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Today's Lesson: Major Disaster
Military Medical School Simulates Chaotic Situations

By Jackie Spinner
Washington Post Staff Writer
Monday, March 10, 2008

Elisabeth Pimentel positioned two metal wands in front of a pink, fleshy gall bladder. With a couple of clean strokes, she snipped at the tissue surrounding the pear-shaped organ, gently cutting it away from the liver. Then she cut a little too deeply, drawing a stream of bright red blood.

She seemed unconcerned as a small monitor nearby showed images of the cut to the patient's innards. "It will bleed," she said.

But Pimentel, a research coordinator at the Surgical Simulation Laboratory of the Uniformed Services University of the Health Sciences, wasn't operating on a live patient in this cavernous room where students study endoscopic and laparoscopic surgical techniques. She was practicing on a computer model in one of the more sophisticated medical classrooms in the country -- a virtual reality and simulation center that lets students experience what it is like to deal with trauma.

The National Capital Area Medical Simulation Center helps the Bethesda-based university train military doctors and public health professionals for battle zones, natural disasters and infectious disease outbreaks. "We use it to teach advanced situations which may be dangerous for the first time," said Army Col. Bruce A. Schoneboom, acting dean and associate professor of the Graduate School of Nursing.

"Fighting for Life," a documentary that opens in Washington area theaters Friday, chronicles the stories of doctors and nurses at the university, which students call the "best medical school no one's ever heard of." It is the only military medical school in the country.

The film follows 21-year-old Army Spec. Crystal Davis from Iraq to Germany to Walter Reed Army Medical Center as she recovers from the loss of a leg in a roadside bomb blast. She interacts with professionals who trained with and graduated from the Uniformed Services University. Of USU's more than 4,000 physician alumni, about three-quarters are in public health or the military.

The medical school sits in the back yard of the National Naval Medical Center; the simulation center is a few miles away at a Walter Reed annex.

At both, men and women in civilian scrubs or military uniforms practice clinical and surgical skills on computer simulations or on actors posing as patients, getting experience they might need to treat mass casualties from war or a public health crisis such as the aftermath of Hurricane Katrina.

The university, established by Congress in 1972, is operated by the Defense Department but also trains civilian doctors in public health. The four-year program is year-round and roughly 700 hours longer than those of traditional medical schools. Medical students pay no tuition or fees in exchange for a seven-year active duty commitment.

Over the years, critics of the university have said students should attend other medical schools and not have their tuition covered. But the university appears to have powerful supporters. The film's credits, listed on a promotional Web site, indicate that "Fighting for Life" was made with support from "many members of the Friends of USU." USU Surgical Associates provided a grant to help fund the film. So did ITT, an engineering and manufacturing company, Northrop Grumman Foundation, Johnson & Johnson Health Care Systems and others.

The simulation center, which conducts about 8,000 virtual operations each academic year, opened in 2000.

"This is batting practice before the big game," said Air Force Col. Charles W. Beadling, vice chairman of the university's Department of Military and Emergency Medicine. "In aviation, they've been doing this for years. Why can't we do this in medicine?"

In one of the simulator's operating rooms, a mannequin on an examining table appeared to be taking deep breaths. It had a pulse, and its face was scratched and bloody.

Students practice on mannequins in groups that simulate a chaotic trauma situation in which doctors and nurses have to collaborate, often to save the lives of severely wounded patients, as in combat.

"This new technology allows for hands-on training in a high-fidelity environment for crisis management as well as repetitive experience for advanced procedures such as intubations for general anesthesia," Schoneboom said.

Students also practice on "real patients," actors and volunteers who pose with a variety of ailments.

On a recent lunch break, actors in hospital gowns gathered outside a bank of examining rooms, where professors could watch medical students conduct routine examinations.

One actor portrayed a patient with gastrointestinal distress. "I have trouble swallowing," another chimed in.

Alice Mark, 75, a former director of a rehabilitation facility for the Howard County Health Department, sipped from a container of lentil soup while waiting to be examined.

"It's worthwhile," she said. "It's something I can do that's giving back, and it's fun. I make a little bit of money."

As she pulled on a pair of hospital booties, Mark listed ailments she has simulated: diabetes, gangrene, a leg cut off from the knee down.

"Our students learn more than just knowledge, but to integrate that knowledge and apply it in a dynamic, stressful situation," Beadling said. "This could be in combat or a domestic disaster. Bottom line, they learn to make difficult decisions and take charge in times of crisis."

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