American women have served in combat and support roles since the Revolution, yet, until now, medical training overlooked battlefield trauma specific to female soldiers. Operative Experience (OEI) addressed this gap with the PCCS Pro Female, the first anatomically accurate female simulator, now deployed in Army training centers. This innovative simulator, developed with a $3.6 million Army grant, prepares medics to handle female casualties accurately, addressing previously neglected trauma needs. Designed for realism, the PCCS Pro Female includes lifelike features such as realistic blood volume and specific injury responses, ensuring gender-specific care for both military and civilian operations.
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Margaret Corbin. Cathay Williams. Yeomanettes. WAACS. MASH nurses. Leigh Ann Hester.
These names are only a tiny fraction of the storied legacy American women have cultivated in the military across the ages. Since the Revolution, women have served in and out of uniform both on the battlefield in direct combat and in dangerous support roles.
Whether taking up arms with their husbands, secretly serving while dressed as men, or participating openly, women have always been involved in combat operations in defense of the nation. According to the USO, since 2001, more than 300,000 women have deployed to Iraq and Afghanistan’s war zones and 9,000 have earned Combat Action Badges. In 2015, Secretary of Defense Ashton Carter officially opened all combat roles to women, including those in the special forces. Currently, women make up 17% of active duty service members and 24% of National Guard and Reserve components. As the Department of Defense continues to see women as a valuable and vital resource in the U.S. military, it is likely that their participation in the armed forces will grow over time.
And yet, before 2024, medical personnel were not adequately trained to address women’s battlefield trauma needs. According to the Army University Press, the U.S. military’s rate of survivability for preventable death is not only the highest globally at 92%, it is the highest in history.
Now, there is a groundbreaking and innovative medical simulator that will improve battlefield response and care for women in combat. Developed by Operative Experience (OEI), the Prolonged Casualty Care Female Simulator (PCCS Pro Female) is making medical and military history as the first of its kind to be accredited by the U.S. Army.
Operative Experience Leads The Way
The milestone is an important one for OEI, a small business with global impact located in Maryland. With a mission to revolutionize healthcare training and reduce mortality through better decision-making in the field, OEI designs and produces high fidelity trauma simulators that are used by military, civilian, and humanitarian organizations around the world.
Providing a vehicle for more robust, realistic training was the primary goal for the development and delivery of the PCCS Pro Female. “Data has shown that female casualties have a higher rate of mortality than their male counterparts due to a variety of causes, including hesitancy of males properly assessing fatal wounds, as well as cultural or psychological factors,” says Paul Bernal, OEI VP Global Sales and Business Development.
Research pinpointed medics’ discomfort with going “trauma naked” as the primary factor for such a drastic difference in fatality rates, says Walter Engle, CEO of Chiral Medical Consulting and project consultant. Even during training, medics—regardless of sex—were uncomfortable removing the underwear of a female mannequin while practicing initial triage and treatment.
The cultural discomfort surrounding the female body has drastic consequences in the field. “(Medical professionals are) missing junctional injuries. Those injuries will cause a person to exsanguinate—or bleed out—in three to five minutes,” Engle says.
A First In Army History
To ensure that women service members receive appropriate and quality medical care in the field, the Army has recently placed OEI’s PCCS Pro Female mannequins in all 23 of their Medical Simulation Training Centers (MSTC). MSTCs provide realistic battlefield and pre-hospital care training for military members. The lessons and practice that students receive at these centers are often the difference between life and death for wounded service members.
Using hands-on instruction, MSTCs teach the latest battlefield trauma and critical care techniques to medical and non-medical participants. “The OEI female simulator advances the familiarity and proficiency of a medical provider in a battlefield environment the way the E5 Silhouette advanced marksmanship in combat. It was a game-changer in desensitizing and maintaining skill sets,” says Engle.
The implementation of PCCS Pro Female simulators at all MSTCs is a testament to the high quality and multiple uses of the mannequin. “The Army has never fielded female trauma simulators before, so having the PCCS Pro Female accredited and ready for training is a huge milestone in ensuring all our soldiers receive the highest possible medical care,” says Lou Oberndorf, OEI’s Chairman and CEO. A more accurate, more realistic training foundation means more prepared medical professionals and better results for wounded women in the field—a reality that is no longer an exception.
“You Need A Realistic Trainer”
Prior to the development of the PCCS Pro Female, there were no physiologically and anatomically correct female simulators available on the market. Mannequins were sized to the average male service members’ specifications at five feet eleven inches and 180 pounds, rather than the average female service members’ at five feet nine inches and 135 pounds. If a female simulator was required for training, superficial changes were made to satisfy the training requirements. “You basically had a Russian weightlifter with a female wig and breasts as a mannequin. You had some female landmarks that would cause you to believe this was a female, but it just wasn’t realistic,” says Engle.
The PCCS Pro Female is the average height and weight of a female service member and incorporates other important physiological markers that previously were overlooked. “You need a realistic trainer to maintain familiarity and proficiency treating a female casualty,” says Engle.
In addition to creating an accurate female form, OEI also modified the software algorithms to reflect typical, specific responses for time and injury.
The combination of a true-to-life physiologic simulator and updated software has far-reaching effects on training. For example, the PCCS Pro Female is designed with an accurate blood volume for the average female body at 3.75 liters. (In contrast, the average male body contains five liters of blood.) Because the average woman has less blood than the average man, students will receive a more authentic learning experience when determining the speed at which procedures must be implemented on women. In this instance, Engle says, medical personnel have less time to triage a woman service member with a traumatic amputation than her male counterpart with the same injury. The simulator reflects all aspects of that reality.
The PCCS Pro Female has other highly realistic features, including a variety of skin tone options, simulations of wounds such as IED explosions, blunt trauma, and gunshot wounds, and lifelike tissue and skin. “In simulation, it’s important for learners to suspend disbelief to fully immerse themselves in the experience and perform tasks as if they were in a real-life situation,” says Bernal. “We strive to provide our learners with the highest standards of fidelity, realism and diversity in our simulators.”
Exceeding Requirements And Expectations
The result of a six-year collaboration with the Army, the PCCS Pro Female’s ideation began when OEI was awarded a $3.6 million Phase 2 Small Business Innovation Research grant from the U.S. Army’s Program Executive Office of Simulation, Training, and Instrumentation. OEI matched the grant with its own research and design investment to support the development of the first anatomically and physiologically correct female simulator. “Seeing the results of the collaboration and co-investment by OEI and the U.S. Army and being able to put these medical training products in the hands of our brave military men and women is a minimum standard of care that is long overdue and the right thing to do,” says Oberndorf.
OEI used the Army’s specifications as a jumping-off point, not a finish line. “OEI could have made a female Barbie doll mannequin with no mechanical guts, no physiologic response. That would have satisfied what the request for proposals asked for,” says Engle. Instead, OEI developed a state-of-the-art simulator with forward-leaning software and hardware.
One of those features? Fully articulating joints. While the U.S. Army’s call for proposals required that the mannequin’s hips and knees move, OEI developed the PCCS Pro Female to bend at every joint. Unlike less lifelike options on the market, “you can do a physical exam on this mannequin,” among many other training settings and situations, Engle says.
OEI’s intentional design choices during development mean that the PCCS Pro Female can simulate injuries throughout the entire continuum of care. “We train people to do everything they possibly can, and then we train them to do a little bit more,” says Engle. Because it is a high fidelity and high durability mannequin, a broad range of medical professionals—including those in both civilian and military medicine—are now able to learn to offer better care for women.
Looking To The Future
As the U.S. military’s needs continue to evolve in an ever-changing geopolitical landscape, the PCCS Pro Female is preparing military personnel not only for the present but for the future. The Department of Defense anticipates more threats from near-peer adversaries, an increasingly destabilized developing world, urban combat, natural disasters made more dangerous by a warming planet, and both home-grown and imported terrorism.
OEI’s development and delivery of PCCS Pro Female mannequins to all MSTCs indicates the U.S. military’s commitment to caring for and protecting their most valuable asset in the face of a challenging world: all service members. These simulators will train a generation of students to address the unique needs of women so that all troops receive excellent medical care and have a robust chance of the best possible outcome for their situation.
The effects of PCCS Pro Female-trained professionals will expand beyond the battlefield. In both humanitarian and combat operations, the U.S. military often provides care for the civilian population. Medical personnel will be able to provide gender-specific care with more fidelity for anyone they encounter in the field, at home or abroad.
Over the past two decades, more women have joined the U.S. military’s active duty, National Guard, and Reserve ranks, even as the overall armed forces population declined at the same time, according to the Department of Defense. If trends continue, women will continue to make up larger and larger percentages of service components and will also make up larger percentages of patients who need medical care.
In addition to the PCCS Pro Female, OEI’s co-investment with the DoD resulted in the development of a complete portfolio of anatomically correct male and female patient simulators all built on a common chassis and design. That common chassis provided Operative Experience the platform to field a simulation training suite that supports the full range of Tactical Combat Casualty Care and Prolonged Casualty Care training requirements from point-of-injury care skills to advanced critical care of a patient over extended periods in austere conditions. This historic investment paves the way for a new generation of patient simulators whose impact will be felt on the battlefield and in hospitals as patients receive better care and outcomes from medical professionals trained on OEI simulators.
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