A recent study published in Military Medicine Journal highlights the critical role of nontechnical skills in improving the performance of En Route Critical Care (ERCC) teams. As the nature of warfare evolves, the demand for medical care in combat zones is expected to intensify, potentially overwhelming current ERCC capabilities. This has spurred a need for innovative methods to assess and enhance team performance in challenging operational environments. 

The primary aim of the study was to evaluate the association between nontechnical team performance and the time it takes to perform critical actions during simulated ERCC missions. Researchers conducted simulations with 14 ERCC teams, each comprising a physician, a nurse, and a respiratory therapist or a second nurse, responsible for transporting two casualties in a static aircraft environment. 

Researchers from the 59th Medical Wing's En Route Care Research Center, in collaboration with several other institutions, conducted simulations to explore the link between nontechnical skills and the efficiency of ERCC teams.  

The findings revealed a significant correlation between strong nontechnical skills and faster response times to critical events. Teams exhibiting higher levels of situational awareness and decision-making capabilities demonstrated superior technical performance. Specifically, a higher global nontechnical score was associated with a shorter time to critical action. 

This comprehensive study was the result of a collaborative effort, bringing together a diverse group of experts from military, academic, and international institutions. The research team included specialists from the Science and Technology Division of the 59th Medical Wing's En Route Care Research Center, the Department of Emergency Medicine at Brooke Army Medical Center, and the Department of Military and Emergency Medicine at the Uniformed Services University. 

Further expertise was drawn from Harvard Medical School's Department of Emergency Medicine and the STRATUS Center for Medical Simulation at Mass General Brigham. The project also benefited from international collaboration with the Surgical Sabermetrics Laboratory at the University of Edinburgh's Usher Institute and the Department of Clinical Surgery at the Royal Infirmary of Edinburgh. The team was rounded out by contributions from the Nursing Research Division of the 59th Medical Wing Science and Technology, as well as the Center for COMBAT Research and the Department of Emergency Medicine at the University of Colorado Anschutz Medical Campus and its School of Medicine.  

This research provides compelling evidence that nontechnical skills are a crucial component of effective ERCC operations. The study's conclusions support the need for further development of assessment tools and training programs that focus on optimizing casualty care in field environments. By integrating nontechnical skills training into their protocols, ERCC teams can be better prepared to meet the demands of future large-scale combat operations. 

Davis, W. T., Dias, R. D., Yule, S., Harari, R. E., McGinnis, L. J., Mann-Salinas, E., Larose, M., Michael, S. H., Bebarta, V. S., Araña, A. A., & Easter, B. (2025). Multimodal Team Performance Assessments in Simulated Military en Route Critical Care Missions. Military medicine, usaf557. Advance online publication. https://doi.org/10.1093/milmed/usaf557 

Photo by Staff Sgt. Kelsey Martinez