Document text
Award Number: W81XWH-05-2-0049
AD
TITLE: Ft. Sam 91 Whiskey Combat Medic Medical Simulation Training Quantitative
Integration Enhancement Program
PRINCIPAL INVESTIGATOR: Paul Phrampus, M.D.
CONTRACTING ORGANIZATION: University of Pittsburgh Medical Center
Pittsburgh, PA 15213
REPORT DATE: April 2008
TYPE OF REPORT: Annual
PREPARED FOR: U.S. Army Medical Research and Materiel Command
Fort Detrick, Maryland 21702-5012
DISTRIBUTION STATEMENT: Approved for Public Release;
Distribution Unlimited
The views, opinions and/or findings contained in this report are those of the author(s) and
should not be construed as an official Department of the Army position, policy or decision
unless so designated by other documentation.
REPORT DOCUMENTATION PAGE
Form Approved
OMB No. 0704-0188
Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing this collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-
4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently
valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS.
1. REPORT DATE
01-04-2008
2. REPORT TYPE
Annual
3. DATES COVERED
1 Apr 2007- 31 Mar 2008
4. TITLE AND SUBTITLE
5a. CONTRACT NUMBER
Ft. Sam 91 Whiskey Combat Medic Medical Simulation Training Quantitative
Integration Enhancement Program
5b. GRANT NUMBER
W81 XWH-05-2-0049
5c. PROGRAM ELEMENT NUMBER
6. AUTHOR(S)
5d. PROJECT NUMBER
Paul Phrampus, M.D.
Kimberly Love
5e. TASK NUMBER
5f. WORK UNIT NUMBER
Email: loveka@yupmc . edu
7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)
8. PERFORMING ORGANIZATION REPORT
NUMBER
University of Pittsburgh Medical Center
Pittsburgh, PA 15213
9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES)
U.S. Army Medical Research and Materiel Command
Fort Detrick, Maryland 21702-5012
10. SPONSOR/MONITOR’S ACRONYM(S)
11. SPONSOR/MONITOR’S REPORT
NUMBER(S)
12. DISTRIBUTION / AVAILABILITY STATEMENT
Approved for Public Release; Distribution Unlimited
13. SUPPLEMENTARY NOTES
14. ABSTRACT
This document includes the primary accomplishments for the reporting period, 4/1/07 - 3/31/08.
Primary accomplishments during this period: the continued development and validation of the project foundation materials,
logistical planning, and the purchase of medical simulators.
15. SUBJECT TERMS
16. SECURITY CLASSIFICATION OF:
17. LIMITATION
OF ABSTRACT
18. NUMBER
OF PAGES
19a. NAME OF RESPONSIBLE PERSON
USAMRMC
a. REPORT
u
b. ABSTRACT
u
c. THIS PAGE
u
uu
23
19b. TELEPHONE NUMBER (include area
code)
Standard Form 298 (Rev. 8-98)
Prescribed by ANSI Std. Z39.18
Table of Contents
Introduction . 5
Body . 6
Key Research Accomplishments . 15
Reportable Outcomes . 16
Conclusions . 17
References . 18
Appendices
19
Introduction
The training of the combat field medic is a critical need of the United States Army. The
68W (formerly 91W) program at Fort Sam Houston, Army Medical Department
(AMEDD), Department of Combat Medic Training (DCMT), trains over 7,000 Combat
Field Medics per year. Increased training consolidation in the armed services has put
increased demands on the training program at the DCMT at Fort Sam Houston (FSH).
Efficiency and effectiveness of training are important goals that are continually
undergoing evaluation by the leadership structure of the DCMT.
To ensure a continuous quality improvement implementation strategy, training center
leadership requires feedback on the type of training needed by combat field medic
trainees. The leadership is also in need of information concerning how to revise the
curriculum to continually meet a high state of readiness to support the Army's medical
mission. Additionally, it is beneficial to understand how a soldier’s previous experiences,
as well as their participation in various continuing education activities, influence their
performance on critical skills. There is a need for formalized assessment of combat field
medic skills retention and investigation of the ideal method of retraining, taking into
account previous experience.
This study consists of two phases. Phase One involves the development of a data set that
represents a baseline performance evaluation of the combat medic trainees undergoing
initial training at the DCMT. Phase Two evaluates combat field medics returning to
training from other assignments to assess their performance on similar scenario with
various curriculum delivery methods.
Body
The following is a description of the project accomplishments for the effort associated
with this award.
Administrative
During the timeframe covered by this report, Terri Collin, PhD, joined the project in the
statistical and research coordination role. Dr. Collin is a University of Pittsburgh
employee.
During the first quarter of this annual reporting period, CPT Krustchinsky, Fort Sam
Houston, transferred to another base and, as a result, discontinued participation from the
project. CPT Connie Welch joined the project as the FSH liaison until a base Principle
Investigator was assigned.
During the third quarter of this reporting period, LTC Mayer joined to the project as the
FSH Principle Investigator.
During the fourth quarter of this reporting period, LTC Mayer deployed to Iraq. COL
James Signaigo replaced LTC Mayer as the base Principle Investigator. COL Signaigo
will retire in December, 2008.
Logistical
Accomplishments for this annual reporting period included logistical planning, the
purchase of medical simulators, and the continued development and validation of the
project protocol.
NOTE: At the time of report preparation, discussions were occurring with TATRC
concerning the location of the Phase Two study. At a meeting in March 2008,
COL Signaigo suggested that Phase Two data collection take place at FSH rather
than the National Training Center at Fort Irwin. This change would allow data
collection for both phases to take place concurrently resulting in significant
logistical advantages. This report was prepared with the assumption that the Phase
Two data collection will move to FSH.
Logistical planning and equipment purchase
Accomplishments for this annual reporting period included a very successful face-to-face
meeting at Fort Sam Houston on July 17, 2007. During this visit, UPMC reviewed project
details and goals with DCMT leadership. Based upon input from newly involved DCMT
project team members, several logistical implementation items were more clearly defined
based on the current DCMT workflow. During this meeting, DCMT leadership suggested
that the project be conducted inside a trailer and agreed provide a trailer for project use.
UPMC and DCMT leadership discussed employment of on-site personnel to conduct the
study.
During the third quarter of this reporting period, the DCMT changed the physical location
of the research center to a fixed space facility rather than the trailer previously indicated.
Although this change should not negatively affect the quality of the project, the location
change did affect logistical planning. Because of this change, the project team defined
requirements for the space, including network connectivity, storage, and seating.
On March 5, 2008, COL Signaigo met the UPMC project team in Pittsburgh and toured
the WISER facility. During this meeting, COL Signaigo suggested moving the Phase
Two study to Fort Sam Houston. This move would allow for concurrent Phase One and
Phase Two data collection. As of March 31, 2007, UPMC is planning to submit a formal
SOW modification request to allow for this change.
Equipment for Phase One has been ordered and received. The equipment is currently in
storage at UPMC.
Project protocol
UPMC created the draft of the protocol for Phase One. This draft was informally
reviewed by Dr Stephenson (TATRC), LTC Hernandez (FSH) and the UPMC/University
of Pittsburgh IRB. The draft was updated with several requested changes. As of March
31, the protocol was in the process of being modified to include the logistical updates
required by the site change.
Statement of Work - Phase One
Update and confirm findings of UPMC 2003 DCMT “ Needs Analysis” through a site
visit and project review.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: Colonel James Signaigo
Timeframe
Task
Results
Week 1
1 . Prepare for on-site visit and survey of
Ft. Sam Houston (FSH) 9 1 W
Combat Medic Simulation Program.
This trip took place on July 17,
2007.
Timeframe
Task
Results
Weeks 2-3
1. On-Site Survey of FSH 91 W Combat
Medic Simulation Program to re¬
assess current status of medical
simulation program and to meet with
current leadership.
2. Review preliminary project plan with
the DCMT team.
3 . Identify reporting requirements .
4. Identify operational and infrastructure
issues and requirements.
5. Review hardware requirements.
This trip took place on July 17,
2007. All tasks were
accomplished; however,
revisions will be needed based
upon later meetings with FSH.
Weeks 2-5
1. Design IRB protocol.
2. Modify preliminary project plan, if
needed, and deliver to the DCMT
team.
The protocol is in development.
The project plan will be revised
after the protocol is submitted
as most tasks are linked to the
protocol submission date.
Weeks 3-5
1 . Order hardware.
2. Review FTE requirements.
Medical simulators have been
ordered.
FTE requirements will be
reviewed after a tentative data
collection start date has been
projected.
Weeks 3-15
1 . Design training scenarios.
2. Design and prototype upload tool.
3. Design data reports.
4. Program simulation scenarios.
5. Test simulation scenarios.
These tasks are in development.
Develop necessary hardware, software, and training programs for project
implementation.
UPMC Principal Investigators: Paul Phrampus, MD
US Army Principal Investigator: Colonel James Signaigo
Timeframe
Task
Results
Weeks 6- 15
1 . Receive hardware at UPMC.
2. Test hardware at UPMC.
3. Develop training programs for
data collectors and simulation
instructors.
4. Hire on-site personnel.
Hardware has been received.
The remaining tasks will take
place after the tentative data
collection start date has been
projected.
Weeks 6-27
1 . Obtain IRB protocol approval.
The protocol is currently in
development.
Weeks 16-20
1 . Test upload tool at UPMC.
This task will take place after the
tasks in weeks 6-15.
Deployment of FSH hardware, software, and training.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: Colonel James Signaigo
Timeframe
Task
Results
Weeks 21 -24
1 . Installation of hardware and software
on-site.
2. Test collection of data at simulation
stations.
3. Test upload tool on-site.
4. Training of on-site personnel.
The dates for these tasks
will be determined after
the approval of the
protocol.
Collection and reporting of data.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: Colonel James Signaigo
Timeframe
Task
Results
Weeks 27 - 52
1 . Collect data on-site.
2. Monitor data collection uploads at
UPMC.
3. Observe data collection on-site
through site visits performed on a
regular basis.
4. Perform ongoing quality assurance
testing of data at UPMC.
5. Provide periodic updates to DCMT
leadership and monitor for
significant curriculum and/or
process changes.
6. Allow on-demand data queries by
DCMT leadership.
7. Provider standard reports to DCMT
leadership.
8. Analyze data for results on a
regular basis.
The dates for these tasks will
be determined after the
approval of the protocol.
Provide final analysis of Fiscal Year 04 work.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: Colonel James Signaigo
Timeframe
Task
Results
Weeks 53 - 59
1 . Perform comprehensive data analysis.
2. Create final reports and develop
recommendations .
3. Provide final reports during an on-site
visit with DCMT leadership.
4. Formal close of 04 projects.
The dates for these
tasks will be
determined after the
approval of the
protocol.
Statement of Work - Phase Two
Perform an Operational Review at the NTC through a site visit and project review.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: TBD (NTC)
Timeframe
Task
Result
Weeks 1-2
1 . Prepare for on-site visit and survey
of NTC training program.
This task will be replaced with
an observation of the BNOC
training at FSH.
Weeks 2-8
1 . Recruit and hire
statistician/psychometrician.
Completed.
Week 3
1 . Phone conference with UPMC,
TATRC and NTC leadership.
This task may not be
necessary pending the Phase
Two location change.
Weeks 4-7
1 . Draft preliminary project scope
document for initial site visit.
This task may not be
necessary pending the Phase
Two location change.
Week 8
1 . On-Site Survey of NTC program to
re-assess current status of medical
simulation program and to meet with
current leadership.
2. Review preliminary project plan with
NTC team.
3. Identify reporting requirements.
4. Identify operational and
infrastructure issues and
requirements.
5. Review hardware requirements.
These tasks will be considered
for combination with Phase
One tasks pending the Phase
Two location change.
Weeks 8-10
1 . Work with statistician to determine
statistical analysis.
2. Review planned data metrics and
gathering tools.
3. Determine preferred structure for
data point export from SIMS.
These tasks will be considered
for combination with Phase
One tasks pending the Phase
Two location change.
Weeks 13-16
1. Design IRB protocol.
2. Evaluate needs for project plan
modifications.
These tasks will be considered
for combination with Phase
One tasks pending the Phase
Two location change.
[Week 17
1 . On site visit to present IRB protocol
to the NTC leadership.
This task will not be necessary
pending the Phase Two
location change.
Timeframe
Task
Result
Weeks 20 -27
1 . Modify IRB protocol based upon site
visit to NTC and submit.
These tasks will be considered
for combination with Phase
One tasks pending the Phase
Two location change.
Weeks 20 - 24
1 . Order hardware.
2. Review FTE requirements.
These tasks will be considered
for combination with Phase
One tasks pending the Phase
Two location change.
Weeks 40 - 45
1 . Design data reports.
These tasks will be considered
for combination with Phase
One tasks pending the Phase
Two location change.
Develop necessary hardware, software, and training programs for project
implementation.
UPMC Principal Investigators: Paul Phrampus, MD
US Army Principal Investigator: TBD (NTC)
Timeframe
Task
Result
Weeks 30 - 40
1 . Receive hardware at UPMC.
2. Test hardware at UPMC.
3. Develop training programs for data
collectors and simulation
instructors.
4. Recruit on-site personnel.
These tasks will be
considered for
combination with Phase
One tasks pending the
Phase Two location
change.
Weeks 28 - 40
1 . Obtain IRB protocol approval.
These tasks will be
considered for
combination with Phase
One tasks pending the
Phase Two location
change.
Weeks 42 - 50
1 . Hire on-site personnel.
These tasks will be
considered for
combination with Phase
One tasks pending the
Phase Two location
change.
Deployment of NTC hardware, software, and training.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: TBD (NTC)
Timeframe
Task
Result
Weeks 52 - 55
1. Installation of hardware
and software on-site.
2. Test collection of data at
simulation stations.
3. Test upload tool on-site.
4. Training of on-site
personnel.
These tasks will be
considered for combination
with Phase One tasks
pending the Phase Two
location change.
Collection and reporting of data.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: TBD (NTC)
Timeframe
Task
Result
Weeks 56-96
1 . Collect data on-site.
2. Monitor data collection
uploads at UPMC.
3. Observe data collection on¬
site through site visits
performed on a regular basis.
4. Perform ongoing quality
assurance testing of data at
UPMC.
5. Provide periodic updates to
NTC leadership and monitor
for significant curriculum
and/or process changes.
6. Allow on-demand data
queries by NTC leadership.
7. Provider standard reports to
NTC leadership.
8. Analyze data on a regular
basis.
The timeframe for these tasks,
regardless of location, will be
defined after the protocol is
submitted_/_approved.
Provide final analysis of Year 05 work.
UPMC Principal Investigator: Paul Phrampus, MD
US Army Principal Investigator: Colonel James Signaigo and TBD (NTC)
Timeframe
Task
Result
Weeks 96-104
1 . Perform comprehensive data
analysis.
2. Create final reports and
develop recommendations.
3. Provide final reports during
an on-site visit with DCMT
91 W leadership and NTC
leadership.
4. Formal close of FY05
project.
These tasks will be considered
for combination with Phase One
tasks pending the Phase Two
location change.
Key Research Accomplishments
The following is a bulleted list of key research accomplishments emanating from this
effort:
• A project team was established during this annual reporting period.
• UPMC purchased and received study equipment.
Reportable Outcomes
During this report period, no final outcomes were developed. The project is in process
and under revision.
However, interim materials include:
• FSH Kickoff Meeting materials
• Meeting materials for a March 5, 2008, meeting with COL Signaigo
They are included in the Appendices section.
Conclusions
Due to leadership and program changes at the DCMT, this project has required a great
deal of flexible and creative planning in order to meet the needs of the DCMT while
adhering to the intent of the Congressional appropriation.
We feel confident that UPMC, in collaboration with WISER and the University of
Hawaii, will provide a successful program with quantifiable results.
References
This report did not require the use of documented reference material.
Appendices
(materials for 7-17-07 meeting)
AGENDA
Kickoff Meeting for
Cooperative Agreement #W81XWH-05-2-0049
Department of Combat Medic Training, Fort Sam Houston
July 17-18, 2007
July 17, 2007
Morning - 9:00 AM
• Tour of Training Facilities
Lunch - TBD
Afternoon - TBD
• Introductions
1. DCMT - CPT Connie Welch
2. UPMC WISER - Dr. Paul Phrampus
3. University of Hawaii - Dr. Ben Berg
4. TATRC - Harvey Magee
• Project Significance - Harvey Magee
• Project Overview - Dr. Paul Phrampus and Dr. Ben Berg
• Operations and Logistics Discussion - All
• Next Steps and Action Items - All
1. I RB Protocol
2. Principal Investigator (DCMT)
3. Letter of Intent
• Closing Remarks - Harvey Magee
July 18, 2007 (if needed)
Continuation of follow up items
Key Information
Cooperative Agreement #W81XWH-05-2-0049
Combat Field Medic Longitudinal Performance and Baseline
Training Comparative Analysis
Abbreviations:
DCMT
FI
FSH
NTC
UPMC
WISER
Purpose:
The purpose of this study is to create a statistical analysis comparing training methods, work experiences,
and performance results for the purpose of providing information to the Department of Combat Medic
Training and the National Training Center. This information can be used by the DCMT and NTC for a
variety of purposes including identifying retraining needs, skills assessments, and performance
benchmarks.
Overview:
The study will be conducted during two phases. Phase One will take place at Fort Sam Houston and
Phase Two occur at Fort Irwin.
During Phase One, medic baseline performance data on three key combat medical conditions will be
collected. These conditions are:
• Hemorrhage
• Airway Control
• Tension Pneumothorax
During Phase Two, these same three scenarios will be assed and demographic data concerning combat,
civilian, and continuing education medical experiences will be collected. Three different training
methodologies will also be evaluated.
The data sets will be compared and feedback will be provided to the DCMT and NTC leadership.
Expectations:
Data collections and all other aspects of the study will be conducted by training/simulation personnel
funded by the appropriation. All necessary steps will be taken to minimize disruption to the current
training workflow. Equipment, including SimMan mannequins and laptop computers, will be provided
through the appropriation.
Department of Combat Medic Training
Fort Irwin, CA
Fort Sam Houston, TX
National Training Center
University of Pittsburgh Medical Center
Peter M. Winter Institute for Simulation Education and Research
Combat Field Medic Longitudinal
Performance and Baseline
Training Comparative Analysis
Paul E. Phrampus, MD FACEP
Interim Director, WISER Institute
UPMCii:
WISER
Peter M. Winter Institute for Simulation. Education & Research
(materials for 3-5-08 meeting)
AGENDA
Update Meeting for
Cooperative Agreement #W81XWH-05-2-0049
March 5, 2008
Morning - 9:00 AM
• Introductions and Project Significance - Harvey Magee
• Peter M. Winter Institute for Simulation Education and Research (WISER)
Overview - Dr. Paul Phrampus
• Tour of WISER
• Break
• Project Overview - Dr. Paul Phrampus
• General Discussion - All
Lunch
Afternoon - 1 :00 PM
• Project Planning - All
• Next Steps and Action Items - All
1. I RB Protocol Process
2. Protocol Contact Person
3. Letter of Intent
4. Base Clearances
• Closing Remarks - Harvey Magee
UPMC
Innovative IDedica! find Information Technologies