Combat & Casualty Care

Summer 2017

Military Magazines in the United States and Canada, Covering Combat and Casualty Care, first responders, rescue and medical products programs and news\Tactical Defense Media

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practiced on something other than a patient. While modern medical simulation is relatively new compared to other areas of simulation, such as flight simulation, the future of modern medical simulation has the potential to be revolutionary. Early medical simulation was typically seen as a sub-standard detractor from medical training provided by practicing on patients and human cadavers. Medical simulation tools were typically purchased by individuals or medical offices that did not have a long- term training strategy. Investment by the public sector was limited, as very few companies saw these tools as profitable. This sentiment changed as simulation matured and became a more accepted method of training basic medical procedures. A universally recognized example of modern medical simulation is the Cardio Pulmonary Resuscitation mannequin that was developed in the 1960s, commonly referred to as the "Resuscitation Annie." Simulation capabilities have evolved tremendously from their early beginnings and their use is now widespread. Today, medical simulation is most often utilized by the military services for first responder training, along with general medical education and medical team training. Although use has grown and is more widely accepted, it has yet to be fully embraced. This is likely due to known technical limitations. Tremendous efforts have been made to develop simulation that more fully meets the needs of even the most complex medical procedures. This creates a demand for synthetic patients, which replicate real patients more closely in tissue, organs and internal systems, including accurate physiological and pharmacological responses. One of the largest changes is the way the military services manage medical simulation. In 2009 the United States Army established the first formal program of record known as the Medical Simulation Training Center, along with a dedicated program office to develop, field, sustain and maintain medical simulation across the Army. The Army program was the first of its kind and determined that strategic planning and execution of simulation was highly necessary. Closing the Gap Between Virtual and Real-World Combat Casualty Care In the past few years, industry has identified opportunities within the medical community for simulation and has dedicated resources to future development of capabilities. With this added industry engagement, competition has had positive effects on the simulation community including lower prices, more choices and increased capabilities. Cost savings are expected as standardized capabilities are provided to the military services through bulk purchases of training capabilities and pre-planned lifecycle management. The Medical Simulation Enterprise also directly addresses the public concern of live tissue training using animals for the very first time, with programs within the MSE defining requirements to reduce and eventually replace live tissue training with human-like synthetic patients. Challenges and Expected Improvements Despite these advances, the medical simulation community faces several challenges. There continues to be a perception that medical simulation is only relevant in the training sector and that there is a gap between integration and interoperability across commercial products. The lack of a Department of Defense-wide strategic vision for medical simulation often leads to a disjointed purchasing of simulation tools by individual offices across the military services. Finally, there is a concern that medical simulation is not as effective as using animals for skills training, as well as the level of fidelity of the products. What needs to change with regard to medical simulation? The organization of medical simulation within the DoD is at the early stages of changing with the advent of the Defense Health Agency. Just as the military services worked to find out what simulation was already being utilized, what was needed and how it is best managed across the organization, the DHA is beginning to wrestle with the same questions. The addition of the rate at which new technology is being matured and put into operation, along with the ability for any office to purchase the tools which that office wants to use, further complicates the answers to those questions. Part of the answer has been the development by the DHA J-7, of the DHA Medical Simulation Enterprise, that identifies a strategic vision of programs to replicate the military Continuum of Care, and to address medical simulation needs of not only the training sector, but of the medical operational and clinical sectors also, thereby enabling the old adage of training as you fight. Moving Forward New obstacles will be confronted as medical simulation matures. As the world becomes more electronically connected, so does military medical simulation. Therefore, the security of life-long training information could enable an adversary to identify DoD weaknesses or expected areas of future operations. Another challenge involves the use of holographic simulation in the medical operations and clinical sectors. Holographic simulation has the potential to guide a non-medical Warfighter or a medical provider through an unknown procedure when the correct medical care is not readily available in a disbursed operation or a degraded communications environment Although it has taken a long time for simulation to be accepted by the medical community, and while it still is not widely embraced, it is becoming a more integrated and integral part of the military medical capability. Medical simulation is moving from being strictly part of the medical training sector toward utilization across medical operations and clinical sectors, which will result in all three sectors being more closely linked. Furthermore, a strategic DoD path forward will result in overall cost savings for the DoD while at the same time delivering more applicable and useful simulation products. The U.S. Army Medical Research and Materiel Command (USAMRMC) is the Army's medical materiel developer, with responsibility for medical research, development, and acquisition and medical logistics management. COMPLIMENTARY SUBSCRIPTION | scan the code to sign up now! 28 | Combat & Casualty Care | Summer 2017 HEALTH READINESS INNOVATION IN MEDICAL SIMULATION

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