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Synthetic Task Environment for Patient Preparation and Care in an A2/AD Operations



OBJECTIVE: The topic is focused on the development and demonstration of a synthetic task environment for en route care patient preparation and care in Contested Degraded Operations (CDO) environments. This includes the capacity for creating/editing scenarios, recording performance and simulation data, and interoperating with external simulations. 

DESCRIPTION: Currently, patients are transported out of theaters of operation after they have been stabilized. Additionally, medical treatment and holding facilities manage patients until they are placed on aeromedical aircraft for transport to definitive care. It is anticipated that future theaters of war will take place in Contested Degraded Operations (CDO) environments, whereby enemy actions may prevent military forces from establishing ground facilities for patient care. Additionally, CDO environments may prevent or delay transport into and out of combat/disaster areas. Thus, medical management as we know it today will be completely disrupted in a game changing way (Krepinevich, Watts, & Work, 2003). We are seeking to develop a disruptive innovation to familiarize en route care personnel (people who work in environments spanning from point of injury through transport to definitive care (i.e., first responder medics on the front lines, forward operations locations, theater hospitals, and en route patient staging facilities)) with patient stabilization, patient placement and mission management in a simulated CDO environment, as little to no existing training at this time exposes or immerses medical personnel to these vastly different operational contexts. Trauma assessment and patient management from point of injury through transport are essential skills for medical professionals in the Department of Defense. The most critical aspect of trauma care is primary and secondary assessment of patients at first encounter and throughout the treatment process. Based on the initial assessment, implementation of stabilization measures and monitoring capabilities, proper placement on transport aircraft, and mission management during flight are paramount to patient survival. Providing opportunities to rehearse and hone these skills in a simulated, virtual CDO environment will expose personnel to operating in a completely new operational context, help them acquire and routinize underlying competencies they would not otherwise have an opportunity to rehearse, and ultimately improve outcomes for warfighters on the battlefield. Importantly, it has been shown that medical professionals who are experts in trauma care do perform this initial assessment more quickly and accurately than novices, and training leads to better performance (Holcomb, et al., 2002). Moreover, training opportunities are limited for many of the injuries sustained on the battlefield, creating a need that can be partially addressed with simulation (Bruce, Bridges, & Holcomb, 2003). Additionally, providing stabilizing care in volatile environments is lacking in standardized training platforms. High-fidelity medical mannequins provide a valuable opportunity, but lower-fidelity training options may provide value in some instances. The Air Force Research Laboratory is interested in virtual environments that can present medical professionals with trauma and mission management scenarios where the critical steps of patient stabilization, patient placement, and mission management can be rehearsed. To be of value in assessing the development and maintenance of skills, a virtual environment must also support the collection and recording of critical simulation and performance data and events. It must also have the capacity to interoperate with external software to allow bi-directional communication of data. That is, the simulation must be able to both communicate state/event information to external components and be able to accept inputs (e.g., actions) as well. Finally, it should support authoring through an interface that can be used by medical subject matter experts to create and modify scenarios. 

PHASE I: The Phase I deliverable will be a proof-of-concept outline demonstrating the feasibility for a virtual environment to support patient stabilization, patient placement, and mission management. It should include a plan for practical development and deployment, and demonstrate appropriate data capture and interoperability. 

PHASE II: The Phase II deliverable will build upon the Phase I outline to develop a functional prototype demonstrating and validating a synthetic task environment (STE) that supports rehearsal of patient stabilization, patient placement, and mission management. The STE must include: 1. The capacity for creating and editing scenarios, meaning that subject matter experts (SMEs) should be able to access the system to clearly define the scope of scenarios to be practiced as a function of expertise and level of skill of a specific trainee. 2. SMEs should be able to access the system to clearly define the scope of scenarios to be practiced as a function of the specific targeted skills being trained. 3. SMEs must have the ability to modify the scoring system under the hood of the system to deliver appropriate outcome-related measures to the skills being trained. 4. Feedback/Reports must be delivered to trainers and trainees based on SME defined scoring system for specific scenarios. 5. System must support interoperability with external software. 6. The system should run on standard desktop computing software. 

PHASE III: The SBIR can be leveraged for training interventions for patient stabilization, patient placement, and mission management that can prepare medical professionals for the unique situations and challenges associated with casualties in operational contexts. Target government customers include Enroute Care (Air Mobility Command), the United States School of Aerospace Medicine (USAFSAM), and the Air Education Training Command (AETC). Medical training and preparedness is just as critical in civilian contexts as in military contexts. Simulations that help to prepare medical professionals for rare, but most severe, cases they will see have the potential to greatly improve patient outcomes and strongly impact the field of medical training. As such, we anticipate the development of this capability being commercializable to the civilian sector as well. 


1: Bruce, S., Bridges, E. J., & Holcomb, J. B. (2003). Preparing to respond: Joint Trauma Training Center and USAF Nursing Warskills Simulation Laboratory. Critical Care Nursing Clinics of North America, 15, 149-162.

2:  Holcomb, J. B., Dumire, R. D., Crommett, J. W., Stamateris, C. E., Fagert, M. A., Cleveland, J. A., Dorlac, G. R., Dorlac, W. C., Bonar, J. P., Hira, K., Aoki, N., & Mattox, K. L. (2002, June). Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training. The Journal of TRAUMA Injury, Infection, and Critical Care, 1078-1086.

3:  Krepinevich, A. F., Watts, B. D., & Work, R. O. (2003). Meeting the Anti-Access and Area Denial Challenge. Washington, DC: Center for Strategic and Budgetary Assessments.


KEYWORDS: Synthetic Task Environment (STE); Simulation; Virtual Environment; Trauma Care; Mission Management, Patient Stabilization 

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