Impact of fire arms training in a virtual reality environment on occupational performance (marksmanship) in a polytrauma population

Introduction: Polytrauma, to include major limb amputation, in a military population presents uniquerehabilitation challenges with the overarching goal of restoring function leading to the primary question, "Is thisService Member (SM) capable of returning to duty following rehabilitation?" The US military has a vested interest inmaximizing injured SMs occupational performance to allow for return to duty. The purpose of this report is to describemarksmanship (shot grouping and weapon qualification) and return to duty outcomes following a course of VRE-basedfirearm training in a polytrauma patient population. Methods: The medical records, stored in the Armed Forces HealthLongitudinal Technology Application (AHLTA), of all patients who received rehabilitative care at the Center for theIntrepid (CFI) to include VRE-based firearms training between 01OCT2015 and 01AUG2016 were manually reviewedfor inclusion. Subjects included all adult (18 years and older) SMs (active duty at time of admission) with a diagnosisof polytrauma who had been referred to and treated (received additional services such as physical and or occupationaltherapy) at the CFI. Approval for this research was received from the Brooke Army Medical Center Department ofClinical Investigation Office of the Institutional Review Board. Results: Medical records of 30 SMs with a polytraumadiagnosis met the inclusion criteria. Mean shot group sizes for the M9 and M4 weapon decreased between initial andpost training time points for the M9 zero (p = 0.009) and M4 zero (p = 0.020). There was no significant differencebetween initial and post training time points at the other shooting distances with either weapon. There was an 89%qualification rate for both the M9 (n = 18) and M4 (n = 19) weapons for those who attempted qualification; 43% ofthe population (n = 13) did not attempt qualification with either weapon. Conclusion: SMs with polytrauma demonstrated a high rate of weapon qualification (accuracy) following VRE-based firearm training. Shot group size (precision) at short distances with a M9 pistol and M4 rifle also improved with training. While overall marksmanshipappeared to improve, high return to duty rates were not directly related to firearm training or marksmanship. Futureefforts need to focus on consistent clinical documentation of firearm training procedure and the establishment of psychometric properties for marksmanship outcome measures.