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Deployed In Situ Simulation: Ready for REBOA? (1090-004072) (Research Abstract Professor Rounds: Group 2)
Start time: Thursday, January 28, 2021, 10:00 AM End time: Thursday, January 28, 2021, 11:00 AM Session Type: Research Abstracts (Completed Studies) Cost: $0.00
Content Category: Researcher
Hypothesis:
We present a project evaluating in situ readiness for REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) placement and monitoring at four U.S. Military medical treatment locations in the Iraq and Kuwait during the spring of 2019. We hypothesized there would be a support staff training gap and equipment limitations. We completed site evaluations, focus group discussions, and integrated a REBOA simulation curriculum in a mature combat theater.
Methods:
We completed four site evaluations (3 in Iraq, 1 in Kuwait) during the spring of 2019. These included two Role 2s (one was collocated with a German FST, and another a Danish FST), one role three in Iraq, and one role three in Kuwait. Data was collected through individual site visits, equipment inspection (evaluating trauma bays and equipment storage locations), focus group discussion with local physician/nurse/medic/supply personnel, audience polling, and pre-post tests before and after the training. a lecture-simulation curriculum was presented for physicians and support staff. The curriculum involved 1.5 hours of lecture describing pathophysiology, indications, contraindications, complications, management, transport considerations, and discontinuation of REBOA. It was followed by a hands-on simulation segment with two simulated cases (Zone 1 and Zone 3), that required the team to correctly select a zone, deploy, and monitor a REBOA catheter in a pressured simulation model.
Results:
All four sites had the minimum training and equipment requirements (one trained provider, and a REBOA device plus introducer catheter) to complete the procedure, all though one site did have the introducer located in an outside overflow storage facility. None of the sites had all the equipment for best-case use and deployment. Each site had training limitations in primary, support, and transport personnel. There were noted training limitations in support staff roles (nurses/medics). We do note several of these skills are not in traditional training for these groups, and all individuals present were very enthusiastic to learn about this intervention. Of the individuals surveyed, very few nurses/medics felt they could assist with REBOA placement, or set up, and use an arterial pressure monitoring system/device. Our training curriculum was implemented for 98 individuals with most indicating it was a useful course.
Conclusions:
All four sites were capable (based on training and equipment) to deploy a REBOA catheter. However, we did note several potential areas for improvement. These include additional training for support personnel (medics, nurses, transport teams), and better equipment tracking. We also recommend in situ training with deployed teams (perhaps coordinated by the role 3) when in mature theaters. There were several limitations to this study, most notably that all data was obtained from individuals who sought out the training. We did try to account for this through discussions with on-site leadership teams, but we may have missed additional providers/support staff who may have had formal training. In conclusion, based on this in theater site evaluation, we are very optimistic this life-saving capability is slowly becoming more readily available, and we propose further efforts could include in situ team training and in-theater supply optimization.