Download Rough outline NOTE: my terminology is mostly wrong and needs to

Rough outline
NOTE: my terminology is mostly wrong and needs to be corrected
Maximus Prime (MXP) proposes to build a 3D immersive software simulation and training program for
training tactical combat casualty care (TCCC), including advanced scenarios with multiple levels of
difficulty. Scenarios will include environmental / situational stressors to the medic & non-permissive
environments, including care under fire, unplanned events, and equipment simulation. Special
attention will be placed on simulating auditory and tactile experience to increase the overall immersive
quality of the training exercise. The simulator engine (SE) will be designed to handle simulations of high
stress / combat area risks at point of injury, simulation of patient delivery, and simulation of forward
deployed hospitals. A variety of medical packages can be simulated, including small rapid response such
as SPEARR, Forward Surgical Teams (FST), and more definitive care packages, including EMEDS packages
and Air Force Theatre Hospitals, including simulation of medical equipment, tents, beds, and NPC
representation of medical personnel.
The training interface (TI) will include a graphical user interface that represents lifesigns and feedback
from simulated medical equipment (SME), including the ability to check for life signs, checking for pulse,
listening for lung flow, etc. The training experience can be delivered in live-time, testing response time
to events. The TI will also include simulated tactile effects, including simulated stressors while
administering care under fire and in general will include real-world dirt, grime, and confusion at the
point of injury.
The SE will also have the ability to simulate care during transport, including transport by land or air, and
in particular will include simulation of CCATT in flight. This scenario can be seamlessly tied to
aeromedical evacuation from a forward operating hospital such as EMEDS. In particular, the SE will
support seamless transition between these zones. A student could begin a scenario at any point, and
training could cover any range of experience, from point of injury to delivery to a level-1 trauma
hospital.
Once the student logs into the system and begins a scenario, their avatar will spawn in a starting
location and a timer will begin. Events can be scripted to occur at specific times, or in response to the
trainee reaching a preset waypoint. For Phase-I, a primary scenario will be developed where the trainee
will locate an injured soldier and administer treatment at point of injury, facilitate the transfer of the
patient to an evacuation vehicle (wheeled or helicopter), and continue monitoring and treatment intransfer, and will facilitate the transfer of the patient to care at a field hospital or theatre hospital.
The Phase-I development will include server design for seamless transitions between these zones, AIscripted behavior for patient avatars, and AI-scripted behavior for NPC's & vehicles in zone. An
extended scenario can also include follow on critical care air transport to level 1 trauma hospital in
theatre or in CONUS.
For Phase-I, the trainee will select an avatar and scenario that includes a load-out (equipment profile).
Scenarios will be pre-programmed but may offer settings, such as difficulty. The scenario will include a
point of injury environment, including hostile environments and combat zones. Optional settings can be
made to this scenario, for example day/night, equipment damage such as broken NVG's, hostility of
zone, etc. The avatar load-out and scenario can be saved as a pre-set profile so students can select a
preset scenario. The configurable load-out allows training with limited equipment, or specialized
equipment, or new equipment that remains in testing and has not yet been fielded. It will also include
method of transport to site, number of wounded, and what kind of injuries are simulated.
The simulator engine (SE) will be architected to support a variety of scenarios, including those listed
below.
From a medical perspective, the following use cases will be supported:

-Care Under Fire

-Stopping bleeding of an extremity

-Airway management

-"Sucking" chest wounds

-Transporting a patient off the battlefield

-Triage of a patient

-Calling in a Medical Evacuation (Helicopter)
All of the above use cases can be combined in creative ways to simulate a real world situation. For
example:
- Care under fire: RPG explosion, foot patrol, 1 wounded, area under sniper fire (stressor) - patient
suffering from extremity hemorrhage, will bleed to death if C.A.T. Tourniquet not placed, tourniquet
must be placed before onset of shock or patient will have much higher chance of death - bleeding must
be controlled, distal pulse remains after placement of first tourniquet, a second one must be placed just
proximal to the first (increasing effective WIDTH) - Care under fire," the only concern is stopping
bleeding using a tourniquet. Because there are issues with limited care at that phase, then the goal is
limited exposure to the rescuer - exposure will cause rescuer to be wounded or killed by sniper fire.
- Care under fire: IED detonation, Humvee patrol, multiple casualties, 1-3 wounded, blast and blunt
force trauma type injuries, secondary IED explosion/hazard, configurable with ground-assault after
initiation of the IED, options can also include high traffic street, crowd gathering, -- casualty has blunt
trauma, penetrating trauma, blast, and burns, scenario can throw in spinal fracture (thoracic) - must
maintain spinal alignment
- Stopping bleeding of an extremity : soldier with gunshot wound to left leg, open fracture left femur,
injury to popliteal artery and vein, three CAT tourniquets required placed to save
- Stopping bleeding of an extremity : tourniquet malfunction, velcro band must be tightened as tight as
possible before starting to use windlass, loose velcro band contributes to tourniquet malfunction
- Stopping bleeding of an extremity : a FAKE CAT tourniquet shows up in threatre. Doesn't have the NSN
number (NSN-6515-01-521-7976) - prone to failure
- penetrating eye trauma, placement of rigid eye shield, if eye shield not in IFAK then use medic's own
tactical eyewear, required to save eye
- Under "airway management" the concern is NOT CPR but using airway assisted devices such as nasal
airways or Combi-Tubes or surgical trachs.
- surgical airway, field crics done incorrectly, either through thyroid cartilage, or through vocal cords scenario for casualty care can include nighttime / non-permissive environment - medic can be
influenced by injury sustained on infil (damaged NVG's as well) - casualty has gunshot wound to jaw,
medic not called to scene for 10 minutes due to ongoing firefight, jaw shattered / heavy maxillofacial
bleeding, casualty refused to take "sit up lean forward" recovery position, anxiolysis attempt with
Versed to facilitate maintaining the airway position fails. casualty becomes increasingly combative. all
landmarks have disappeared due to soft tissue swelling of the neck. by performing a cric, a definitive
airway is established under extremely difficult conditions. if no cric, the airway is lost during evacuation.
- endotracheal tube is cut, must be taped securely or the tube will slip into the trachea, cease to
function correctly, and must be surgically removed
- "Sucking" chest wounds deal with open chest injuries that must be taken care of by sealing the chest
and performing a needle decompression (which is where a large bore needle is inserted into the chest)
to aid in decreasing the build up of air pressure in the chest.
Notes below
Greetings again,
Sorry for the delay, I wanted to check out some more information before I relayed the information to
you.
Under the idea that you are trying to design/develop, it has to adhere to the tenet of "Tactical Combat
Casualty Care" or TCCC as we call it.
There several basic items that are covered under TCCC:
-Care Under Fire
-Stopping bleeding of an extremity
-Airway management
-"Sucking" chest wounds
-Transporting a patient off the battlefield
-Triage of a patient
-Calling in a Medical Evacuation (Helicopter)
This is the "written" rules that we go by on the battlefield. Case scenarios are developed around each
specific area. For example, under "Care under fire," the only concern is stopping bleeding using a
tourniquet. Because there are issues with limited care at that phase, then the goal is limited exposure to
the rescuer.
Under "airway management" the concern is NOT CPR but using airway assisted devices such as nasal
airways or Combi-Tubes or surgical trachs.
"Sucking" chest wounds deal with open chest injuries that must be taken care of by sealing the chest
and performing a needle decompression (which is where a large bore needle is inserted into the chest)
to aid in decreasing the build up of air pressure in the chest.
And the list goes on.
Scenario building should be limited to the top ten or twenty "real world" issues. For example blunt force
trauma and IED's. Additionally, you can build upon non threat injuries such as motor vehicle crashes and
falls from height (such as falling down stairs or off a wall).
Currently there are two good schools that both the Air Force and the Army go through. One is for PHTLS,
Pre Hospital Trauma Life Support and the other is the Special Operations Medical Course. Also there are
several "off the shelf" games that we have used that helps build "critical thinking" skills as a medic.
When trying to incorporate the above into a "computer model" the hardest to design is the tactical feel
of what you are doing. On the video game model, it is "point and click" but there is no "tactile" sensation
of it. The user would have to have a 3D visor/glasses as well as a palm or hand wired system that allows
the user to make movement with his hands as if he is picking something up or putting on a medical
device (such as a traction or tourniquet). An example of this could be electro sensing hand wear (gloves)
that allows for 3D involvement in the simulation.
Brooks Army Hospital has a "virtual surgery" program that allows students to work on "patients" using
real instruments but in a virtual environment. The other tool we use is the Sim Man which is a
mannequin based , controller operated tool that allows for many patient scenarios. An idea could be to
"marry" those two technologies to remove the controller and use the virtual environment for the medic.
Using goggle or a visor, you could provide light and input control to the mannequin.
It could run something like this:
You could place your "patient" in the room and the medic would don the "eye wear" before entering the
situation. The computer would then supply info to the medic and give the "visual" information. There
would be a "virtual" trauma bag that the medic would draw from and work on the patient with. There
would be the "solid" feel of the patient while using the computer based application to go through
situation. The whole set up could be placed in a large RV/Van that allows for complete mobility to each
training site, such as the "virtual" airplanes you see the Air Force bring to the airshows as a recruiting
promotion.
I hope this helps a little bit, I just wanted to toss some information to you. I am still very much
interested in helping and getting this off the ground.
Let me know if I can help.
Thanks.