The Department of Anaesthesiology and the Department of Trauma Surgery at the University Hospital Zurich have developed a simulation-based concept to evaluate the management of modern combat injury patterns in various Swiss medical teams. The project is supported and funded by the Swiss Armed Forces’ Center for Military and Disaster Medicine (MKM), whose cooperation is gratefully acknowledged.
The pilot simulation will be conducted in collaboration with ESTES during the Interdisciplinary Polytrauma Course 2025 at the University Hospital Zurich.
Registration and further information for the course:
Modern armed conflicts such as the war in Ukraine are characterized by a large number of casualties with complex and severe injury patterns caused by high-energy explosions. Penetrating monotrauma from firearms is now rare. Instead, multiple injuries from explosive devices and their fragments (e.g., drones, rockets, artillery) dominate the picture. These injuries are often accompanied by traumatic brain injuries, burns, shrapnel injuries, extensive soft tissue injuries, and facial or airway trauma, which significantly complicate treatment. (1, 2)
In Switzerland, prehospital as well as specialized clinical teams lack routine and hands-on experience in the treatment of such combined injuries. Beyond the number and severity of injuries, additional unfamiliar challenges arise for civilian teams—for example, the handling of incorrectly applied tourniquets or the use of whole blood and plasma transfusions, as are commonly practiced in military medicine. (3-5) Furthermore, the presence of protective gear—standard for military and police personnel—makes the clinical assessment and treatment of patients more difficult. These factors significantly impact the quality and efficiency of care. We hypothesized that such factors can be improved effectively through simulation.
Picture 1 (Source: NATO COMEDS UKR Dialog 05/2023)
Picture 2 (Source: NATO COMEDS UKR Dialog 05/2023)
The aim of this multicenter simulation study is to assess how civilian, military, and prehospital teams in Switzerland manage typical combat-related polytrauma in a realistic setting:
– Analysis of treatment quality and efficiency across different teams; identification of key factors contributing to effective and timely care
– Advancement of medical knowledge and practical skills in the management of modern combat injury patterns
– Structured debriefings to improve individual and team performance with a focus on specific injury mechanisms
– Strengthening of the interface between civilian and military trauma care providers, with targeted theory inputs after each simulation (e.g., protective equipment, injury profiles, tactical treatment recommendations)
The study is based on standardized high-fidelity simulation scenarios with realistic injury presentations (moulage, role players, military protective gear). Each scenario lasts 30 minutes and collects the following data:
– Time to life-saving interventions (e.g., chest drain insertion, hemorrhage control, airway management)
– Quality of medical measures (assessed by independent expert instructors)
– Team structure and participants’ level of training and experienc
– Communication, leadership behavior, and Crew Resource Management (CRM) practices
A total of 18 simulations are planned (6 in-hospital, 6 prehospital, 6 military). All scenarios will be video-recorded and evaluated. The study is conducted in accordance with ethical standards and requires informed consent from participants.
This study is expected to provide significant value to both civilian and military stakeholders in Switzerland:
– Improved care for complex trauma patterns seen in modern battlefield injuries
– Enhanced training of civilian teams in managing military-relevant trauma scenarios
– Strengthened collaboration and knowledge exchange between military and civilian trauma systems
– Increased visibility of the Armed Forces as an interprofessional contributor to medical emergency preparedness
In the long term, the study could serve as a foundation for developing standardized education formats—e.g., integrating combat injury simulations into the Interdisciplinary Polytrauma Course, civilian simulation-based trauma training, military education programs, or national disaster preparedness exercises.
This simulation study offers a unique opportunity to prepare both civilian and military trauma systems for managing modern combat injuries under realistic conditions. It addresses both the clinical injury patterns and the practical constraints of working with military protective gear. The core aim is to improve medical knowledge and treatment performance for complex polytrauma resulting from battlefield environments. At the same time, the study identifies critical challenges that may compromise care delivery. Through structured interdisciplinary exchange and scientific analysis, targeted improvements for the treatment of these vulnerable patient groups can be achieved.
References
1. Lawry LL, Mani V, Hamm TE, Janvrin M, Juman L, Korona-Bailey J, et al. Qualitative assessment of combat-related injury patterns and injury prevention in Ukraine since the Russian invasion. BMJ Mil Health. 2025.
2. Quinn J, Panasenko SI, Leshchenko Y, Gumeniuk K, Onderková A, Stewart D, et al. Prehospital Lessons From the War in Ukraine: Damage Control Resuscitation and Surgery Experiences From Point of Injury to Role 2. Mil Med. 2024;189(1-2):17-29.
3. Patterson JL, Bryan RT, Turconi M, Leiner A, Plackett TP, Rhodes LL, et al. Life Over Limb: Why Not Both? Revisiting Tourniquet Practices Based on Lessons Learned From the War in Ukraine. J Spec Oper Med. 2024;24(1):18-25.
4. Pusateri AE, Moore EE, Moore HB, Le TD, Guyette FX, Chapman MP, et al. Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes: A Post Hoc Analysis of the PAMPer and COMBAT Clinical Trials. JAMA Surg. 2020;155(2):e195085.
5. van der Horst RA, Rijnhout TWH, Noorman F, Borger van der Burg BLS, van Waes OJF, Verhofstad MHJ, et al. Whole blood transfusion in the treatment of acute hemorrhage, a systematic review and meta-analysis. J Trauma Acute Care Surg. 2023;95(2):256-66.
