Staying Ahead of Force Medical Need

From Combat & Casualty Care, Q2 2019 Issue

The U.S. Army Medical Department Center and School Health Readiness Center of Excellence is one of DoD’s newest centers of excellence working to align medical application with force modernization initiatives.

By Jay Harmon, Deputy to the Commanding General, HRCoE

In October 2018, the U.S. Army Medical Department Center and School, Health Readiness Center of Excellence (AMEDDC&S HRCoE) was realigned from the U.S. Army Medical Command to the U.S. Army Training and Doctrine Command (TRADOC). The HRCoE is now one of nine Centers of Excellence under TRADOC; each has a different specialty or branch focus, from Aviation to Signal to the Maneuver branches.

HRCoE is still the Army’s proponent for medical capability development and training. The mission is to envision, design, train, educate, and inspire the world’s premiere medical force to enable readiness and strengthen America’s Army. The AMEDDC&S HRCoE does this through two functionally aligned constructs: the center and the school.

The school mission is facilitated through two training brigades and the Directorate of Training and Academic Affairs (DoTAA). They focus on the development and execution of training and education. Annually, the CoE trains over 37,000 in 104 officer and warrant officer areas of concentration and 24 enlisted medical military occupational specialties within Initial Entry Training (IET), Advanced Individual Training (AIT), Professional Military Education (PME) and advanced professional development courses.

The envision and design missions fall primarily within the center. The Capability Development and Integration Directorate (CDID), Center for Prehospital Medicine (CPHM), AMEDD Personnel Proponency Directorate, the AMEDD Board, and other directorates work together to accomplish those functions. The Directorate of Simulations (DOS) is the HRCoE’s newly established directorate with unique functions that facilitate into both the center and school concept and internal and external functions.

We must ensure that Army Medicine remains an integral part of the Army Modernization Strategy and Future Force Modernization Enterprise (FFME). CDID and DOS are focused on ensuring Army Medicine capabilities are designed to support Large Scale Ground Combat Operations in the Multi-Domain Environment. This will include HRCoE’s ability to synchronize health service support and force health protection across the Doctrine, Organization, Training, Materiel, Leadership, Personnel, Facilities, and Policies (DOTmLPF-P) domains while maintaining the commitment to “Conserve the Fighting Strength” of the Army and the Joint Force.

Gaining New Perspective

With the transition to TRADOC, HRCoE looked at other centers of excellence and realized that, while they had staff elements working around training simulation development, mainly within the CDID, DoTAA, and CPHM, there was a need for a dedicated Directorate of Simulations (DOS). Colonel Rob Hennessy is currently the Director, CPHM, and Medical Director, Operational Medicine and Sustainment (OMS), but will soon transition to serve as the Director of the new DOS within HRCoE. “I see it as a function of the DOS to manage live, virtual, constructive and gaming efforts to identify medical simulation solutions and systems in support of the sustainment and modernization of Army lethality and readiness,” said Hennessy.

Within HRCoE’s DOS is the OMS Division and the Army’s Medical Simulation Training Center (MSTC) Program of Record. The DOS will also assist with development of the medical simulation (MEDSIM) requirements to support the envisioning and designing of MEDSIM as well as a “suite” of medical simulations to support the execution of training. “A key purpose of using advanced simulation is to provide proficiency through repetition, training and mission rehearsal capability,” noted Hennessy. “This will be critical to execute the training, both within the HRCoE and the operational force, to provide Prolonged Care and Prolonged Field Care to meet future operational requirements.”

The Challenge

The CDID is focused on many issues and initiatives across a wide spectrum of medical capabilities ranging from medical force structure modernization, medical capability and capacity, materiel requirements and medical doctrine to integrating and supporting the efforts throughout the other Doctrine, Organization, Training, Materiel, leadership, personnel, facilities, and policies (DOTmLPF-P) domains. A major concern shared by all is the provision of prolonged care within Multi-Domain Operations.

CDID and DOS are taking a fresh look at the operational medicine needs and the issue of prolonged care and prolonged field care from HRCoE’s perspective of envisioning, designing and training the future medical force. In an effort to address prolonged care and prolonged field care capability, the CDID and DOS collaborate with training developers. This ensures that the training not only mitigates the operational risk, but that the simulations are capable of supporting the training requirement and ensuring maximum benefit to the force within the Total Army Concept. “We strive to ensure integration of initiatives from other medical and non-medical capability and training requirement and capability generating organizations, such as CDIDs from the other Centers of Excellence within the Army and multiple research and development organizations within the force,” emphasized Sergeant Major Litt Moore, HRCoE CDID Chief Medical Noncommissioned Officer.

Another CDID function is medical modeling to help determine medical force structure needs. “The CDID studies lessons learned to identify trends and best practices from the Combat Training Centers to assist with modeling and integrate with the other CDIDs to form a comprehensive view of the Army’s future force structure needs,” Moore added. Simultaneously, the newly developed HRCoE DOS is primarily focusing on medical simulation (MEDSIM) requirements to support training in prolonged care and increase clinical and trauma care training. “The DOS is working with medical simulation and research, development, technology, and education (RDT&E) organizations to facilitate the development and fielding of simulations to support the MEDSIM training needs of the Army,” said Hennessy.

“HRCOE also strives to integrate with various medical exercises, such as the Joint Warfighting Assessment, to assess and provide input to combat trauma scenarios where on-site surgical care is critical,” Hennessy confirmed. “HRCoE interests remain centered on training critical skills required for care at the point of injury before casualties reach trauma centers and expanding that training across the continuum of care.”

Nested Priorities

The HRCoE CDID is looking at increased medical capabilities at the Role of Care I through Role of Care III. “The CDID works with the DOS, CPHM, DoTAA, and other external organizations to develop capability requirements throughout the DOTmLPF-P domains,” Moore indicated. Examples include the medical input for the Individual First Aid Kit (IFAK), a Soldier system managed through the CDID at the Maneuver Center of Excellence. “This is to increase medical capability and healthcare provision in the Role of Care III to Role of Care IV within the medical community,” he continued. This collaboration includes medical doctrine revision, doctrine updates, medical force structure revisions, medical equipment requirements, and medical evacuation requirements. “We also ensure medical input into other non-medical focused areas like the Soldier/Squad Virtual Trainer (S/SVT) or Head-Up Display (HUD) 3.0 where Medical could be injected into Infantry,” said Hennessy.

While the DOS is primarily focused on MEDSIM that supports the training requirements for increased healthcare capabilities at the Role of Care I through Role of Care III, Hennessy clarified, “emerging requirements will expand the MSTC capability, potentially combining exercises where a single scenario takes a casualty from point of injury, evacuation, and surgical intervention, spanning the continuum of care.” Treatment capabilities at each echelon affect the patient’s condition at the higher levels of care.

Additionally, the DOS works with other MEDSIM organizations throughout the military and civilian sectors to ensure the Army Medicine’s MEDSIM requirements are met to support operational medicine training. The DOS is also integrated into military and civilian groups, such as the Defense Health Agency Medical Modeling and Simulation Office, Joint Program Committee (JPC)-1, JPC-6, and the Federal Medical Simulation Training Consortium, to facilitate MEDSIM development while capturing MEDSIM lessons learned for dissemination to other organizations within the HRCoE and Army Medicine as needed.

Virtual Capabilities

The HRCoE DOS is also looking toward the virtual environment to determine how virtual reality (VR) may be used to augment more traditional methods of medical training. “Virtual interactive environments are in broad use by law enforcement and transportation agencies, bridging the gap between traditional simulators and real-world activities in order to deliver highly realistic training. It makes sense to harness this type of technology for Army medicine in order to augment traditional moulage and interactive simulation,” Hennessy clarified.

From a DOS standpoint, virtual environment medical training is especially beneficial for the training scenarios and the evaluation of decision-making skills. “Using these virtual tools, we will be able to assess whether the trainee is developing those critical thinking skills such as when to return fire and when to approach a casualty in the tactical environment,” said Hennessy. Follow-on interactive simulation also plays a key role in the evaluation of hands-on skills such as transfusion delivery and tourniquet placement. Hennessy believes that using augmented reality, or combining virtual reality and physical environment, is critical to medical training and testing. “Tactical medicine is unique in the fact that it involves critical decision-making processes and problem-solving while performing hands-on tasks that require fine-motor skills that depend on tactile feedback,” said Hennessy. “We expect medical trainees to do all of this while maintaining a tactical posture and situational awareness,” he continued. Using augmented reality training is ideal for tactical pre-hospital medicine. Together these kinds of technologies create situations that maximize the nuanced aspects of tactical combat casualty care for medical personnel.

Combat Medic Training

The HRCoE DOS is very early in its implementation of more enhanced simulations in training our combat medics and providers. “We already recognize some hurdles we must overcome to deliver maximally valuable solutions such as standardization of simulation training and maintenance of equipment,” noted Hennessy. To develop solutions for these challenges, the DOS works with the Army’s Synthetic Training Environment Cross-Functional Team to ensure medical training equities are synchronized with the other domains within the synthetic training environment. “Training is key to solving the problems of prolonged care, and because of the uniqueness of prolonged care scenarios, simulation will be essential to that training,” said Hennessy.

To maximize training benefit, training must incorporate a ”suite” of simulations ranging from moulaged role players to the virtual reality to engage the optimum level of Soldiers’ senses without under or overloading those senses. The CDID has participated in multiple medical simulation research and development efforts on the subject. More recently, the DOS, CDID, DoTAA and other medical and operational entities have participated in a working group to revise a capability document to optimize the capabilities in MSTCs across the Army.

“Ultimately, the capability of a combat medic is limited to the availability of critical gear to address injury,” Moore explained. Therefore, another area in development at HRCoE is an enhanced carry configuration to better distribute weight for the extended range required in prolonged field care. The CDID consistently works with the Army’s medical materiel development and acquisitions organizations and medical research and development organizations to reduce the equipment size and weight demands for the Combat Medic medical equipment set while maintaining, and in some instances increasing, the set’s capabilities to meet the current and future operational requirements.

“The Combat Medic medical equipment set is consolidated into the standard equipment set cyclical review process,” Moore said, “The CDID continues to analyze future requirements to ensure that not only the Combat Medic medical equipment set is up to date, but other medical equipment sets remain current as required through scheduled cyclic reviews.”

Futures Focus

As the Army Futures Command, sister services, and Coalition Partner forces prepare for Multi-Domain Operations and the challenges it will present, all organizations within Health Readiness Center of Excellence will continue to strive to meet the medical training and readiness of the current and future force.

Command Sergeant Major William “Buck” O’Neal, is the HRCoE Command Sergeant Major and admits that the Army, and along with it, Army Medicine are going through a very complex time of change. “Even though we are charging the DOS and CDID with the task of continuing to develop our capabilities, simulations, and training, I want people to understand that combat medics, and our medical force as a whole, are fully capable of accomplishing their current mission,” said O’Neal. “Our new focus is to elevate Army Medicine training methods and deliveries to meet the challenges of a future Multi-Domain Operational environment and identify and fill potential gaps.”

By Harnessing the transformational power of 21st century technology, we are going to fundamentally transform how we train and equip our medics and soldiers.