Education & Training How Tactical Medicine Sensory Deprivation Training Benefits EM Residency Education

How Tactical Medicine Sensory Deprivation Training Benefits EM Residency Education

By Aaron Kuzel, DO, MBA, and Taylor Diederich, MD on behalf of the SAEM Education Committee

In training law enforcement officers and members of civilian tactical teams, many programs provide instruction on providing life-saving medical care while employing sensory deprivation. Students are instructed to evaluate patients and perform clinical skills while under pressure and with the loss of a physical sense whether that be sight, sound, or touch. Often, in simulated drills, members of the team must identify casualties, identify their injuries, and attempt to exfiltrate those individuals to safety or higher levels of care; all the while having to overcome a deprivation. While the tactical elements may not be immediately applicable to emergency medicine residents, sensory deprivation or low resource training may provide some benefit to developing resident fine motor skills under pressure. There are many ways to simulate sensory deprivation in a tactical environment. One that we have employed locally in Louisville as well as with emergency residents in Kaunas, Lithuania is a physical assessment and treatment of a wounded individual while blindfolded. Students in this course had to identify injuries through moulage

“…sensory deprivation or low resource training may provide some benefit to developing resident fine motor skills under pressure.” or the use of binder clips to identify injuries and either place a tourniquet or chest seal over the injury site, all while blindfolded. The blindfold attempts to simulate fog conditions in which officers may have to employ life-saving measures under tear gas or oleoresin capsicum (OC) spray (i.e., “pepper spray”) or in low-light conditions.

“While most emergency medicine residents are unlikely to find themselves participating in a prehospital mass casualty incident response or tactical operation, sensory deprivation training may prove useful in preparing residents for more common situations they will encounter during their careers. The most obvious relevant circumstances include prehospital practice in urban, rural, and wilderness environments.”

Additionally, officers are challenged with placing a tourniquet on themselves in under 30 seconds while their fingers are locked down with tape to simulate their fingers wounded in an engagement. Further, one can simulate injured extremities by securing these extremities with triangular bandages and having them perform self-tourniquet application. These simulated scenarios can also be enhanced by eliminating a second sense, such as sound, by playing loud music or distracting sounds while the student attempts to perform these exercises. These are just some of the exercises that use sensory deprivation to simulate trauma scenarios under pressure to best simulate tactical medical situations.

While most emergency medicine residents are unlikely to find themselves participating in a prehospital mass casualty incident response or tactical operation, sensory deprivation training may prove useful in preparing residents for more common situations they will encounter during their careers. The most obvious relevant circumstances include prehospital practice in urban, rural, and wilderness environments. In each of these environments, physicians are called upon to evaluate and treat patients in low-resource settings with different challenges to sensory input. For example, in an urban setting one may evaluate and even perform procedures on patients in a dark and loud nightclub where both sight and hearing are significantly impaired. In austere environments, physicians may be called upon to provide aid in complete darkness or adverse weather — performing an evaluation or procedure in a snowstorm whilst protecting the patient from the risks of hypothermia, for example, may render the physician devoid of normal visual and/or tactile feedback. Of course, many residents will not go on to serve in a prehospital setting. The argument could be made, nonetheless, that emergency physicians should be prepared to aid those around them in ordinary (e.g., finding someone down in an airport) or extraordinary (e.g., mass casualty) circumstances.

Sensory deprivation training may also instill invaluable skills within the hospital setting. There are many circumstances in which physicians become devoid of full sensory feedback within hospital walls. For example, attempting intubation during the earlier days of the COVID-19 pandemic often required PAPR (powered air purifying respirator) use, which limited both peripheral vision and some degree of hearing. For patients requiring decontamination, physician donning of hazmat suits sharply limits tactile, auditory, and peripheral visual feedback. Consider the emergency department (or prehospital setting) during an extreme weather event resulting in power outage. Of course, hospitals typically have protections against these adverse events in place but even the briefest of interruptions to light and electronic equipment use may be enough to pose a serious threat to critical patients we encounter in the ED. Formal training with sensory deprivation simulation would provide trainees with a baseline approach to treating patients effectively and safely in any number of these possible, and even probable, situations.

Further, a key element to emergency care that can be simulated is emergency communication. Any time a medical team is stripped of resources — whether they be medical supplies, personnel, or the full use of one’s senses — communication becomes all the more critical. Sensory deprivation exercises, such as solving a puzzle while blindfolded and responding only to verbal instructions of unblinded teammates, serve to improve team communication. Trainees certainly could benefit from the opportunity to strengthen their team communication skills regardless of the practice environment.

Sensory deprivation training often utilized in tactical and law enforcement training would provide value in emergency medicine residency education. Given the roles they fulfill in the prehospital setting and on the front lines of the hospital, emergency physicians may find themselves in circumstances throughout their careers that demand the evaluation and treatment of patients without full use of environmental or intrinsic resources. Sensory deprivation, incorporated into simulation training, gives trainees an opportunity to consider and adapt to this need ahead of time so they are better able to serve their patients when that need arises.

ABOUT THE AUTHORS

Dr. Kuzel is the current EMS Fellow at the University of Louisville School of Medicine and serves as RAMS associate editor for SAEM Pulse.

Dr. Diederich is a first-year emergency medicine resident at the University of Kansas. She also serves as a member-atlarge on the SAEM RAMS Board and as the RAMS liaison to the SAEM Education Committee.