How Our TCMC Instructors Support U.S. Medical Heroes

Most of us will never know what it takes to save a life, to be a hero, and for that we should be grateful.

All of our daydreams and hypotheticals about how we would behave in an emergency focus on our altruism, our courage, or our quick thinking skills. What do those of us who haven’t felt the unimaginable burden of keeping another human being alive fail to account for? The hours upon hours of training that real heroes go through, and the intense stress of the environments they face.

Despite what the occasional trending news stories lead us to believe, lives are almost never saved by accident. It is a once-in-a-million occurrence when some random passerby with no medical training to speak of knows exactly what to do at just the right time. So, those are the stories we celebrate. We like to imagine ourselves in the role of the spontaneous savior, forgetting some of the most important truths about heroism:

Most lives are saved with no fanfare, because the people who saved them were in the business of doing just that. Most miracles happen because someone devoted their career to making them happen.

 

Emergency medicine isn’t just about doing what’s right when faced with a critical situation. It’s about making an active choice to do the right thing every day, over and over again, until you are so prepared to administer care that your mind and body act before your emotions have the chance to react. This kind of heroism requires first learning how to save a life, and then following through with a premeditated decision to place yourself where lives are threatened.

Wild ideas about how skillfully we would behave if confronted by a potentially fatal emergency fall apart when reality sets in. Most critical patients don’t have one moment that defines their survival, or even one person. Hours of repetitive training administered by highly experienced instructors guide the hands of the caregivers who successfully perform life-saving procedures under pressure.

Like all heroes before them, our medical champions are defined by sacrifice. They forfeit their time, their energy, and often their personal safety, to provide their patients a longer existence on this earth.

SIMETRI is a business devoted to honoring this sacrifice. We design, manufacture, and implement training products and services to make sure that the emergency medical providers we all rely on have the most realistic, efficient training that modern science will allow. We may not be physically standing by their side in every combat zone, disaster site, or emergency room around the world, but the comprehensive training regimens we oversee will always have their back.

Emergency medicine takes a wide range of forms—combat medics, disaster response teams, local firefighters and EMTs, hospital workers, and more—and the staff we employ to solve their training problems is just as diverse. We gather experienced and highly capable medical professionals, chemists, special effects artists, mechanical engineers, electrical engineers, software engineers, and scientists from many other domains. Then, we put them all under the same roof, a state-of-the-art design and manufacturing facility where they can collaborate on concepts through every stage of development. We explore all avenues, and we create new ones when we have to.

 

This unique process allows SIMETRI to custom manufacture the most realistic and reliable medical training and simulation products on the market. We are justifiably proud of our cutting-edge training tools, but there is another aspect of our work that is just as personal to us: We employ some of the very same medical heroes we strive to support.

Retired U.S. Army Captain Miguel Moran is one such hero. It’s doubtful he would ever make that claim himself, but those of us at SIMETRI could not imagine describing him any other way. Like many of the emergency caregivers we work to support, his story is one of passion, dedication, family, and above all, service.

Given his extensive background in both military and civilian medical care, it is no surprise that Miguel conveys his significant expertise with a clear-cut confidence. His years of commitment to military service, spanning multiple deployments, may explain why he speaks in such a controlled, diplomatic manner. If you ever have the good fortune of conversing with Moran, what might catch you off guard is the profound humility that grounds each word he sends your way.

Miguel is a valued member of the SIMETRI team currently working as an instructor of the Tactical Combat Medical Care Course (TCMC) at Fort Sam Houston, Texas.

Alongside the considerable expertise he brings to the table, Moran is a perfect example of all the values CEO Angela Alban held dear when she founded SIMETRI. He is a soldier who sincerely believes in giving back to his country. He is a compassionate emergency caregiver. He has found inspiration in each generation of his family and is driven to make a better world for them.

We asked Moran some questions about his career, his motivations, and the importance of the TCMC.

 

The Tactical Combat Medical Care Course

Our products and capabilities are now available to consumers and the greater medical community, but many of them originated as solutions we developed to meet the needs of the U.S. military. SIMETRI takes great pride in our partnerships with the United States government to implement curriculums for our combat medics. Training services like these, such as the Tactical Combat Medical Care Course where Miguel Moran serves as an instructor, can be the determining factor in whether our warfighters are properly prepared for the combat zones they are deployed to.

Effective training relies on accurate simulations. Preparation requires realism. When medical personnel are studying procedures under conditions that do not mimic the limitations they will soon be facing, their skills will not translate to their new environment.

To address this issue, the U.S. Army Medical Center of Excellence, Health Readiness Center of Excellence created TCMC to give physicians, physician assistants, nurses, and senior medics realistic and applicable training to prepare them to treat traumatic injuries under combat conditions.

SIMETRI supports TCMC by providing trained-and-ready medical personnel—Physician Assistant Instructors/Subject Matter Experts—to support worldwide contingency operations; produce concepts, doctrine and organizational structure that meets current and future force requirements; create integrated and relevant training strategies, products and programs and make them available for use; and support the Readiness and Managed Care missions of the Military Health System. Our Physician Assistant Instructors augment TCMC program personnel by delivering and executing standardized instruction and testing for Health Care Providers in Tactical Combat Casualty Care and Role 1 Aid Station operations.

SIMETRI Physician Assistant Instructors teach a wide range of individual courses, including didactic instructional support in casualty care at the point of injury, triage, primary and secondary survey of combat casualties to include, airway management, extremity trauma, chest trauma, thermal burns, blood transfusions, wound management, antibiotics and pain control in the combat environment, splinting and dressing workshop, and fluid maintenance. We conduct practical exercises in airway management, treatment of extremity trauma, treatment of chest wounds, packing of medical treatment bags, treatment of a combat casualty in a Battalion Aid Station, life-saving emergency surgical skills, and the evaluation and management of mass casualties utilizing simulated combat casualty scenarios.

Miguel Moran is one of our Physician Assistant Instructors working out of Fort Sam Houston in San Antonio. While he is instructing as part of the SIMETRI team right now, his roots in the TCMC run much deeper, beginning with his medical career in the U.S. Army.

What made you decide to instruct TCMC under SIMETRI?

Initially, I was a medic—that was my first job in the Army. I got to go up the ranks, then come back as an instructor to teach other medics. At that time I had some very good mentors who were PAs, and they recommended that I do the Physicians Assistant program.

So I went through and did the Army PA program, and some of those folks that I knew started a program called the Tactical Combat Medical Care Course. After I became a PA I did a couple of deployments to Iraq. I was in about four years. I asked if there were any openings in the TCMC, and said that I’d like to come back and serve with them on active duty. They gave me the opportunity, and told me that as long as I had at least two combat deployments I could. I made it back and served with them on active duty.

About a year and a half after I retired they told me that the work had gone to contract and asked if I was interested in doing what I was before.

To me that was super. I got to keep working with people who train the doctors, the PAs, the medics that go out in combat and help those that are injured and wounded. I really wanted to keep doing that.

Can you explain a bit about what TCMC does?

Doctors, PAs, medics—they know their jobs. What we focus on in the course is making sure they know what equipment they have and their limitations. Making sure that they focus on the things that are going to kill the soldier.

If you’re a doctor in emergency medicine or a clinic, you have a lot of assets. If something goes wrong you can always call for blood or call for the surgeons. You have help very quickly. Where they are going to be, that’s not gonna be the case. Some of those places are very isolated and it’s going to be awhile before they get a medevac. Their equipment is going to be limited, and they are going to need to know how to use it.

So I think the course we teach through SIMETRI is important in bridging the gap between providers in the United States where they are in a safe facility with plenty of equipment and staff, and places like Iraq, Afghanistan, Syria, or Africa where they may not have that.

We wanna make sure that they know what they don’t have, and how to make the most of what they do have.

How important is repetition to pre-deployment medical training?

You can be very sharp at what you do, but when your heart rate is going fast and you are working on a young person that is going to die if you don’t do the right thing—and you’re worried about your own safety because there could be rockets and mortars coming in on your location—you may not be able to focus.

The only way you are going to perform in those situations is by muscle memory. When you’ve done it so many times that even during the worst of the worst times you can still perform. The preventable causes of death on the battlefield are ingrained in you: You know that hemorrhage is gonna kill, so you stop it. You know that without an airway a person can’t live, so you ensure a good airway. You make sure that a chest injury which has lead to a tension pneumothorax, if present, is treated immediately and you make sure to keep the casualty warm.

Those things kill people on the battlefield and are things that you as a provider can do something about in that limited deployed environment.

Those things kill people on the battlefield.

So we make sure students know those procedures, and we practice them repeatedly. We never let them take shortcuts where they verbalize their actions. We don’t let them say, “I would control bleeding at this time,” or, “I would give this medication at this time.”

If they tell us at all, we just say, “Well go ahead.” We want them to do the pulling of a medication, so we can make sure they got the right dosage, got access to an intravenous or intraosseous site, that they are able to push those medications or push blood. We want them to know how to do it when they are stressed.

If they are verbalizing what they would do, then we know they won’t be prepared when they are under stress because they haven’t actually practiced anything. They’ve just said it.

We want hands on training with repetition, and with every step present. We do not take shortcuts.

It’s the same for troubleshooting equipment. All of the equipment they deploy with is the same equipment they use in training. Blood donation kits, intraosseous needles, IV kits—we train them on everything they will use in real life, so when they open up the equipment after deployment it won’t be the first time they see it.

How much has TCMC grown since you began instructing?

When I first started back in 2012, when this was just run by the military, they didn’t have enough active duty PAs they could pull from the ranks to train folks, so classes were smaller and less frequent. A lot of people were deploying without the program because there just weren’t many slots available.

When we picked up this contract, SIMETRI made sure we had enough instructors to teach many more students than we were previously able to. Not only did we increase the number of people we could train per session, but we are also doing more classes each month. That makes a big difference.

It’s incredible how many students we can now put through in a year.

Family and Service

Whether personal or professional, SIMETRI founder and CEO Angela Alban always credits her success to the lessons she learned from her parents. She was the child of hard-working immigrants who not only taught her the values of a formidable work ethic, but also the importance of giving back to your country and community.

Fate has a funny way of working out sometimes, because when hearing about Miguel’s journey it’s hard not to find some parallels between the two.

Moran’s entire life has been defined by finding inspiration from his family and focusing that energy into better serving his country and community. An immigrant himself, Miguel has his mother and uncle to thank in equal measure for his career path. Today, he has an even more powerful motivating force behind his work: His son is now serving as an Infantry Officer.

Why the military, and why medicine?

When I was little, my mother was a nurse and she always wanted me to be in the medical field. She wanted me to help people. We were both immigrants from Mexico. We struggled initially, but we pulled through. My mother always said that this country had been good to us, and I had to give back.

My uncle was serving in the Army. I always admired him—he took real good care of us—and I wanted to follow in his footsteps. He was a private in Germany and we basically lived off of what he sent us every month.

I figured the Army was a good opportunity. As a young man when I talked to the recruiter, they said to think about it like a career. They offered me a couple of other jobs first, but when I finally heard medic I thought, “Wow, I can serve my country, be in the medical field, and follow in my uncle’s footsteps.”

How has your family influenced your service?

Well my family is what kept me going.

My wife always supported me throughout the 24 years of military service. Whenever I told her, ”Baby, we’ve got orders,” she would be ready to pack, never complained. My son, who is in the military now, never complained about new schools or leaving his friends. They never made me feel guilty. They understood it was a mission, and that the mission came first.

My family is the backbone of my support. Without them, I wouldn’t have been able to do everything that I did. They are my motivation, my strength. And of course, my job provides for them, so I always made sure that I worked hard for them.

From the beginning, as a Private, I always knew that my responsibility was to them. To care for them, make sure they had a roof, a meal on the table, clothes on their back. It was like a big circle. The job provided what we needed to live, and they provided the strength I needed to be able to work.

I’m humbled to be able to have the job that I have, to do something that I enjoy to pay the bills.

With your son now serving, how strong is your personal connection to those you train?

It enters my mind every day.

If I see something that is done incorrectly and I don’t see somebody catch it, I’ll come back and tell the student, “Hey, did you see that? Do you understand how that’s done? Why that’s done?”

I need to be sure, because sometimes pride gets in the way of a student. If they don’t feel comfortable with something they might act like they understand. I can tell in their performance that they didn’t get it, but they don’t want to verbalize that in front of their buddies. As an instructor, I can’t take it for granted that someone understands.

I want to make sure that when people leave TCMC I know that they have a strong understanding of all their equipment, why they are doing what they are doing, why we are taking a certain step-wise approach in the treatment.

You can be a genius, but when you are under that stress and your heart is going a million times a minute, you are going to forget a lot of things. We want to make it to where you’ve done it so many times that you can perform at those lower level brain functions, where everything is just automatic.

I always think of my son, but on top of that, I want to make sure that whoever the patient is will be getting the best possible care. That no one is going to lose their lives because of something simple that could have been done, but wasn’t done because there was not a thorough understanding of the training.

Miguel is just one of the many passionate experts that make up our team. Check out our recent article on SIMETRI’s in-house special effects wizard Barry Anderson to see behind the scenes on how our product concepts come to life.

While many of our products were designed to stand up to military demands, SIMETRI makes our cutting-edge technology available to consumers. Shop our products now!