Application of Treatment simulation Software for War Injury in Emergency Treatment Training on the Battlefield based on Chinese Visible Human Datasets

21 Background: Proficiency in self-help and mutual aid skills is correlated with the 22 prognosis of injured patients, and this study aims to create treatment simulation 23 software for war injuries that reflect the physical constitution of Chinese people and 24 study its application in first aid training on the battlefield. 25 Methods: Based on thin-sectional, highly precise Chinese Visible Human (CVH) data 26 with high resolution, combined with self-help and mutual medical aid measures such 27 as digital pressure hemostasis, cricothyroid membrane puncture, pneumothorax 28 puncture and bone marrow puncture for battlefield first aid, useing Amira and other 29 softwares to building the simulation software for the technical training of military 30 medical students and basic medical officers was constructed. Eighty medical service 31 students were trained on battlefield first aid technology, and a new training mode for 32 the treatment of war injuries was developed and optimized. 33 Results: Simulation software of hemostasis and puncture for battlefield first aid that 34 was suitable for the technical training of military medical students and its supporting 35 teaching materials 3D-PDF were established. The software included modules of 36 hemostasis of the vertex, face, head-shoulder, shoulder-arm, forearm, upper forearm, 37 lower limb and foot and puncture of the cricothyroid membrane , pneumothorax, and 38 bone marrow cavity. Collaborating with interactive 3D-PDF, it was successfully used 39 for on-site first aid training of military medical students. The questionnaire results 40 showed that the trainees had a high recognition of the human-computer interactive 41 performance of the software with a clear interface and easy operation. The accuracy 42 and richness of the three-dimensional model structure, knowledge of hemostasis and 43 puncture and applied anatomy contained in this software were high, helping trainees 44 to quickly master the knowledge points and operation techniques related to 45 hemostasis and puncture . 46 Conclusion: The system can effectively mobilize the learning enthusiasm of students 47 and fully improve the learning efficiency of the basic materials and applied anatomy 48 of battlefield first aid, as well as the teaching efficiency of teachers. The training 49 simulation of battlefield first aid, comprising a combination of various modes, 50 effectively complemented each other, met many training needs, and achieved 51 satisfactory training results. Additionally, this software could be used in the 52 emergency training of traffic accident injuries and disaster-related injuries. 53


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According to the casualty data and related reports of the US and UK military 59 forces during the wars in Iraq and Afghanistan, the rates of blood vessel injury were 60 8 by adding 3D model data, graphic interpretation and video teaching of the treatment 141 of war injuries into the PDF document. 142 Verification of the software 143 The development of the software was completed under repeated communication 144 among experts in anatomy, emergency and software engineering. To verify its 145 feasibility and effectiveness, the software was transplanted to the Intranet of the 146 campus network and was used in the browser by downloading relevant plug-ins. The 147 military medical students at our school were invited to participate in testing of the 148 software, and the operation and use of the software were briefly explained to them. 149 Once the military medical students clicked the corresponding module, the animation 150 of the wounded individual would be played, and the injury situation and treatment 151 measures would be explained to the trainees by voice to help them understand the 152 characteristics of the injury and treatment points. Thus, the trainees could accurately 153 identify the hemostasis point or puncture point in subsequent activities and become 154 familiar with the whole emergency treatment process. 155

Curriculum design 156
The course design of the hemostasis and puncture simulation treatment on the 157 battlefield was as follows: a course on basic theory (0.5 class hours) and a practice 158 course (1.5 class hours). The participants completed 3 class hours of study. The basic 159 theory course explained the operation method of the simulation software of 160 9 hemostasis and puncture and 3D-PDF for trainees. The software was used to explain 161 the key points of knowledge and caution during digital pressure hemostasis, 162 cricothyroid membrane puncture, pneumothorax puncture and marrow cavity 163 puncture. A 3D-PDF download service was provided to trainees via the Intranet cloud 164 disk. During the practice course, the trainees could freely operate the software to learn 165 and master relevant knowledge of hemostasis and puncture and verify knowledge on 166 the real human body by self-study or with the help of trainees sitting beside them. 167

Performance evaluation of the software 168
The "teaching satisfaction questionnaire for the simulation software of 169 hemostasis and puncture on the battlefield" was designed to evaluate the application 170 effect of the software, and trainees participated in the evaluation anonymously. 171 Eighteen items were in the questionnaire, which was designed by referring to a Likert 172 scale, and the scoring standard was based on a 5-point system. Arabic numbers "5, 4, 173 3, 2, and 1" represented "strongly agree, agree, neutral, disagree, and strongly 174 disagree", respectively (Table 1). 175

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In this study, the CVH data were used to construct a war injury model that could 177 accurately and intuitively reflect the spatial position, three-dimensional morphology 178 and adjacent relationship of vital organs, muscles, blood vessels and bone of Chinese 179 people. Using Unity3D, the data on CVH tomography, teaching video of first aid, 180 10 images and texts of first aid teaching and model of war injury were integrated, and 181 first-aid teaching software applicable to the battlefield was developed ( Figure 3-6 ). 182 This provided a training platform for trainees with good interactive anatomy teaching 183 function, which controlled the functions of a concealable anatomical structure display, 184 an optional pressing point or puncture point, clues for wrong pressing or puncture 185 point, video teaching, and contrast learning of the sectional and injury models. 186

Application of 3D-PDF 187
The production of 3D-PDF ( believed that it presented the process of treatment for war injury vividly, and users 219 could intuitively visualize the pressing point and puncture point. After mastering how 220 to operate the software, the trainees believed they could repeatedly operate the 221 12 software and learn the knowledge points without the teachers' explanation (Table 1,  222 Q17). Regarding the deficiency of the software, they proposed that the bleeding effect 223 should be added in the three-dimensional interactive area to simulate the arterial 224 bleeding state and obtain a more realistic simulation effect, and that the radius of the 225 pressing point should be expanded, with different hemostatic effects for different radii. 226 Advice and suggestions on the learning module of first aid measures such as adding 227 combat application tourniquets and dressings and fixation after first aid management 228 were also proposed ( Table 1, Q17-18). 229

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In this study, the CVH data were used to construct a war injury model that could 231 accurately and intuitively reflect the spatial position, three-dimensional morphology 232 and adjacent relationship of vital organs, muscles, blood vessels and bone of Chinese 233 people. Using Unity3D, the data on CVH tomography, teaching video of first aid, 234 images and texts of first aid teaching and model of war injury were integrated, and 235 first-aid teaching software applicable to the battlefield was developed ( Figure 3-6 ). 236 This provided a training platform for trainees with good interactive anatomy teaching 237 function, which controlled the functions of a concealable anatomical structure display, 238 an optional pressing point or puncture point, clues for wrong pressing or puncture 239 point, video teaching, and contrast learning of the sectional and injury models. 240 The period from the beginning of the trauma to within one hour after the injury is 241 called the "golden hour". It is based on successive pre-hospital emergency care and 242 13 in-hospital care, with the main goal of providing wounds with definitive treatment 243 within one hour after the trauma. Limited by the battlefield environment, tactical 244 mechanism and mobility of troops, it is difficult for wounds to obtain definitive 245 treatment within 1 hour after injury. Self-help and mutual aid within the "platinum 246 time" provide curative effect guarantees for evacuation and in-hospital treatment 247 within the "golden time". Timely and accurate emergency treatment within the 248