Closing the Trauma and Critical Care Gap: A Paradigm Shift through Virtual Reality and Augmented Reality.

A nationwide surgeon shortage, particularly with general surgeons and trauma surgeons, continues to plague the civilian and military systems readiness. To fill this shortcoming, we provide a narrative review describing current and potential uses of augmented reality and virtual reality (AR/VR) for synthetic training environments which could significantly improve the Army's wartime medical readiness through improved skills of surgeons and non-surgeon providers. Multiple studies demonstrate the potential benefits of AR/VR in cost, time, and critical medical skills for enhanced care delivery. While encouraging, the novelty and relative youth of AR/VR platforms requires further prospective validation as the data for its use as a training adjunct is limited. Nevertheless, state of the art simulated training platforms like AR/VR which mimic surgical trauma cases and review critical surgical skills could help enable a transformation of non-surgeon providers to quickly augment current surgeon personnel shortages.

Unit Collective Medical Training in the 75th Ranger Regiment.

The 75th Ranger Regiment's success with eliminating preventable death on the battlefield is innate to the execution of a continuous operational readiness training cycle that integrates individual and unit collective medical training. This is a tactical solution to a tactical problem that is solved by the entire unit, not just by medics. When a casualty occurs, the unit must immediately respond as a team to extract, treat, and evacuate the casualty while simultaneously completing the tactical mission. All in the unit must maintain first responder medical skills and medics must be highly proficient. Leaders must be prepared to integrate casualty management into any phase of the mission. Leaders must understand that (1) the first casualty can be anyone; (2) the first responder to a casualty can be anyone; (3) medical personnel manage casualty care; and (4) leaders have ownership and responsibility for all aspects of the mission. Foundational to training is a command-directed casualty response system which serves as a forcing function to ensure proficiency and mastery of the basics. Four programs have been developed to train individual and collective tasks that sustain the Ranger casualty response system: (1) Ranger First Responder, (2) Advanced Ranger First Responder, (3) Ranger Medic Assessment and Validation, and (4) Casualty Response Training for Ranger Leaders. Unit collective medical training incorporates tactical leader actions to facilitate the principles of casualty care. Tactical leader actions are paramount to execute a casualty response battle drill efficiently and effectively. Successful execution of this battle drill relies on a command-directed casualty response system and mastery of the basics through rehearsals, repetition, and conditioning.