Nearly 90% of combat fatalities occur before the patient reaches a hospital. Therefore, exceptional pre-hospital care is needed to reduce combat deaths. Efforts to improve combat medic training have recently incorporated simulation into the curriculum. At Joint Base San Antonio-Fort Sam Houston, students in the Medical Education and Training Campus (METC) spend the first seven weeks of their 16-week training program learning EMT skills using simulation-based training. The new training has proven effective in helping students rehearse and hone pre-hospital care skills and improve outcomes and combat medic readiness.
Why METC uses simulation in its combat medic program
The METC is the primary training location for Army, Navy, and Air Force enlisted medical trainees. EMT training is integral to the Department of Combat Medic Training (DCMT) program at the base. Its goal is to train the finest enlisted medical professionals in the world. Therefore, providing students with hands-on training experiences is vital to maintaining the highest level of care for three branches of the U.S. military.
Initially, this training consisted of classroom instruction, clinical rotations riding in an ambulance, and hands-on work using manikins or classmates in a lab. However, over time, educators realized the training labs had limitations. The scenarios were unrealistic and did not adequately prepare students for the realities of pre-hospital care. Chris Kwader, the DCMT simulation supervisor, stated, “[the training labs] were becoming boring and stale and didn’t provide students with any sort of realist patient encounter.”2
Thus, a shift to more experiential scenarios was seen as necessary to improve student training. Investing in new simulation-based training labs allowed educators to design scenarios that challenge students to connect what they have learned in the classroom with the realities of care in the field. While the original training labs helped students gain foundational knowledge, they lacked substantial experiential experiences, which provided a deeper and more comprehensive understanding of pre-hospital care.
The simulation labs allow students to respond to different real-world situations where they must evaluate their setting, examine realistic patients, make treatment decisions, and prepare their patients for transport to the next level of care2. These opportunities to practice skills and apply knowledge hands-on in every step of the treatment process means students enter the workforce with the experience needed to provide the best care possible.
METC enhances combat medic readiness with simulation
In September 2019, construction began on five new simulation labs at the METC. The labs were completed in January 2020 and were equipped with high-fidelity simulators to provide students with real-world patient encounters and hands-on training experiences. Students now receive EMT training in these labs through hands-on instruction in pre-hospital care in various operational and clinical settings.
Each lab is designed to reproduce the environments combat medics work in. Students apply their knowledge and skills to Gaumard’s Trauma HAL® simulator, whose advanced features allow them to use real tools and equipment. HAL’s vital signs, physical presentation, and bleeding respond to the students’ interventions, recreating the stress and anxiety inherent in these time-sensitive emergency scenarios.
A combat medic needs to be able to think critically and determine the best intervention to ensure a positive outcome for the patient. The sim labs allow students to repeatedly and safely hone high-level procedures, improving their performance each time until it becomes second nature. Thus, students leave the program having highly-developed skills, so they can work quickly and effectively as soon as they enter the field.
Moreover, the scenarios in the sim labs recreate the fast pace and stressful elements inherent in these real-world events. Excessive stress can compromise a healthcare provider’s ability to problem-solve and perform tasks optimally, potentially causing mistakes and reducing the quality of care patients receive . Over time, this kind of stress can become physically and psychologically draining, leading to burnout and forcing some combat medics to leave the profession.
The sim labs allow students to develop their ability to cope and work through stress as they hone their skills and become confident in their clinical performance while working under pressure. Moreover, burnout can be avoided by learning to cope with stress and anxiety early on, positively affecting combat medic retention and the quality of care they provide. Ultimately, these skills are not fully realized in the classroom but are refined in the field, giving the students the tools needed to succeed as they enter the workforce.
Integrating simulation-based training in the combat medic program has proven an effective strategy for improving pre-hospital care skills. Simulation-based training fills the gap between classroom learning and real-world experience, providing students with realistic and immersive training opportunities. This hands-on approach allows students to practice critical thinking and clinical skills, enhancing their performance and building confidence working in time-sensitive emergencies. By recreating the fast-paced and stressful environment they will face, students learn to manage stress and work efficiently under harsh time constraints. By embracing simulation, METC is advancing combat medicine and ultimately saving more lives on the battlefield.
Learn more about the METC simulation program by clicking here.
 Engle, Walter, and Jonathan C. Fruendt. Tactical Combat Casualty Care Handbook, Version 5. Center for Army Lessons Learned, 2017.
 Braun, Lisa. “METC combat medic training unveils new EMT sim labs.” Defense Visual Information Distribution Service, https://www.dvidshub.net/news/364298/metc-combat-medic-training-unveils-new-emt-sim-labs. Accessed 22 June 2023.
 Çelmeçe, Nuriye & Mustafa Menekay. “The Effect of Stress, Anxiety and Burnout Levels of Healthcare Professionals Caring for COVID-19 Patients on Their Quality of Life.” Frontiers in Psychology, vol. 11, no. 597624, 2020, pp. 1-7.
 Boas, Anders. “Stressed doctors make more mistakes.” ScienceNordic, https://sciencenordic.com/denmark-job-stress-partner/stressed-doctors-make-more-mistakes/1429486. Accessed 23 June 2023.