Cricothyroidotomy bottom-up training review: battlefield lessons learned.

Challenges with surgical cricothyroidotomy on the battlefield can be attributed to limited frequency of use, procedure unfamiliarity, and limited knowledge base of anatomical landmarks of which is further heighten in the tactical environment. The objective was to identify ways to enhance the cricothyroidotomy training to minimize potential preventable procedural errors. A training review was conducted to determine the gaps in the cricothyroidotomy training in a 4-day Tactical Combat Casualty Care course at the Naval Medical Center Portsmouth. An ad hoc Working Group team identified five specific gap areas in the cricothyroidotomy training: (1) limited gross airway anatomy review; (2) lack of "hands-on" human laryngeal anatomy; (3) nonstandardized step-by-step surgical incision skill procedure; (4) inferior standards for anatomically correct cricothyroid mannequins; (5) lack of standardized refresher training frequency. Specific training enhancements are recommended across each day in the classroom, simulation laboratory, and field exercise.