Biological Response to Stress during Battlefield Trauma Training – Live Tissue Versus High-Fidelity Patient Simulator


  1. Peng, H.
  2. Vartanian, O.
  3. Rhind, S.G.
  4. Jamasz, J.
  5. Tenn, C.
  6. Tien, H.
  7. Beckett, A.
Corporate Authors
Defence Research and Development Canada, Toronto Research Centre , Toronto ON (CAN)
Introduction: Tactical Combat Casualty Care (TCCC) training imposes psychophysiological stress on medics. It is unclear whether these stress levels vary with the training modalities selected. It is also unclear how stress levels could have an impact on medical performance and skill uptake. Materials and Methods: We conducted a pilot study to compare the effects of live tissue (LT) with a high-fidelity patient simulator (SIM) on the level of stress elicited, performance, and skill uptake during battlefield trauma training course in an operating room (OR) and in a simulated battlefield scenario (field). In the report, we studied the effects of training modalities and their changes on stress levels by measuring different biomarkers (salivary amylase, plasma catecholamines, and neuropeptide Y) at various time points during the trauma training course. Results: We found that the training resulted in significant psychophysiological stress as indicated by elevated levels of various biomarkers relative to baseline immediately after both OR and field assessment (p < 0.05). Compared with pre-OR levels, the LT training in the OR resulted in significant increases in the plasma levels of epinephrine, norepinephrine, and neuropeptide (p = 0.013, 0.023, 0.004, respectively), whereas the SIM training in the OR resulted in significant increases in the plasma levels of norepinephrine and neuropeptide (p = 0.003 and 0.008). Compared with pre-field levels, we found significant increases in plasma
stress;biomarkers;medical training;trauma care
Report Number
DRDC-RDDC-2018-P088 — External Literature
Date of publication
01 Jun 2018
Number of Pages
Reprinted from
Military Medicine, Volume number: Vol. 00, 0/0 2018
Electronic Document(PDF)

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