Project PEGASUS (Perfused En-route General and Acute Surgical Utility Simulation): In-flight damage control surgery...

Area of Science:

• Aerospace Medicine
• Surgical Training
• Emergency Medicine

Background:

• Timely surgical care is often delayed by prolonged evacuation, infrastructure issues, and hostile environments.
• Previous operations demonstrated in-flight surgical interventions are possible for life-saving measures.
• This study focuses on training teams for planned in-flight surgery during fixed-wing transport.

Purpose of the Study:

• To assess the feasibility and identify practical lessons for training surgical teams for in-flight damage control surgery.
• To refine protocols for managing casualties requiring operative intervention during fixed-wing evacuation.

Main Methods:

• Conducted 5 C-130 fixed-wing flight simulations during West Virginia National Guard Ridge Healer exercises.
• Simulated scenarios involved surgical and critical care casualties using advanced manikins and role players.
• Utilized after-action reviews and iterative curriculum refinement based on faculty observation and participant feedback.

Main Results:

• Identified recurrent adaptations improving procedural flow and team safety, including patient loading order and communication strategies.
• Highlighted the benefits of using staplers/clips over hand-sewn techniques and standardizing temporary abdominal closure.
• Participant feedback emphasized loadout streamlining and cross-trained personnel as crucial adjustments.

Conclusions:

• Simulation-based training for in-flight damage control surgery is practical and effective.
• Yielded valuable insights into ergonomics, communication, staffing, and procedural simplification for air evacuation surgery.
• Findings provide descriptive lessons learned, not definitive proof of clinical efficacy.