Observer-controllers-trainers from the Army Reserve's Medical Readiness Training Command led military medical professionals from various Army Reserve units through the Team Strategies and Tools to Enhance Performance and Patient Safety training here at the elite Clinic Sept. 15 through Sept. 17.

“I love the whole mission in general. I think it's very important," said Maj. Amanda Varner, the clinical coordinator for the Mayo training program.

The Austin, Texas, native said the Mayo Clinic provides world-class equipment and the military medical professionals from all Army components going through the Team STEPPS program are thrilled for the opportunity to hone their skills at such a prestigious institution.

In addition to the state-of-the-art equipment, the training rooms are also like a video studio with cameras and microphones recording how the Soldiers perform through different patient scenarios, while MRTC observer-controllers-trainers monitor them from behind two-way mirrors.

Varner, who joined the Army in 2007 because she came from a military family, said the clinic's audio-video capabilities allow the observer-controllers-trainers the tools to give Soldiers detailed same-day feedback.

In the Army context, STEPPS is a system of individuals communicating with each other, then different field hospital departments communicating with each other. The final stage is when the field hospital staff communicates with other units to either return the patient to duty or to escalate the patient's care to a facility with a more extensive care capacity. This final stage forces a decision on a 72-hour clock.

“When these units are in the scenarios, a lot of times you're thinking back and you're trying to visualize in your head, 'Oh, well, I remember this happened,' well, the whole thing is actually recorded at Mayo,” she said.

“OC’s are looking like: ‘Oh, they did good here’ or ‘They didn't do good here,’ and we're able to play that back so they can actually see themselves and see the situation,” she said. “A lot of times, that makes a big difference.”

Varner said the AV feedback reinforces the training.

“They see themselves in action, and it forces that communication, not only internally but between departments and the whole hospital,” she said.

“It demonstrates how patient errors can occur, or patient care can be affected, even a patient outcome with a lack of communication,” she said. “If you're not communicating correctly, you can either give the wrong medication or miss something, and that can also affect the patient outcome.”

Major Tessa Howard, the officer-in-charge of the West Hartford, Connecticut-based 405th Army Field Hospital contingent to the Mayo Clinic training event, said her Soldiers came here highly motivated.

“We were looking forward to a high-value training opportunity and being able to utilize our skills and get personnel working within their sections,” Howard said.

“Everyone here is very motivated,” the major said.

“They were willing to rearrange their schedules, some of them surgeons and anesthesiologists and nurses and out of the ICUs, ORs, and make sure that they could attend this training,” she said.

Howard said all the Soldiers are approaching their scenarios with enthusiasm.

“We're continuing to take feedback well and go ahead and improve how we are operating among our sections,” the major said. “There are some that are taking on new roles and doing that well. I think everyone is just interested in providing the most support for what we're trying to do across the sections and support these patients.”

Colonel Joseph Johnson, the medical director of the Team STEPPS training program at the Mayo Clinic, said the program emphasizes communication out of lessons learned in the aviation industry, where they found when flight crew members are mixed, the lack of standard terminology leads to mistakes.

“One of the things they found through accident investigation, aviation industry investigation is that when they don't use structured tools to communicate and go through regimented SOPs, the chances of an error occurring increase,” the colonel said.

“In healthcare, one of the biggest causes, one of the greatest causes of patient deaths in our hospitals in the United States, unfortunately, is medical errors,” he said. “There are things that we unintentionally do by either missing something or miscommunicating something, and that leads to patient harm.”

Sgt. 1st Class Paul Morris, a training noncommissioned officer with the Medical Readiness and Training Command’s Fort Eisenhower, Georgia-based 7303rd Medical Training Support Battalion, said the medical professionals were taught to use STEP techniques, which means they are aware of the status of their team, their operating environment, and their progress towards their goals.

“We're really trying to look at the process of flow of patients throughout the team here,” he said. “We’re trying to evaluate from these teams as they're going through is trying to figure out at what point do we see a breakdown in the process of them handling their patients?”

Morris said it is critical to figure out how to fix it when teams break down.

“Within that breakdown, within that process, what is the breakdown?” the senior NCO, who joined the Army in 2003.

“Our goal is patient movement,” he said. “We've got a field hospital. We are looking to get patients treated and moved, and within that process, we are dealing very specifically with our team members.”

The STEPPS training gives medical professionals tools to access and improve the process, he said.

“Not just where, but what is the breakdown so that we can identify that and send them back with that feedback,” he said. That’s the hope as we go through the process, and then we do the reevaluation at the end of what's gone on at the end of each day.”

He said another technique is the Two-Challenge Rule, which gives team members the responsibility to raise concerns at least twice.

The sergeant first class said the rule was created to avoid a situation such as Malcolm Gladstone wrote about in his book "Outliers."

In the book, Gladstone described how, in the minutes before the 1997 Korean Air Flight 801, the first officer warned the captain that their altitude was too low, but the captain did not respond before it was too late. “This brought sweeping changes to the airline industry after this as it was reevaluated, and they looked at the communication between airline pilots,” he said.

“It's not just hitting it once; it's evaluating whether or not it was properly heard,” he said. “You need that callback, and you need that response. You need verification, and if it doesn't get heard the first time, you make sure it was said the second time--if you have any kind of doubt on that.”

Soldiers from other units joined the 405th Army Field Hospital when slots became available, like Sgt. Ryan Cook, a practical nursing specialist, or 68 Charlie, who joined the Army in 2016, said he was happy to get the opportunity.

The Gorham, Maine, resident said the training played into his situation as he came in from another unit.

“I think people were just more defined in their roles, and that's where it's a challenge because we've never come together and never worked together,” he said. “We're all from different backgrounds—and a lot of people in their civilian side they're communicating, but it's different.”

First Lt. Stephanie Bergeron, an emergency room nurse, or 66 Tango, with the West Hartford-based 947th Forward Surgical Team, said she appreciated the communications and procedures training but also the exposure to the battle rhythm of a field hospital.

Bergeron, a native of Methuen, Massachusetts, said she just deployed with a forward surgical detachment in Mogadishu, Somalia, which is closer to the fight and the casualty events.

"This helped me to give me an insight into how a field hospital works because I'm not part of a field hospital, the nurse said. “It’s given me a lot of insight into how the next role of care works, which I think is really invaluable when you're performing interventions on your patient at the point of injury.”

Bergeron's facility in Somalia was less sophisticated than the Mayo Clinic or the typical field hospital, she said.

“We operate completely differently,” she said. “We were on a 10-man surgical team, and that's all we had, and we had a plywood structure that was the size of one of these rooms.

The first lieutenant said she also appreciated the emphasis on the 72-hour rule, which means the field hospital personnel either return the Soldier to duty or escalate his care to a more robust facility.

“It seems like from a field hospital standpoint, from what I've seen thus far if the resources are properly allocated, I think 72 hours is doable,” she said.

“I think it's going to push the limits, and it's going to stress the staff and stress the system, but I do think that it's doable.”