In Phase III, this limited REST API was replaced with a comprehensive GraphQL API as part of the JETS Developer Package.  The Trauma Simulator system provides two operational interfaces for the user: a full VR interface, and a standard keyboard and mouse interface on a laptop. Both interfaces were tested, and both are undergoing continuous improvements based on user feedback.

A core feature of the system was to provide time scale adjustment to support running a prolonged care scenario of 96 hours within a shorter real time period. The JETS federation and the individual systems all support this feature and HumMod was able to achieve greater than 60x real time speed for the simulated patient time.

Option 3: IVIR completed the JETS Developer Package. This is a software package that can directly join a JETS federation and provides a GraphQL API for third party vendors to access the federation, without requiring direct HLA integration.  Keep in mind the API does not function by itself as it requires a JETS federation on one side, and a vendor connected to the API on another side to communicate.  A JETS TestTool application was also created to act as a black box to publish and subscribe to all federation data assisting with integration.

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

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.

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).

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.

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.

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.

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).

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.

Information Visualization and Innovative Research, Inc. (IVIR Inc.) was funded through the U.S. Army Medical Research Materiel Command (USAMRMC) Cooperative Agreement, to conduct a 1-year research study and design effort to develop an architectural design for a system of systems for joint en route care training specific to patient handoffs and transfers. The specific aims of this Joint Program Committee-1 (JPC-1) led effort were as follows:

• Provide for a more realistic representation of casualty handoffs and transfers that occur in the joint en route continuum of care with improved mechanisms for training, test and evaluation to reduce medical errors and adverse events occurring before, during, and/or after patient handoffs and transfers.
• Add to the current body of knowledge by identifying and addressing gaps in joint en route care training, and construct a top-level interoperable architectural framework for a training system of systems that can track individual and team performance correlated to patient outcomes.

The objective was to provide live, virtual, constructive, and gaming (LVCG) simulations to assess and evaluate the patient handoffs and transfers in a controlled and standardized way to help address these areas. The architectural design for a comprehensive simulated system of procedures represent casualty handoffs and transfers occurring in the joint en route continuum of care, including improved mechanisms for training and test and evaluation.

The medical readiness of military or civilian medical personnel saves lives, making realistic education and training an imperative. However, to perform the correct intervention at the correct time in the continuum of care is critical to maximum effectiveness. It is imperative that training technology is capable of emulating real-life situations. This effort produced reviewable system engineering educational and requirements definition frontend analysis. This information is transferable to design requirements and appropriate test and evaluation procedures, producing accurate objective and repeatable assessment data for research programs in the medical simulation and training research area. The test and evaluation process, when applied with verification and validation principles, serves as an important risk mitigation to ensure requirement adherence and program success.

The mission of this research and development program is to provide a descriptive educational objective with a cross-reference matrix to design requirements definitions, test plans, test instruments, and data collection and analysis. It includes research of available doctrine and literature for a specified procedure and skill level to provide educational objectives. Test procedure and instruments was provided in a test master plan and Institutional Review Board (IRB) documentation as required. Performance assessment was conducted with trained observer/controllers for inter/interrater reliability during test conduct.

The intent was to research, develop, and provide test analysis to support current and future research efforts for meeting the necessary educational and operational requirements for medical training and simulation initiatives. It produced reviewable system engineering educational and requirements definitions frontend analysis, which are directly transferable to appropriate test and evaluation procedures, producing accurate objective and repeatable assessment data for research programs in the medical simulation and training research area. The data will assist the government in determining current and future medical simulation research efforts with objective assessment information.