Cric in the Dark: Surgical Cricothyrotomy in Low Light Tactical Environments.

BACKGROUND: Surgical cricothyrotomy (SC) is a difficult procedure with high failure rates in the battlefield environment. The difficulty of this procedure is compounded in a low-light tactical environment in which white light cannot be used. This study compared the use of red-green (RG) light and red (R) light in the performance of SC in a low-light environment. MATERIALS AND METHODS: Tactical Combat Casualty Care-certified navy corpsmen (n = 33) were provided 15 minutes of standardized instruction followed by hands-on practice with the Tactical CricKit and the H&H bougie-assisted Emergency Cricothyrotomy Kit. Participants acclimated to a dark environment for 30 minutes before performing SC on a mannequin with both devices using both R and RG light in a randomized order. Application time, success, participant preference, and participant confidence were analyzed. RESULTS: There were similarly high levels of successful placement (>87.5%) in all four cohorts. Light choice did not appear to affect placement time with either of the two kits. On Likert-scale surveys, participants reported that RG decreased difficulty (p < .0001) and increased confidence (p < .0001) in performing the procedure. CONCLUSION: RG light increased confidence and decreased perceived difficulty when performing SC, though no differences in placement time or success were observed.

Driving rehabilitation for military personnel recovering from traumatic brain injury using virtual reality driving simulation: a feasibility study.

OBJECTIVE: To investigate the feasibility of virtual reality driving simulation rehabilitation training (VRDSRT) with military personnel recovering from traumatic brain injury (TBI). METHODS: Eleven men with TBI were randomly assigned as controls (n = 5) receiving residential rehabilitation only or the VRDSRT group (n = 6) receiving residential rehabilitation and VRDSRT. All subjects underwent pre- and post-assessments including simulator driving, and completing road rage and risky driving questionnaires. Between assessments, VRDSRT subjects received 4-6, 60- to 90-min rehabilitation training sessions involving practicing progressively more complex driving skills (lane position, speed control, etc.) through progressively more demanding traffic. RESULTS: VRDSRT was well received, considered realistic and effective, with no reported simulation sickness. Driving performance improved significantly in the VRDSRT group only (p < 0.01). They also demonstrated a reduction in road rage (p = 0.01) and risky driving (p = 0.04) at post-assessment. CONCLUSION: VRDSRT showed promising results with respect to retraining driving performance and behavior among military personnel recovering from TBI.