Medical Simulation Training to Advance Trauma Training

Dan Irzarry (US)

Colonel (Retired) Dan Irzarry discussed „Simulation in Medical Training.“ Trauma simulation is essential as it allows mental and practical anticipation of critical situations. “The body cannot go where the mind has never been.“ Practical trauma training requires realistic environments, precise feedback, and integration into the operational context.

Current simulations are often convenient but unrealistic, fostering ineffective training patterns without objective performance evaluation. High-quality military simulations must be immersive, mobile, performance-based, and provide tactical value. Training content ranges from TC3 basics (e.g., hemorrhage control, airway management) to complex scenarios like triage and contingency planning. Training builds gradually: from individual skills to team coordination and decision-making under pressure. Simulation planning must be target-oriented, realistic, and include precise debriefing – offering invaluable benefits at low cost.

Key Messages

• Realistic and tactically integrated simulation saves lives through better decision-making and action training.
• Trauma training must be gradually built and team-oriented to depict complexity realistically.
• Investment in high-quality simulation technology is strategically and economically sensible.

3. Session – SOF Medic Meeting

Training Combat Medics under Wartime Conditions

Anna Kyrnychna (UKR)

The training of Combat Medics during wartime is characterized by scarcity and overload – it is often „too much and yet never enough.“ The most significant challenges lie in the heterogeneity of people, rigid order systems, and the security situation. Time, personnel, changing conditions, information, training, and equipment are constantly limited. Continuous adaptation to dynamic circumstances is required. The speaker emphasized that all forms of help are essential – both received and given. Flexibility and resilience are crucial traits in training under wartime conditions. Training must reach as many as possible, even under the most adverse circumstances.

Key Messages

• Wartime training means constant underprovision amid an excess of challenges.
• Human factors, rigid structures, and security concerns hinder effective training.
• Successful action relies on flexibility, mutual assistance, and personal commitment to further education.

Taking Care in a Tropical Environment and in Jungle Operations. Experiences from the French Foreign Legion

Giovanni Cirincione (FRA)

Giovanni Cirincione, an experienced military medic from the French Foreign Legion, reported on medical challenges and prevention in the jungle. The Legion comprises soldiers from various nationalities and is active in South America, including mine clearance and space security. In the jungle, hygiene, foot care, water purification, and protection against mosquito-borne diseases are essential. Specific prevention measures are taught for typical accidents like drowning, tree falls, heatstroke, or machete injuries.

It is also necessary to remain calm if lost in the jungle, set signals, and avoid unnecessary movement. Equipment should be light, waterproof, and functional to withstand tropical conditions. The goal is to prevent serious health risks in the jungle through proper preparation and behavior.

Key Messages

• Prevention is key to medical safety in the jungle: hygiene, foot care, and water purification save lives.
• Common accident hazards can be avoided through simple measures like base camp inspection, protective clothing, and behavioral rules.
• Lightweight, waterproof equipment and mental endurance are crucial for survival in tropical deployments.

K9TCCC in an Operational Environment-Human Healthcare Providers

Kerri Haider and Lauren Peacock (US)

Military working dogs (MWD) are highly specialized task forces requiring medical care under extreme conditions – often by human healthcare providers. K9TCCC (Canine Tactical Combat Casualty Care) adapts the principles of human TCCC to dogs, focusing on life-saving, simple, and field-ready measures. Care follows the M3ARCH2 protocol, adapted to the physiological characteristics of dogs (e.g., temperature, respiratory rate, blood volume).

Emphasis is placed on pain management, sedation, fluid administration, and wound care in the field. Prolonged care includes nutrition, burn care, and blood transfusion with exclusively animal blood.

Integrating medical personnel into the care of injured MWDs without veterinary training is essential, as veterinarians are often not immediately available. Extensive resources, guidelines, and apps like “DeployedMedicine.com” facilitate access to knowledge and improve the animals‘ survival chances.

Key Messages

• K9TCCC specifically adapts TCCC principles for military dogs and is crucial for their survival in ­operations.
• Human healthcare providers must be prepared for K9 emergencies, as veterinary personnel are often not immediately available.
• Resources like guidelines, training materials, and specialized apps are central to successful K9 care in the field.

Fig. 2: History of K9TCCC (Image: K. Haider)

The Change in Trauma Patterns due to the Use of Thermobaric Weapons

Ishay Ostfeld (ISR)

Since October 7, 2023, Israel has been in a comprehensive conflict with various adversaries such as Hamas, Hezbollah, and Iranian proxies. The use of thermobaric weapons has created a new trauma pattern distinct from conventional injuries.

Thermobaric weapons cause burns, inhalation injuries, and lung and brain injuries due to heat, underpressure, and oxygen consumption. Particularly in enclosed spaces, these weapons result in high lethality and severe aftermaths such as PTSD and TBI. Clinical data show an increase in thoracic trauma while classical penetrating injuries decrease. This leads to new requirements for TCCC protocols, focusing on early airway management, oxygen administration, ventilation, monitoring, and burn management. Military and civilian trauma care systems must adapt to these changing conditions.

Key Messages

• Thermobaric weapons create unique trauma patterns focusing on blast, burn, and inhalation injuries.
• Classical TCCC models like „Stop the Bleed“ are no longer sufficient – new airway and ventilation strategies are needed.
• Military and civilian trauma care systems must prepare for the increasing use of thermobaric weapons.

4. Session – SOF Medic Meeting

Moral Injuries: Hidden Wounds

Jennifer Spohrs (DEU)

Moral Injury (MI) describes psychological injuries caused by experiences that deeply shatter one‘s sense of values and morals. Soldiers who experience „Potentially Morally Injurious Events“ (PMIEs), such as personally or observed morally injurious acts, are particularly affected.

Studies show that 80% of active soldiers and up to 90% of veterans exhibit at least one MI symptom. Common symptoms include guilt, shame, loss of trust, and a sense of inner alienation. MI is captured through instruments like the MIQ-M and the EMIS-M scale, supplemented by trauma and alienation assessment questionnaires. New methods such as VR-based exposure are being discussed for diagnosis and therapy.

Psychological care in military hospitals must specifically address MI to recognize and treat hidden wounds.

Key Messages

• Moral Injury is a common and profound psychological burden for soldiers and veterans.
• Guilt, shame, and alienation are central symptoms often overlooked.
• Standardized questionnaires and innovative methods like VR help identify and treat moral injuries.

Fig. 3: Moral Injury is a common and profound psychological burden for soldiers and veterans (Image: J. Spohrs)

When Do We Stop? Making the Transition to Palliative Care in the Irregular Warfare Surgical Setting

Jason R. Pickett (US)

In irregular warfare situations, the difficult question often arises of when to transition from curative trauma care to palliative care. Particularly with complex, non-survivable injuries – such as retrohepatic bleeding, refractory shock, or severe metabolic derangement – the costs and risks of interventions outweigh their benefits. Resources in the field (blood, fluids, surgical capacity) are severely limited and must be used responsibly. There is a moral pressure to „do everything,“ but this can lead to team exhaustion, logistical overload, and moral injury. Palliative care allows for the relief of pain, anxiety, and breathlessness, enabling a dignified farewell – even in a military context.

Communicating a shift in therapy requires courage, compassion, and coordinated leadership within the team. The goal is not giving up but a responsible handling of non-viable situations.

Key Messages

• In hopeless cases in the field, transitioning to palliative care is often medically and morally sensible.
• Resources in irregular warfare are limited – futile care can harm others.
• Respectful, empathetic communication is crucial for a dignified farewell under extreme conditions.

Triage system: What Works when Tactics Play a Role

Julien Galant (FRA)

In tactical mass casualty scenarios (MASCAL), triage systems must be quickly, intuitively, and flexibly applicable. The study aimed to investigate the effect of colored wristbands on triage performance – both in terms of objective efficiency and subjective factors like stress and self-efficacy.

The simulation with 170 participants and 1,680 casualties showed that wristbands can be effectively used as simple triage and counting aids. Complex, formal algorithms were rarely applied in tactical situations, underscoring the need for simple, practice-oriented tools. Training first responders to make intuitive decisions under stress is critical.

The findings are based on realistic simulations in a military context (Level 2 Forward Combat Care). Overall, the study demonstrates that practical, visual aids and targeted training can significantly improve triage performance.

Key Messages

• Colored wristbands effectively improve triage performance in tactical MASCAL situations.
• Intuitive decision-making requires training and simple aids – not complex algorithms.
• Simulations are essential for creating realistic conditions for first responder training.

Experience Gained during the Russian-Ukrainian War

10^th Border Guard Detachment DOZOR (UKR)

The experiences from the Russian-Ukrainian war show how drastically medical care must change under extreme conditions. Winter conditions make it difficult to detect and treat injuries, as clothing, cold, and confined spaces slow down care. Liquids freeze, vehicles are often usable only once, and evacuations frequently occur over several kilometers on foot. The classic separation between Care Under Fire and Tactical Field Care is increasingly blurred. Blood transfusions are life-saving but often fail due to logistics, equipment, personnel, or cold chains. Standardized medical backpacks are no longer sufficient – multifunctional equipment combining medical and tactical material is needed. In this reality, adaptability is crucial: self-care, improvisation, and decentralized action are vital for survival.

Key Messages

• Extreme conditions, such as cold temperatures, limited space, and the absence of vehicles, necessitate flexible and improvised care concepts.
• Blood transfusions are essential but often hindered by logistical barriers.
• The clear separation of tactical care phases is dissolving – Prolonged Field Care usually begins directly at the site of injury.

For the Authors 

Lieutenant Colonel (MC) Dr. Stefan Kühn
Department of Anesthesia, Intensive Care, Emergency Medicine, and Pain Therapy (AINS)
Bundeswehrkrankenhaus Ulm
Oberer Eselsberg 40, 89081 Ulm
E-Mail: stefankuehn@bundeswehr.org