By Robert von Tersch et al.
Experts at the USAMRIID introduce their work in training and educating Service Members on the medical management of biological casualties.
Tucked into the mountains of central Maryland, the United States Army Medical Research Institute of Infectious Diseases (USAMRIID) stands unique in service to the U.S. Army, the U.S. Department of Defense (DoD), and United States of America. Since 1969, USAMRIID has been home to cutting-edge biodefense research, developing diagnostics, therapeutics, and other medical countermeasures to counter biological threats.
USAMRIID proudly operates the only Biosafety Level (BSL) 4 research facility in the DoD and has the largest biocontainment research facility in the nation. USAMRIID conducts three broad missions, specifically, research, operational support, and training in support of U.S. and allies’ military needs, and U.S. national needs.
With one of the core missions of the Institute being to train and educate the Force, USAMRIID’s team continues to provide world-class education on the medical management of biological casualties.
Multiple military operations and missions, including Large Scale Combat Operations (LSCO), require the U.S. DoD to provide Service Members with the knowledge, skills, training, and resources to accomplish the mission. Readiness and preparedness are paramount in deterring the use of weaponized threat agents and dealing with infectious diseases on future battlefields. However, as the COVID-19 pandemic has shown us, biological threats do not always come from hostile nation states or terrorist organizations; they can also have a natural or accidental origin.
Education and Training
Understanding the nuances of the medical management of these biological casualties can be the deciding factor in mission success versus mission failure, regardless of the origins of the causative agent. USAMRIID’s Education and Training (E&T) team is the bridge connecting the science and what is learned at the laboratory bench to the soldiers on the battlefield, teaching the medical providers, first responders, and special purpose forces how to operate and treat casualties in a biologically contested environment.
Through professional education courses like the Medical Management of Chemical and Biological Casualties (MCBC) course, taught jointly with the United States Army Medical Research Institute of Chemical Defense (USAMRICD), the E&T team prepares physicians, nurses, commanders, and other civilian and military medical professionals to reduce vulnerabilities to biological threats through the ability to rapidly assess, protect, and mitigate these biothreats without severe impact to the mission within the future operational environments.
While the first biological casualty course was taught at Camp Detrick in 1944, the current iteration, the MCBC, has been taught quarterly since the 1991 Persian Gulf War. Since then, the E&T mission has grown to include four resident courses, a mobile training course that travels around the world, and an online, distance-learning course that provides education to thousands of students each year. In addition to the MCBC course, during the Ebola outbreak in West Africa in 2014, USAMRIID was asked to help train deploying Service Members on how to don and doff personal protective equipment (PPE), along with infection control and prevention strategies. Due to this training, zero cases of Ebola infections occurred in the trained Service Members. In addition to training deploying Service Members, USAMRIID was also asked to help develop a course to address future outbreak response operations. The purpose of the course was to train active-duty military and civilian healthcare personnel in the planning, training, recognition, and response to infectious diseases that could potentially cause public health crises or overwhelm the ability of medical facilities to respond.
Training Demand Increasing
Since the inception of the courses, over 11,000 students have been trained. These students come from various organizations such as the DoD, including representatives of the White House staff, U.S. interagency, state, and local governments, as well as international students. The courses are composed of medical providers, emergency managers, and hospital and unit chief executive officers to name but a few of the skill sets attending.
Each course is designed to train up to 150 students based on logistics and a student-to-instructor ratio of no more than 10:1. Post-COVID, the training demand has been trending up, with 478 and 576 students in fiscal years 22 and 23, respectively. Additionally, the mobile training demand has doubled from four to eight iterations over the same fiscal period. To assess whether USAMRIID is meeting DoD and national needs, a post-course survey is always sent to the students of these courses, and the results are astounding. Comments have included the following:
“I found it a well-executed course that provided concise, actionable, and salient training. In retrospect, now framed in the COVID pandemic, the time was perfect.”
“The course was well prepared and organized with knowledgeable presenters. The material, format and presenters kept the topic lively. The course was an excellent prep for the pandemic.”
“I always feel hands-on learning is best. I truly gained valuable experience by being able to attend this training.”
One of the strategies that makes USAMRIID’s training so successful is that the E&T team capitalizes on creative learning platforms. In 2018, the team began to modernize their course content. The goal was simple: to create innovative and creative learning platforms that will engage students across a broader spectrum of learning modalities. With this simple goal in mind, the E&T staff began developing several new and exciting training platforms including unique small group activities, interactive video-based case scenarios, and tabletop exercises. With these innovations, USAMRIID has taken adult learning to a new level.
The engaging lectures are complemented with realistic training that allows the students to take their knowledge and practice application. Not all the learners will have the same background, focus areas, and experience levels, or be credentialing in the same fields. Therefore, staff has incorporated a tailored approach to the trainings they provide so that the training can be beneficial to the most junior inexperienced individual as well as to the most knowledgeable senior level leader, from the medic in the field to the physician in the intensive care suite. Using Gagné’s nine events of instruction as a guide for providing the training, the students can develop a clearer picture of complex topics.
While the interactive and engaging lectures provide a framework, the application of content discussed can be applied in a variety of methods depending on the educational background of the students and occupational roles that they fill as a Service Member. Students have well received the recently developed training aides which are not only realistic and applicable to the medical personnel receiving the training, but also are engaging and fun. One training aide that has garnered a lot of positive feedback is the concept of an “escape room” that is carefully developed, planned out, and prepped for each class iteration.
The “escape room” concept takes the attendees into an interactive, time-limited scenario where the story develops and unfolds as puzzles and challenges are accomplished. However, what is unique is that the “escape room” concept was applied to a mobile concept where the students are not breaking out of a room, but instead using clues to predict patient care or solve a ‘crime’ scene. Coupling the puzzles and interactive scenarios with the application of concepts discussed during the lecture portion of the course allows students to apply complex knowledge of medical management of biological casualties into fun learning experiences.
Another area of development for the E&T team has been the use of augmented and virtual reality. Caring for a patient with viral hemorrhagic fever carries an inherent risk of contamination and operational environment stressors; however, applying these medical management skills in an augmented or virtual reality concept allows learners to practice their skills without the unnecessary risks associated with caring for actual patients. Learners using the virtual reality simulator will care for a CBRNe patient from field environment medical care to higher echelons of medical support and capability, providing decontamination and immediate field care to more medical in-depth management.
They will be graded on providing the above and knowledge on donning/doffing PPE and proper steps of medical management of various CBRNe casualties. This gives learners engaged in the medical management of biological casualties course additional informative experiences, enhancing the learning and comprehension of the students by providing hands-on patient care using augmented or virtual reality.
Additional Resources
USAMRIID has created additional resources to help provide refresher training and resources to access material discussed during the courses. An online training course, comprised of 25 modules on the main threat agents, is housed within the Joint Knowledge Online Learning Management System and has been accessed by over 31,000 Service Members since its creation. The USAMRIID’s Biodefense Tool mobile app is also available for both Apple and Android mobile devices. The app distills key information presented in USAMRIID’s courses and serves as a quick reference for the identification of these agents in the field. The USAMRIID Medical Management of Biological Causalities Handbook, also referred to as the Blue Book, is currently in its ninth edition. A field expedient Quick Reference Guide version of the material is also available.
Where the DoD may be called upon to support the preparedness and response to a natural, accidental, or deliberate exposure to a biological warfare agent or infectious disease, through E&T efforts, military clinicians and operators can develop the readiness and knowledge to stand ready in the face of an uncertain future. Therefore, with this expert training, USAMRIID fulfills one third of its missions by preparing the Force to provide leading-edge medical capabilities to deter and defend against current and emerging biological threat agents.
By Mr. Coleman W. Erwin, BSN, RN, CPT (Ret), U.S. Army; Lead Clinical Training Nurse, Education and Training Department Division of Medicine, USAMRIID; Mr. Charlie A. Boles, U.S. Army Veteran; Medical Education / Training Development Coordinator, Education and Training Department, Division of Medicine, USAMRIID; Ahmad H. Yassin, DO MPH MA FS, LTC, U.S. Army; Chief, Division of Medicine, USAMRIID; and corresponding author Robert L. von Tersch, PhD, MSS, COL (Ret), U.S. Army; Chief Science Officer, USAMRIID, to whom questions should be addressed. To learn more information regarding course content and course schedules, please consult the E&T Team at: usarmy.detrick.medcom-usamriid.mbx.training-education-branch@health.mil
