science around this concept and measure the self efficacy. “By partnering with the Joint Community, we have gained trememdous insight from care providers at all levels. Together, we are analyzing what is out there that might start to meet the need, pull a lot of those little pieces of technology together and begin to get clear direction on what we might be able to do and how we might be able to leverage many prototype capabilities already in existence,” said Pettitt.
Currently, one of the STTC’s main thrusts is the idea of the virtual patient through serious games training. The STTC is very tuned into virtual humans because of the work conducted along with ICT. They are taking their best practices and adding them to the things they know are out there. “We’ve been leveraging previous technology investments from through the ICT ,” stated Pettitt. “We are taking the goodness of what we’ve research and developed and hoping to make it accessable across the Joint medical training community.” For example, the virtual patient has a heart rate and exihibits physiologically accurate responses, similar to what is seen in traditional medical mannequins. If the patient is sick or stressed he might have an elevated heart rate, he might have a temperature or his blood pressure might be high or low allowing a caregiver to actually assess the virtual patient’s vitals.

Beyond vitals, there are physiological characteristics the trainee can determine for the best possible treatment to the patient. As much as the STTC has done in that arena there is still so much to do to get this type of capability in the mainstream. Pettitt expanded, “Part of the problem is developing scenarios that have to be vetted across different medical schools, different teachers. Every physician has a different idea about what the right treatment really is – very similar to – going to the doctor and getting three different opinions for one health concern.” Something as simple as nailing down a basic dialog between doctor and patient upon an initial visit; making sure the dialog is correct. After the dialog is nailed down, the student converses with the patient on initial assessment. “Our virtual characters must be good enough to allow us the in-depth diagnosis and treatment we eventually need to do,” said Pettitt. “The next step is to take that technology beyond hello and vital signs.”

Another thrust area is holograms for medical training. In fact, they are the first ones to effectively use this technology. “We have been moving forward at a rapid pace in 3D visualization of anatomy using the static holograms,” stated Pettitt. “The ultimate goal would be to do a dissection on a virtual image. We chose the eye because of the ocular trauma we sometimes see in combat.”

Many of STTC’s 3D images have been driven by the work of Dr. Bob Sweet, University of Minnesota. Dr. Sweet’s models are based on engineering analysis of cadavers. Pettitt stated, “In my opinion, these are the best 3D models out there. We are using Dr. Sweet’s models to feed the 3D visualization tools and do something more portable that has a dynamic capability.” Holograms are an effectively simple method to teach students basic anatomy and how all the parts of the body are integrated ina three dimensional environment. In fact, the technology can be transferred down to introductory course. “Any middle or high school, for example, that teaches the dissection of frogs could effectively train on a 3D hologram, said Pettitt. “Imagine the coolness factor of this technology moving to a civilian middle school classroom.”

Smells or olfactory is another area the STTC has experience with in medical training. Even though they have used smells in training for years, they continue to increase their capabilities with new and different smells. “Smells are indicative of some medical conditions,” said Pettitt. “We help identify smells that need to be created for different conditions and some of them are very unpleasant. We are effectively trying to help trainees link the odor to the medical problem.” The STTC is conducting ongoing research around the area of smells and is making sure they are tying the right smell linked to the right medical condition – and that the trainee is getting it.

Moving forward, the STTC’s goal with everything is to transition technology where it needs to go so it can help people. “So much gets done in labs and it just never gets funded or bought and used,” stated Pettitt. We are really trying to ensure what we are doing is meeting a direct need so somewhere, someone can effectively use it and we are making a difference.” Beth Pettitt is speaking for the fourth consecutive year at the annual MT3 Conference in Orlando, May 9-12.

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