closeup of surgery

Successful Initiatives

IVIR Inc. has been successful in both program development and instructor training and developed a comprehensive program-specific course for the VISN 23 initiative. Some of the skill sets taught included: key communication skills, networking concepts such as situational awareness, and debriefing. An important goal for the VA was to use simulation-based training to improve understanding of the dynamics of typical non-operative and non-code medical emergencies which are inherently unpredictable and highly dynamic in order to improve both individual and team performance in these clinical situations.

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Product Features

Optimized Training

  • Facilitates standardized curriculum
  • Allows tailored training for learning deficiencies
  • Creates consistency of instruction
  • Provides performance-based outcomes
  • Ensures training accountability
  • Measures performance in cognitive, clinical and decision-making skills proficiency

Powerful Design Features

  • Customized test instruments based on learner category
  • Randomized electronic pre/post tests
  • Scenario-based psychomotor skills checklists
  • Automatic, real-time, weighted and percentile scoring

Unique Evaluation Component

  • Assesses cognitive, psychomotor, and decision-making learning domains
  • Provides comprehensive skill assessments
  • Generates immediate data at all levels
  • Student
  • Class
  • Site

IVIR A needle in arm

The Partial Task Training IV/Orthopedic/Tourniquet Arm (PTT-Arm) research and development (R&D) project was to develop an advanced orthopedic, physiologically modeled, high fidelity human arm partial task trainer, capable of pronation and supination with end effectors to execute three functional areas:

  • Orthopedic injury immobilization
  • Hemorrhage control
  • IV administration

The development began with realistic anatomical designs, including:

  • Realistic bone structure
  • Realistic muscle groups
  • Realistic arteries and veins
  • Hemorrhage control system
  • Fascia layer
  • Realistic overlaying skin (replaceable)
  • Breakaway wrist to simulate a broken wrist if too much force is applied during extrication

Physiological Models

The PTT-Arm also incorporated physiological models derived from the University of Mississippi’s open source physiological modeling program, HumMod. The models are displayed on a tablet computer and are designed to show the effects of hemorrhage and IV fluid resuscitation, including heart rate and blood pressure changes.

All three versions effectively satisfied a need.

Three versions of the PTT-Arm were created:

  • Version A – a surgical version made with bio-realistic, live-tissue replacement materials
  • Version B – a durable version that allows for rough handling and can be attached to a mannequin
  • Version C – an advanced mechanical version that includes multiple electro/mechanical end effectors and fits between versions A and B in regards to realism and durability, respectively

LIVE TISSUE 1

Live Tissue Cadavers

The minimization or elimination of live tissue training will depend on the investment in the advancement of medical simulation technology. It also will require a reconsideration of trauma teaching curriculum, algorithms, and instructional modality integration. It will most likely be evolutionary rather than revolutionary, and it will be driven by an overriding principle which is to provide the best possible training for medical warfighters for combat trauma to save lives on the battlefield.

Simulation is the ultimate information visualization technology, especially when its suspension of disbelief components is maximized.

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Initial Research Using LiDAR In Medical Lane Exercise

Expanded Research For Objective AAR Capability

A research and development program investigated the current position tracking and digital image capturing technologies, their potential uses, and their integration with a LiDAR AAR system. The research was conducted on these technologies for fusion within an AAR system, to provide real-time feedback of a 3-D lane training activity. The initial approach is to inventory existing technology and firmly establish the educational requirements based on desired training outcomes for a mobile medical lane training AAR capability.

The LiDAR 3D AAR capability exists as a proof of concept for individual position location under a previous research effort. A variety of audio/visual systems currently exist that record medical task performance.

The selected technologies will be integrated and demonstrated along with the U.S. Army’s Medical Training Evaluation and Review System (MeTER) tactical and clinical skills checklist as a performance assessment. For this project, IVIR partnered with Bolt, Beranek, and Newman (BBN).

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Optimized Training

  • Facilitates standardized training output
  • Identifies learning deficiencies to allow for tailored training
  • Creates consistency of instruction
  • Provides performance-based outcomes
  • Yields measured learning results for accountability 

Powerful Design Features

  • Customized test instruments based on learner category
  • Randomized computer-based pre/post tests
  • Scenario-based psychomotor skills checklists
  • Automatic, real-time, ratio-scaled and percentile scoring
  • Modifiable assessment tools to suit user needs

MeTER provides the foundation for streamlined, effective, and tailored training that will significantly advance educational capabilities. By populating a computer based educational assessment system with technical, tactical, and clinical knowledge skills, automated pre/post tests for cognitive and psychomotor skills are generated that are customized to specific student categories.
By utilizing these real-time measurable results to verify competencies and timely decision making, MeTER forms the beginning assessment architecture to determine the effectiveness of conducted learning.

Soldier with military working dog.

The conduct of this research effort resulted in the following:

  • Generation of C-TCCC educational and skills requirements traceability matrix
  • Gap Analysis of current canine simulation technologies ability to meet the educational objectives and skills requirements for canine medical care
  • Annotated bibliography of all topical research
  • Overview of the structure of canine medical care (military and civilian)
  • Summary of canine medical care with emphasis of C-TCCC procedures within each phase of care (Care Under Fire, Tactical Field Care and Tactical Evacuation (TACEVAC)
  • Summary of Non-Combat Emergency Care

Gap Analysis

A Gap Analysis was conducted based upon the procedures for C-TCCC defined in the Handler Training Manual, June 2015, as it provided a comprehensive summary of C-TCCC skills required in each phase of care, i.e., Care Under Fire, Tactical Field Care and Tactical Evacuation (TACEVAC). Furthermore, Non-Combat Emergency Care skills requirements were also addressed. The canine medical simulation trainers investigated included 7 full body trainers (1 of which is an academic research effort) and 4 partial task trainers. The ability for the canine simulation products investigated to meet C-TCCC and Non-Combat Emergency Care skills requirements.

Conclusion of the research is that currently available canine medical simulation devices are lacking in areas for training: prevent/treatment of shock induced hypothermia, analgesia, splint fractures of limbs, managing eye trauma and burns.

PFC

As a team member of the MU CCTC, Information Visualization and Innovative Research Inc. (IVIR Inc.), was responsible for the overall program management function for the MU CCTC. IVIR Inc. will lead the research study design and data analysis efforts culminating in the development of a training gap analysis, curriculum recommendations, and technology roadmap.

In addition to IVIR Inc., the MU CCTC primary grant partners include the University of Alabama-Birmingham, the University of South Florida, and the University of Central Florida, and with a team of more than 30 civilian and military trauma casualty care subject matter experts from across the country.

IVIR military medical helicopter

JETS Continued

Transitions in care, or handoffs, have long been considered danger points in the patient care process, contributing to medical errors and adverse events. Communication breakdowns, decreased situational awareness, absent or non-effective training, and lack of resources are common threats to patient safety. Training the process for patient handoffs is often not conducted, or is inadequate.

Using Live, Virtual, Constructive and Gaming (LVCG) simulations to train and study joint evacuation and transport should map the integration of service-specific, cross-cutting operational sub-system components, including but not limited to the functions of inter-service qualifications, communication, mission planning, mission rehearsal, en route care, patient movement, command and control, and logistics and their associated operational supporting sub-systems for training and assessment.

Data exchange mechanisms in medical simulation represent a significant gap in the translation of clinical conditions from the real world to a virtual patient. Therefore, standards for data transmission for medical simulation training must be established.

A standardized Federated Object Model (FOM) has proven to be a viable vehicle for prior interoperability in other operational simulation domains and will be utilized in this effort as a proof of concept implementation strategy for the architecture. In order to accommodate changing (DHA) needs and the evolving technologies that support them, the Joint Evacuation and Transport Simulation (JETS) operational architecture will need to include standards-based interfaces, while still supporting the integration of legacy systems.

The system framework provides the structural basis for simulation inoperability and the specifications of a common technical architecture for use across all classes of simulation. The purpose of the standard is interoperability and reuse, in support of training, analysis, test and experimentation and concept development. The focus is reusing and combining existing and delivering new capabilities in a systemic approach, with the need to replace current systems, allowing not only forward, but backward compatibility. The framework does not impose constraints on what is represented in the simulation systems (federates) or how it is represented but will require that all federates incorporate specified capabilities to allow the objects in the simulation to interact with objects in other simulations through the RTI.

The intent was to design an architecture that integrates existing LVCG simulations into one cohesive system of systems for joint en route care training. The architecture focuses on communication between the providers, en route care, patient movement, patient handoffs, transfers, and logistics. The focus on open architecture and robust standards allows for all subsystems, such as simulation devices, mission planning, rehearsal components, and inter-component qualification systems, to integrate with the architecture. This allows the systems and devices to integrate with each other while avoiding the need to develop specific integration strategies between them. The architecture accounts for all necessary training and simulation data and is expandable to cover future training needs.

Abstract

Phase 1 Abstract: This Phase 1 effort focused on creating prototype knowledge products that will interoperate and integrate with future programs within MSE. Designs for an overarching architecture, including a common, objective, and engineering-oriented lexicon, along with a governance strategy, a definition of shared services, and application programming interfaces (APIs) for interoperability were produced. A collection of architecture views was developed and presented for possible integration into the JETS Capabilities Development (CDD).

Phase II Abstract: Phase II of the program focused on Point of Injury Training System (POINTS) architecture, the second system within the overarching Medical Simulation Enterprise (MSE), System of Systems. Phase II includes additional front end research and updated DoDAF views for both the JETS and POINTS architectures. Phase II also includes a preliminary Medical Modeling and Simulation Federation Object Model (MMS FOM).

fitness  tracker concept in flat style vector illustration

Wearable Sensing Technology

During the conduct of this research, several observations/findings were noted regarding the state of ER technologies and their uses:

  • The use of wearable sensing technology to measure physiological and emotional responses to external stimuli is a relatively new method of conducting research. Early developers and manufacturers, in some cases, were not able to proliferate their technologies into a viable and sustainable business. New applications outside of pure research utilizing wearable sensing technology have emerged, in particular, healthcare diagnosis/monitoring, fitness monitoring, neuromarketing, and advertising, which will further development of these technologies and enhance commercial viability.
  • In selecting a system to use in a specific research context, researchers should consider not only the need for ease of application, low cost or mobility, but also possible restrictions on coverage and flexibility (Grummet et al, 2015), which applies to all sensing technologies.
  • The focus has been placed on the development of wearable sensing technology that is unobtrusive to the subject that is being measured. Furthermore, the growth of mobile device applications and the live streaming data have allowed these devices to be used 24/7 in a comfortable and non-distracting way. These applications are driving the growth in wearable sensing technologies used in everyday life outside of their use in standard laboratory research.
  • The majority of the ER devices investigated incorporate the synchronization of multiple sensing technologies (i.e., HRV/ECG, GSR, EEG, etc.) and time stamping of events from a single or multiple subjects. This capability eliminates the need for multiple, costly and time-consuming studies.
  • All of the ER devices investigated provide proprietary software for data visualization and analysis. Furthermore, data from these devices can be exported to analysis software such as SPSS, MATLAB, etc.