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.

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 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

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

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).

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.

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.

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.