Joint Medical Modeling and Simulation Improves Training and Health Care

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Col. Scott McIntosh, joint project manager for medical modeling and simulation, discusses improving medical training, the technologies that are improving health care, and the role that augmented reality plays in the medical enterprise during an interview at the 2018 AUSA Annual Meeting in Washington, DC.

Joint Medical Modeling and Simulation

AUSA Annual Meeting

October 2018

Vago Muradian:  Welcome to the Defense and Aerospace Report.  I’m Vago Muradian here at the Association of the United States Army’s Annual Conference and Trade Show, the number one gathering of U.S. Army leaders from around the world to talk about the service’s future, its strategy, budgets, doctrine, technology and more.  Our coverage here is sponsored by Bell, a Textron company; Elbit Systems of America; Leonardo DRS; L3 Technologies; and SAFRAN.

We’re talking to U.S. Army Colonel Scott McIntosh who is the Joint Project Manager for Medical Modeling and Simulation.   Every branch, every part of the U.S. military is in now flux because of reorganization, the acquisition community, certainly the military medical community in terms of the sort of better integration of all the health systems that we have.

But I want to talk about what you’re doing which is utterly fascinating.  The Iraq and Afghanistan wars advanced the state of medical military art, and on top of that we’ve had this revolution in training and simulation technology that’s been enabling military medical folks to do an even better job, right? They’ve always done an extraordinary job, but they’re doing an even better job than they ever have.

Talk to us about the nexus of all of this and what you’re trying to do, first in the job in a joint way to try to harness some of these technologies to improve medical training.

Col. McIntosh:  Certainly.  We’re a joint project office.  We’re dual chartered by the Army Acquisition Executive and by the Defense Health Agency Component Acquisition Executive.  Our vision of the organization is to save lives and improve health care through simulation.  That’s exactly what we’re doing for both the Army and the Defense Health Agency.

One of our kind of flagship projects for the Army right now is an effort called Tactical Combat Casualty Care Exportable, or TC3X.  What that effort is, is an ultra-realistic trauma mannikin.  It is designed to really get after the three leading preventable causes of death on the battlefield which are bleeding from a hemorrhage by the application of a tourniquet.  It’s a compromised airway, so you can apply an artificial airway to create the breathing.  And it’s also to be able to know how to treat a tension pneumothorax or a collapsed lung. We do that through training the needle chest decompression.  A phenomenal capability.  It’s revolutionizing how we do medicine.

Mr. Muradian:  So what are some of the technologies that help you with that.  We’ve been at overseas shows where we’ve seen just staggeringly realistic mannikins, both with circulatory systems so that you can get a far better idea.  I mean the [scare] city of cadavers.  So from a medical training standpoint that’s an important issue.  So we’ve seen that in the UK.

Talk to us about some of the enabling technologies that allow you to get here.  One of the things we were talking about before we started the interview was sort of the end of the year rush to buy broken — mannikins that nobody really uses and they’re just stuck on a shelf.  You’re trying to change that dynamic with useful tools that people want to engage with.  Talk to us a little bit about that approach you’re taking.

Col. McIntosh:  Certainly.  Not only are we trying to do project management, the typical cost, schedule performance, but we’re actually trying to tackle the way that medicine, that the Defense Health Agency approaches the life cycle management of simulation.  We’re trying to take it away from the end of year buys with O&M dollars, buying mannikins that maybe kind of fit with the training scenario, but don’t because folks are rushed to by those on contracts at the end of the year.  And ultimately, those mannikins break, they didn’t have any type of sustainment package with them, and they’re sitting on the shelves; or the folks that have the passion in the simulation center moved on.  And because of that lack of passion we don’t have folks in the simulation center that are really trained to utilize those mannikins.

So what we’re trying to bring is lifecycle management.  The same way we would manage a tank or an aircraft in the military. We’re trying to apply that to medical simulation.  We think that will really, really make a difference for really the joint warfighter in how we approach training.

The TC3X capability, as I mentioned, is ultra-realistic, and it’s realistic because it bleeds, it breathes, and if the first responder doesn’t do the proper intervention, the patient dies.  And having that type of realism is just priceless.

As we talked about earlier, I’m not a medical professional.  I’m a project management professional.  But I am blessed with some talented resources on my team, one of which is a medical doctor who was a prior combat medic in the Army.  When he went through his combat medic training about ten years ago what they really used for medical simulation was like something out of the Macy’s department store window that looked like a human, and that was about it.  They might put a little blood on it to make it realistic or put some moulage to try to simulate some wounds.  But the realism wasn’t there.

What we have now with the capability is, again, it’s a mannikin that bleeds, breathes, and if you don’t do the right things will die.  So when a first responder is on the scene, they’ve got to assess the actual patient.  The simulator patient, and do the proper procedures.

In the past what we’ve seen with medical training is, because it may be your buddy on the ground, you’re talking to an instructor, so you’re assessing the patient but you’re treating the instructor.  Now with these mannikins, you actually have to treat the patient.  Through the remote control devices for the mannikins the instructor is able to see exactly what the first responder’s doing, take the amount of time it has taken to apply a tourniquet, the amount of blood lost, and really provide objective feedback to the soldier that’s training, which is phenomenal.

The other piece, the mannikins also have kind of a two-way radio.  So with all simulation, you want it to be ultra-realistic.  So it’s not, unfortunately, if you’ve got an instructor-operator that’s standing right over the mannikin having a dialogue with the person that’s attempting to treat them.

With the TC3X through that two-way radio, the instructor can be 50 yards away, kind of around the block, but playing a realistic casualty, and that really increases the amount of realism.

The other piece with these mannikins is the bleeding from an extremity, a hemorrhage from an extremity and the ability to apply a tourniquet properly.  In the past we’ve really had kind of a negative reinforcement of what right looks like because if it’s you and you’re simulating that wound on an extremity, you are not going to be able to tolerate a tourniquet applied with the proper force that would stop the bleeding because you’re going to not, it doesn’t work that way with the amount of pain.  With the mannikins today we’re able to actually see the pressure that’s applied and the bleeding will not stop until the tourniquet is actually applied properly.

It’s amazing, folks that have used this capability for the first time in the amount of pressure on a tourniquet that it really takes to stop the bleeding.  It’s just, that realization of the individuals, kind of the flash of what right looks like, which like I said, we’ve never really been able to do before with medicine in training.

Mr. Muradian:  I think it’s extraordinary, and I agree that the first time you do that you’re like holy cow, man, that is a lot more pressure than you would imagine, to the point of acculturating folks to what these injuries look like in real life as opposed to them experiencing it for the first time when they’re in combat. Absolutely critical difference.

What’s the role of augmented and virtual reality systems in sort of advancing that state of the art?  Because if you look at the technology, whether it’s training, on whether it’s maintenance, it’s having already a dramatic impact on how folks do things. What’s the room for dealing with those technologies in the medical enterprise?

Col. McIntosh:  I think there’s a lot of opportunity to really augment the live training piece.  Our partners within RDE Com are working also on the synthetic training environment, the STE. One of the efforts they’re working is tactics.  The gloves to give you the actual tactile feedback, and trying to incorporate the augmented reality piece to where perhaps you’re looking at a trauma mannikin but you can increase the realism through augmented reality to try to increase the training piece.

The challenge with tactics and medicine is that response needs to be so incredibly accurate to realistically simulate what a medical professional would need.  It’s something that’s definitely in the S&T realm at this time, but we’re definitely, from a project management standpoint, tied into what our S&T partners are doing and looking for those opportunities to transition the capabilities.

Mr. Muradian:  And let me ask you one last question.  You’re an acquisition professional, you went to Defense Acquisition University, you’ve got some chops, you’re a former aviator so you bring a lot of operational experience also, a lot of soldier experience to the job as well.  Everybody’s looking at how Futures Command, the Cross-Functional Teams are going to work.  One of the challenges and questions asked is hey, these might be very, very smart folks but they’re not acquisition folks that are involved in that process.

From your standpoint, how is this revolution, what is it going to mean at your working level? Do you know, or are clear in how all of these processes are going to work as the Army works to reinvent how it goes about acquiring things?

Col. McIntosh:  Sure.  I think we’re all kind of looking for that clarity.  What I can tell you with Futures Command, and the role of medicine in the synthetic training environment, in particular, it just presents a great opportunity to improve not only how the Army approaches training, but really our joint medical force approaches training.  And I think we’re going to see the transition of technologies and capabilities quicker. And any time that we can leverage our commercial partners, and medical simulation as we discussed earlier, is really a commercial-driven enterprise.  They’re the ones that are really out there on the kind of cutting edge.  So that Futures Command, that tie to industry I think is going to make a huge, huge difference in how we approach joint medical training.

Mr. Muradian:  And what are the things you’d like from industry?  In your interactions here, you’ve been on the show floor. There isn’t as large of a medical component as perhaps there should be.  But what are some of the things you’re asking them?  What do you want folks to, if somebody was watching this, what are the top three or four things you want industry’s help with?

Col. McIntosh:  We’ve kind of discussed some of them.  It’s how we kind of take and incorporate augmented and virtual reality into medicine.  The use of tactics, the gloves that kind of make that tactile feel relevant for our medical professionals.

The other piece I’d say is continuing to push the state of the art, the art of the possible in terms of the biofidelic response, trying to emulate to our best ability a human, which is different than trying to build a simulation that replicates an aircraft or a vehicle.  But continuing to push the envelope in terms of the biofidelic responses and trying to make simulation as life-like as possible.

When it’s all said and done, it’s about the warfighter and whatever we can do to make the training experience as realistic as possible will increase our opportunity to train and it will create an environment where the warfighter who’s out in an operational environment, the first time they have a chance to respond to a casualty, you don’t want it to be then.  You want them to experience that realism in training so they know exactly what to do when placed in that situation.

Mr. Muradian:  United States Army Colonel Scott McIntosh, the Joint Project Manager for Military Medical Modeling and Simulation.  Sir, thanks very much.

Col. McIntosh:  Yes, sir.  Thank you. I appreciate it.

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