NMCP ER Nurses, Simulation Training Team Support Continuing Promise 2015

Story Number: NNS150924-04Release Date: 9/24/2015 10:32:00 AM
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By Cmdr. Christopher Niles, Lt. Robert Williamson, and Ens. Norving Gutierrez

USNS COMFORT, At Sea (NNS) -- A training team from Naval Medical Center Portsmouth's (NMCP) Bioskills Simulation and Training Center and Emergency Room nurses embarked the Military Sealift Command hospital ship USNS Comfort (T-AH 20) in support of Continuing Promise 2015 (CP-15) from April through Sept. 2015.

The multidisciplinary team was led by Cmdr. Christopher Niles, who currently serves as Comfort's senior nurse educator and department head for the Casualty Receiving (CASREC) department.

Nine additional staff members comprised of nurses and Hospital Corpsmen joined Niles in CASREC to serve as instructors for the Trauma Nurse Care course (TNCC), the Tactical Combat Casualty Care course (TCCC), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS) and Basic Life Support (BLS).

Additional tasks included instructor's simulation drivers, moulage experts and assisting with the coordination of mass casualty training exercises, code blue drills, man overboard drills, pandemic outbreak drills and general trauma training.

The embarked team assisted in the training of 1,000 medical personnel during two multidisciplinary mass casualty drills, 16 code blue drills, four general trauma drills and three pandemic/infectious disease drills containing over 50 simulated casualties. The simulated casualties included life actors with moulage gear and high-fidelity patient care simulators.

During the series of mass casualty drills, simulated patients were triaged on the ship's flight deck and then moved to CASREC for continued treatment.

Once in CASREC, patient simulators augmented the shipboard actors as training aids for continued treatment. The simulators allowed the medical providers to perform hands-on training skills including: intravenous (IV)/ intraosseous (IO) placement, chest tube placement, intubation, defibrillation with live electricity, tourniquet placement, and focused assessment with sonography for trauma (FAST) exams. Several of these simulations were recorded to provide staff with performance improvement opportunities and feedback.

The training was accomplished by providing moulage for the live-actors and utilized advanced patient simulators.

Additionally, senior Nurse Corps officers served as observers and facilitators, challenging the staff's critical thinking skills and enhancing the overall learning experience. After each drill, the training team members provided feedback and discussed lessons learned with the crew to encourage an environment of continuous improvement, efficiency and quality.

The training team consisted of NMCP Nurse Corps officers, Hospital Corpsmen and a civilian volunteer representing Latter-day Saints Charities. The team brought with them first-hand experience in emergency medicine and real-world experience with combat medicine and humanitarian assistance from their previous operational assignments.

The training team taught three Tactical Combat Casualty Care courses (TCCC) to 15 shipboard personnel and over 130 host nation personnel, as well as nine ACLS classes, seven PALS classes and 12 BLS classes to over 890 host nation participants.

Additionally, the team facilitated ten skill stations for first time deployed personnel at the "Skills Station Fair", teaching a range of topics including basic electrocardiogram (EKG) interpretation, suture skills, IV placement, bag-valve mask ventilation, cardiac monitoring, defibrillator use, nasogastric tube placement, FAST scan assessment, respiratory and circulatory assessment.

This mission was the first time that advanced patient simulation equipment was used aboard Comfort while underway. The collaboration with host nation partners greatly enhanced the military medicine objectives of the common goal of interoperability of a combined medical force and increasing the familiarity of partner nation military medicine practices, capabilities and experiences through the use of subject matter expert exchanges (SMEEs).

"Having the simulation equipment has increased my skills as a junior nurse corps officer and my confidence in the ability to deliver high quality care," said Ensign Norving Gutierrez, assigned to CASREC. "The training here is so realistic that it reminds me of real-world scenarios that I have encountered while deployed to combat zones as a prior enlisted Hospital Corpsman with the Fleet Marine Forces."

Gutierrez's statements were furthered echoed by other members of the training team and crew.

Lt. Robert Williamson, an emergency room nurse assigned to CASREC and former Navy Diver, said he had little experience working with the simulators prior to the deployment, but now regularly uses them to train Navy nurses and hospital corpsmen.

"This level of realistic training significantly increased the practical knowledge and confidence of our staff," said Williamson. "With this equipment, I was able to conduct several drills each day, covering multiple topics. In a real world environment, the first-hand exposure to all of these situations could potentially take months, possibly years."

Williamson added that the training contributed to a deeper level of understanding and application of ACLS, PALS, and other algorithms that are used in daily practice.

"The experience, education, and confidence gained by training with the simulators teach an amazing level of critical thinking and decision making to our staff," he said.
The Comfort training team also implemented the Team Strategies and Tools to Enhance Performance and Patient Safety (Team STEPPS) system into each of their training scenarios and classes in order to improve communication and skills that are vital to successful teamwork in the healthcare environment.

The Team STEPPS system was developed by the Department of Defense's Patient Safety Program. The goal of the system is to increase a team's awareness and understanding of the roles within that team in order to improve the sharing of information and eliminate barriers to patient safety.

The program gives every team member the ability to provide crucial information to the team and uses a simple process of escalation to ensure that all input, regardless of the source, is given the appropriate amount of consideration. The training serves to empower members to have a more proactive role within the team and encourages people to speak up when they notice preventable mistakes and changes in the patient's condition.

The training team is currently preparing to setup a permanent simulation center aboard Comfort that will be used to conduct training for future missions.

Plans are currently underway to gain accreditation from the American College of Surgeons through collaboration with the Bioskills and Simulation Center located at Naval Medical Center Portsmouth.

Continuing Promise is a U.S. Southern Command/U.S. 4th Fleet-conducted deployment to conduct civil-military operations including humanitarian-civil assistance, subject matter expert exchanges, medical, dental, veterinary and engineering support and disaster response to partner nations and to show the United States' continued support and commitment to Central and South America and the Caribbean.

For more news from Continuing Promise, visit www.navy.mil/local/cp/.

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