C-STARS: Diverse trauma training saves lives Published July 27, 2007 By Tech. Sgt. Phyllis Hanson Air Force News Agency ST. LOUIS (AFPN) -- A hands-on medical trauma training course being conducted at a local university medical center here is using the experience of medical crews who have treated thousands upon thousands of wounded warriors to teach others. The Air Force Expeditionary Medical Skills Institute's Center for Sustainment of Trauma and Readiness Skills, or C-STARS, is an Air Force medical training program that is embedded in a civilian academic trauma center, said Lt. Col. (Dr.) Jeffrey Bailey, C-STARS director. The C-STARS program exists as a formal curriculum in the school of medicine at St. Louis University. The C-STARS staff is a total-force platform led by trauma surgeons, physician assistants and flight nurses from active duty Air Force and Air National Guard, said Colonel Bailey, a Missouri Air National Guard officer on active duty assignment. Its purpose is to prepare Air Force medics by providing hands-on clinical sustainment training in the care of seriously injured patients, he said. The treatments involve trauma the students are likely to encounter during wartime. "When you get deployed, that isn't the time to be learning your job; that's the time to know your job," Colonel Bailey said. "Anything we can do to help with that is very valuable." Through a memorandum of understanding with St. Louis University, C-STARS students are made the equivalent of the university students or residents of the hospital, Colonel Bailey said. The 14-day course starts with orientation lectures to get the team on "the trauma page," and is followed with an expeditionary medical equipment refresher, he said. Physicians, physicians assistants, nurse practitioners, nurses and medical technicians scheduled to deploy are identified and then are selected to train in the hospital. The program here pairs Air Force medical personnel with Saint Louis University Hospital trauma doctors and hospital nurses to help the team care for patients with injuries. "(This program) signals the synergy we have with our counterparts here at St. Louis University," said Brig. Gen. (Dr.) Byron C. Hepburn, command surgeon at Air Mobility Command headquarters at nearby Scott Air Force Base, Ill. "It is an awesome partnership we have with the surgeons, nurses and techs here who train our medics who are going forward in the war on terrorism," the general said. As the command surgeon, he ensures maximized operational health, combat readiness and the efficient delivery of peacetime health benefits to beneficiaries. This training has been invaluable to the more than 800 medics who have come through the trauma course. "The training is very realistic and it's high quality," he said. "Most of the staff who teach here already have been deployed to Afghanistan and Iraq and they're taking their lessons learned and applying them to realistic scenarios," said the general, who is one of 15 Air Force pilot-physicians and is a command pilot. There is a great partnership with the states of Missouri and Illinois, General Hepburn said July 5 during a visit to watch a human simulator scenario being demonstrated by an Expeditionary Medical Support unit called EMEDS. The simulator has computerized sensors that react to any medical treatment a student applies. The life-like mannequin has the replicated anatomy of a man. Because of the technology built in the human patient simulator, it comes to life and can die too, just like a real wounded warrior. It can breath, talk, choke, scream. The eyes can dilate and blink. The heart beats. It even has bodily functions such as urination. The mouth can drool and the eyes and ears can secrete fluid. An added enhancement to the scenarios, done three times throughout the course, is the instructor's capability to control the mannequin's voice and even follow the vital signs of the patient. When treatment is correct, the mannequin's condition improves. If incorrect treatment occurs, the patient's condition will worsen. It can even die. Medication (made of water) can be injected. The computer will tell if the correct medication was prescribed. Add chest tubes, IV hookups and hundreds more conditions and capabilities and it makes for a graphic, realistic and emotional scene. In one trauma scenario, using a high-end human patient simulator, a 22-year-old Soldier who had been pinned under a Humvee after a bomb struck the vehicle was brought in for emergency care. The medical team immediately went into action assessing the patient's injuries and stabilizing him. As the patient gasped for air, team members calmed the patient and opened his airways within minutes by doing an endotracheal intubation, the insertion of a tube directly into the trachea, or windpipe. As the scenario progressed, the patient's leg began gushing blood and a tourniquet was strapped tightly around the leg. The human simulator is just one part of the training curriculum. The C-STARS hands-on experience includes working in the intensive care and burn units, going on ambulance and fire department ride-alongs and flying with a medical helicopter service. This integration with civilian counterparts enables the colonel's staff to provide real-life hands on trauma care experience and exposure for Air Force medical personnel, Colonel Bailey said. The goal of C-STARS is to produce "ready medics," according to the Air Force Medical Service. The intense workload and clinical experiences are intended to sharpen and refresh medics' trauma care currency, increase the knowledge base and help them become even more competent and confident medics. There are currently three C-STARS programs, including the St. Louis program, and programs in Baltimore and Cincinnati. "We've had a very successful relationship in helping train folks for the C-STARs' program," said Ms. Crystal Haynes the chief executive officer of SLU Hospital. "With the large number of trauma cases that we have here, we're able to provide (the C-STARS students) with an experience that is really difficult to replicate in another environment. It is so beneficial," she said. The C-STARS course is an important confidence builder for the rotators who come through here, Colonel Bailey said. "When they go downrange, we're not asking them to do something that they really have never seen before," he said. Although the team was able to save the patient, lack of some actions beforehand could have been the difference between life or death. If a tourniquet had been applied in the field appropriately, it would have definitely diminished the bleeding, would have diminished the amount of blood loss and fluid loss ... which would have made the resuscitation easier and his outcome better, said Capt. Jeffrey Egly, a flight nurse with the 375th Aeromedical Evacuation Squadron at Scott AFB. "It's important for servicemembers to know how to do self-aid and buddy care," he said. "Poor self-aid and buddy care in the field could equal a very poor outcome for the patient despite the resuscitation team's best efforts. "If those initial stabilization steps have already been started when we get (the wounded), we can focus on the bigger things and get them even more stable so that they can safely get into the operating room and ultimately ... out of theater to the definitive care that they need," the captain said. During both short missions and long missions, the C-STARS training he received gave him a comfort and strong knowledge level, he said of his deployments to Bagram Air Base, Afghanistan, and Balad Air Base, Iraq. Deployed Air Force medical teams are in the fight to win the war on terrorism, too. As C-STARS alumni can attest, with the partnership with the civilian medical center, they are more able to fight to save the lives of the critically-wounded warriors. USAF. (U.S. Air Force Graphic by Rosario "Charo" Gutierrez) Photo Details / Download Hi-Res USAF. (U.S. Air Force Graphic by Rosario "Charo" Gutierrez)