Rush program trains military and civilian providers in crisis trauma care
ISIS has infiltrated and bombed a military recruiting station. Medics and other first responders arrive to a chaotic scene.
Dozens of casualties, many with mortal injuries, are screaming for help. Smoke from the explosion makes it difficult to see, and guns are firing off from various directions. As medical personnel begin triaging, treating, and evacuating the victims, another bomb goes off across the street.
Fortunately, this scene is a simulated event: It’s part of Rush’s Advanced Trauma Training Program, a comprehensive curriculum for military medical personnel and civilian first responders. The mock bombing, which is based on a war-zone situation, is staged in an abandoned building near the Rush campus on Chicago’s near West Side, and the injured casualties are actors or mannequins.
“We stage it to be realistic and chaotic because that’s what responders will see,” says Louis G. Hondros, DO, the course director. Hondros also is Rush’s director of emergency medical systems, and associate professor in Rush Medical College’s Department of Emergency Medicine.
Program has trained more than 3,500
The Rush Advanced Trauma Training Program, or ATTP, was launched in 2006 with a grant from the U.S. Department of Defense to prepare medical personnel in the Illinois National Guard before they were deployed to military conflicts in Iraq and Afghanistan. Over the past 11 years, the program has expanded to train more than 3,500 members of the Army, Navy and Air Force, as well as civilian first responders, such as Chicago-based FBI and SWAT units. In addition to physicians, the program trains nurses, paramedics, physician assistants, respiratory therapists and other personnel who may be called on to provide care in a crisis.
“Our goal is to give them all the tools, knowledge, skills, and confidence they need to go into a trauma situation and treat the wounded on an acute basis,” Hondros says.
Capt. William White Jr. has taken the Rush ATTP trauma course twice since becoming a physician assistant in the Army. Currently stationed in Virginia, White works in hospital emergency departments, but he rarely sees trauma cases like he would encounter in a military conflict or natural disaster.
The simulated exposure to these situations is why he finds the hands-on approach used in the Rush ATTP so valuable. “In my opinion, it’s a phenomenal program,” White says. “We get taught in a classroom setting, but then we move on to practice and brush up on all the advanced trauma procedures like emergency cricothyrotomy (making an incision to create an airway), chest tubes, and different intubation techniques.”
Research backs up the importance of providing trauma training to military medical personnel before and after deployments. A Rush study found that programs like the ATTP reduced battlefield deaths by at least 20 percent.
Sharing expertise in trauma care
The Rush ATTP includes a number of different courses intended to help military medical personnel sustain and improve their clinical skills, as well as earn various certifications. Medical personnel are required to be re-certified in various critical skills every 24 to 36 months to maintain their licenses.
One of the most popular courses is the six-day trauma course. As an academic medical center and tertiary care hospital, Rush is uniquely positioned to offer this intensive training. The course is primarily taught by Rush board-certified emergency medicine clinicians and professors who are experts in treating patients with complex injuries and conditions.
Other Rush subspecialists are also brought in to provide relevant training. For instance, Rush psychiatrists teach students how to recognize and address post-traumatic stress disorder, as well as how to stay calm and focused in stressful combat situations.
In addition, Rush’s specially equipped Emergency Department, which is the nation’s first advanced emergency response center, enables ATTP instructors and students to conduct mass casualty drills. After evacuating the mock patients from the disaster site, the ATTP students bring them to Rush’s ED. The 60-bed, state-of-the-art facility can be easily converted to handle surges of patients, and the center’s layout and airflow can be controlled to isolate victims and prevent the spread of infectious agents.
Afternoon work with mannequins, evening rides with paramedics
The weeklong trauma course typically includes about 32 students and is taught six times a year at Rush. Most mornings the class receives interactive instruction by Rush experts on how to recognize and treat various types of injuries, from severe burns to traumatic brain injuries. The curriculum is based on the standard training course developed by International Trauma Life Support, a non-profit organization in Chicago’s western suburbs.
In the afternoons, students practice various procedures on sophisticated, human-like mannequins in the Rush Clinical Skills and Simulation Center and on cadavers in Rush University’s human anatomy laboratory. Rush emergency medicine physicians provide immediate feedback and discuss different approaches for handling procedures.
Evenings offer another unique opportunity. Thanks to a partnership between Rush and the Chicago Fire Department, students ride along with Chicago paramedics as they respond to 911 calls. Rush also has partnered with local trauma centers at Advocate Christ Medical Center and John H. Stroger, Jr. Hospital of Cook County, so when paramedics bring patients to these hospitals, the ATTP students can follow the patients into the emergency department.
“My favorite part of the course is the application of procedures, because I’m able to practice those skills that I’ve gotten a little rusty at because I don’t do it all the time,” White says.
The week kicks off with the mock simulation, which includes difficult scenarios that students are likely to encounter in a catastrophic or combat situation, such as having to decide whether to leave behind mortally wounded soldiers to save those who are less severely injured. “The point is that, if you’re in a disaster, you’ve got to stay focused and systematic to try to save the most amount of people that you can,” Hondros says.
Keeping skills sharp at home for when they’re needed away
While the Army, Navy and Air Force branches of the armed services provide medical training, they look to the Rush ATTP to help their personnel sustain important trauma care skills and proficiencies so they are always ready to be deployed. The ATTP is one of a handful of programs of its kind in the country, and Rush’s curriculum is known for providing the type of critical hands-on training that military and civilian medical personnel need to maintain readiness.
“Military deployment numbers are not nearly as high as they were in 2007 and 2008, when we had over 250,000 members deployed in Afghanistan and Iraq,” explains retired Col. Dave Leckrone, Rush ATTP program liaison/consultant. “In addition, on military bases the hospitals or medical treatment facilities primarily provide outpatient care.
“The skill levels of medics, nurses, doctors and physician assistants in the military can diminish when they don’t regularly see trauma cases, such as gunshot wounds or penetrating knife wounds. They need a way to maintain critical trauma care skills, and at Rush, the students get a very excellent opportunity to not only sustain but upgrade their skills.”
Responding to first responders’ responses
In addition to the trauma course and numerous certification classes, the Rush ATTP offers a critical care course for flight paramedics and an infectious disease course for public health personnel. In the near future, a mental health course will also be available, which will focus on treating victims of post-traumatic stress disorder and sexual assault, as well as building emotional resiliency.
As the demand for ATTP courses has grown, Rush partnered with five other Chicago-area hospitals to help provide instruction: Advocate Christ Medical Center, John H. Stroger, Jr. Hospital of Cook County, Loyola University Medical Center, Memorial Medical Center and Northwest Community Hospital
A key to the Rush ATTP’s continued growth and success is a spirit of continuous improvement. After every course, students are asked to provide feedback and suggestions for how the program can better serve their needs and ensure they are prepared for any combat situation.
“We get people with all kinds of experience, including military personnel from all different types of units. Many of our students have been deployed and have a lot of field trauma experience,” Hondros said. “The students are valuable resources for us, and we’re very in tune to their feedback.”
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The opinions expressed by Capt. William White in this article are his and not those of the U.S. Army.