Air Force Medical Modeling & Simulation Program: “Building the AFMS Cloud” Colonel Deb Burgess, MD, FACP Chief, Medical Modernization Division Headquarters, Air Education & Training Command 20 July 2010

Huffman Prairie – AF Island on Second Life Overview Mission/Vision Program Overview Training Limitations Future Technology The AFMS Cloud Huffman Prairie – AF Island on Second Life

Air Force Medical Modeling and Simulation Program Mission Integrate Modeling and Simulation Technology into all AF Medical Education, Training and Sustainment Platforms Vision Build a Distributed Simulation Network, Create Simulation Centers of Excellence, and Exploit Technological Innovation Battlefield Trauma, Critical Care Air Transport, In Garrison Care, Patient Safety, Humanitarian Missions, CBRN, Disaster, Homeland Defense and Pandemic Response

Air Force Medical Modeling & Simulation Target Areas Combat Casualty Care Critical Care Air Transport/Aeromedical Evacuation Proficiency & Sustainment Training Graduate Medical Education Nurse and Allied Health Education Patient Safety & Team Training Pandemic Response Natural Disaster & Homeland Security Response STARS P Sustainment of Trauma and Resuscitation Skills Program CSTARS Center for Sustainment of Trauma and Readiness Skills RSVP Readiness Skills Verification Program

Medical Modeling &Simulation: Playing Catch-Up 1960’s—Resusci Anne 1994—Peter M. Winter Institute for Simulation Education and Research (WISER), UPMC 1995—International Meeting for Simulation in Healthcare 1999—National Capitol Area Medical Simulation Center Established (USUHS) 2004—Society for Simulation in Healthcare Medical simulation only come into being in the last 10-15 years WISER-University of Pittsburgh Medical Center; Cooperative with 59MDW on Simulation International Meeting for Simulation in Healthcare Annual meeting now Society for Simulation in Healthcare (2004) AIMS--coalition of individuals and organizations committed to promoting medical simulation

Medical Modeling & Simulation: Training Platforms Computer-Based Training (CBT) Standardized Patients Human Patient Simulators Task Trainers Laparoscopy Anastomosis Bronchoscopy Central Line Computer-based Training Task Trainers Standardized Patients—Models Virtual Reality Trainers Full Environment High-Fidelity Human Patient Simulators

Medical Modeling & Simulation: Training Platforms Serious Gaming for Operational Medicine Avatars & Virtual Words Squad-Based Multi-player Single or Multi-player Immersive Virtual Environments Computer-based Training Task Trainers Standardized Patients—Models Virtual Reality Trainers Full Environment High-Fidelity Human Patient Simulators “Holodeck”

“On-The-Job-Training” Not An Option 8

Central Program Office (AETC/SG) Current Program Central Program Office (AETC/SG) Provide CONOPS, strategic plan and oversight, Simulation training & execution consistent across AFMS Standardize and validate current & future simulation req’s Ensure total asset visibility Equipment packages c/w requirements and training platform Staff contract support Consultant for equipment purchases/bulk negotiating agent Staff assistance and technical support Program for sustainment through corporate process

Distributed Simulation Training Network: Tier I Sites BEGINNING VALIDATION STUDIES OF THE SIM EXPERIENCE Wilford Hall * Keesler * Travis * C-STARS Saint Louis C-STARS Baltimore C-STARS Cincinnati USAFSAM - EMEDS * Lakenheath, UK National Capitol Area Simulation Center (USUHS) Defense Medical Readiness Training Institute (DMRTI) * Simulation Operator Course – Community College of the Air Force Certification/Special Experience Identifier LAKENHEATH USAFE

Distributed Simulation Training Network Tier 2 Central Program Office Tier 3 Tier 1 Standardized Curriculum and Scenarios Tier 1 Students Tier 1 to Tier 2 & 3 sites Knowledge Sharing Tier 2 Tier 2 Students Tier 3 Dynamic Network for Knowledge Sharing

Current Program: Distributed Simulation Network 33 Medical Simulation Scenarios loaded on the Knowledge Exchange (KX) Relational Database for cross referencing; Inventory ID CME/CEU/EMT credit now available for time spent in the simulation lab Must use standardized scenarios on the Kx Simulation training incorporated into medical RSVP

Web-Based Simulation E&T Tool Defense Connect Online & Web Based Tool Simulation Supervision Procedure Supervision Image Sharing Multi-User Collaboration Begun DCO Online connections locally and are trouble-shooting software issues. Connected 2 Tier 2 sites

Challenges of Conventional Training Lack realistic simulation--surgical & invasive procedures Fail to exhibit dynamic physiological sequela of trauma management and critical care Students cannot appreciate or anticipate complex pt care Simulation curriculum is not standardized Variable quality and execution Training is not reproducible internally or within the AFMS Dependant upon availability of skilled instructors, simulation operators, program directors and SMEs

Challenges of Conventional Training Low throughput – extensive set-up & breakdown time High student-instructor ratios limit: # of decision-making training sessions Individual instruction opportunities Objective performance metrics not established, tracked or archived Feedback variable, format not standardized: verbal vs taped AAR Lost workload and cost if TDY to simulation center

We need to be on the cutting edge Future Technology Technological advancement is accelerating at an exponential pace. Future education and training platforms must be as innovative as the young Airman we wish to recruit. We need to be on the cutting edge

The Future is Upon Us

Virtual Reality and Avatars Leverages gaming technology High throughput Available 24/7 Standardized, Performance Metrics Tracked, AAR Visit remote locations before deployment Equipment familiarization

Avatars and Virtual Worlds: Educational Uses Artificial Intelligence Triage/Trauma/Disaster Response Virtual Patients/Humans Scenario and Simulated Illness Practice Team Training and Group Exercises Interview Skills, Cultural Training Anonymous Supervision Empathy Training/Doctor-Patient Interaction Virtual Classroom

Future Technology Blended Learning – Live, Virtual, Constructive, Gaming Didactics Open courseware Electronic books, journals Available 24/7 Portable device Learning Management System Enterprise-wide solution Track and archive metrics from all learning sources Historical documentation

Virtual Iraq & Virtual Afghanistan Future Technology Virtual Medical Campus, Medical Gaming, LMS In Garrison and Deployed Environments Air Force Theater Hospital (Balad & Bagram), C-17 walkthrough Hospital or Aircraft Tour, Equipment Familiarization Patient Management Scenarios Virtual Iraq & Virtual Afghanistan

Future Technology: Serious Gaming “Operational” Rehearsals – Virtual Surgery Scenarios: Trauma, Critical Care, Burns, CPGs from JTTR Solo or Multi Player SCORM compliant, performance metrics tracked, archived, AAR Display dynamic physiological responses trauma & tx Train for “worst case scenario” and catastrophic complications Map to task trainer or simulator (mannequin) Must work on standard desktop computer

Future Technology: Knowledge Management Infrastructure is Knowledge Centric NOT Network Centric Enterprise Learning Management System Overarching Framework Data tracking (performance metrics) Enables archiving/historical documentation Tailored learning – Learner Centric Type of learning environment Rate of information delivery Knowledge pushed & pulled on demand Information access 24/7 Persistent environment Public, NIPR, SIPR, portable device Identify/incorporate new technology Based on requirements Live Virtual Constructive Gaming (LVCG) Mix Create (Requirements) Acquire (LVCG) Integrate (Curriculum) Distribute (AFMS) Apply (when/where/how often) Archive (Review/ROI) Knowledge Base Standardized knowledge-centric framework

Future Technology: Knowledge Management Mobile Learning Ensure access to Knowledge Base information (reach back) Enable quick, informal learning “on the go” Access whenever and wherever needed – airport, AOR Enable communication and collaboration Deliver learning content through videos, simulations and text messaging Matches learner needs 24 24

AFMS Cloud Architecture AIR FORCE MEDICAL SERVICE HAPTICS Evolutionary Phased Development 6 1 3 CBT/EBOOKS AFMS WEB PORTAL MEDICAL SIMULATION VIRTUAL ENVIRONMENT MEDICAL LEARNING MANAGEMENT SYSTEM 5 Performance Metrics LIVE TISSUE MEDICAL GAMING 2 4 SIMULATION TRAINING MEDICAL MODELING & SIMULATION 25 25

Way Ahead Air Force Strategic Plan for Future Technology R&D Joint DoD Cloud Partner with Professional Societies, Academia Systematic Approach to New Technology Integration Investment Strategy to Resource & Sustain Close Integration of Training & Operations Rapidly Integrate Lessons Learned 26

AFMS Medical Modeling and Simulation Vision JOINT INTEGRATION Theme: CENTER DEVELOPMENT SERVICE SYNERGY 1. Simulation Centers 2. AFMS Distributed Simulation Network 3. Educate/Train Med War Games Phase: Doctrine Joint integration for training/war games Doctrine Service Organization Primary Location/Med Facility Consolidation Integration of training sites Organization Training Standardized Joint Standardized Joint Integration Updates Training Standardized Service Standardized Service Synch Updates Materiel Materiel Solutions Materiel Solutions Materiel Solutions Materiel Attached is my vision for the AF MM+S Program. The red triangle depicts where we are along this continuum. Currently in Phase I. Developing Simulation capability at each center with Tiered organizational structure. Standardizing curriculum, templates, validation and RSV tracking. Will incorporate joint curriculum where able: GME, Tactical Combat Casualty Course from Army. Partnering with TATRC to develop standardized curriculum. Partnering with Air Force Agency for Modeling and Simulation for funding. Partnering with Research, Development Education Command (Army) and PEO STRI (Army) for information sharing. Phase 2. Develop Distributed Human Patient Simulation Network. May require additional Materiel and software which can obtain with alternate funding from DHP (T2, GWOT). Air Force Agency for Medical Simulation will help write white paper for GWOT funding. Also partnering with AETC, USUHS/NCA, DARPA, and other agencies to see if there are other innovative solutions to education and training. Will continue to standardize service updates in education and training and consolidate training on Website for expert to other training sites within the AF and .mil domain. Phase 3. Joint Integration with Army and Navy, Academia, State, Local Governmental organizations. Vision is to create a sophisticated Medical Modeling and Simulation capability at SAMMC to be used by METC, SAMMC and other entities to include University and state/federal government. Vision is to play medical war games with the Maries/Army/Air Force and incorporate immersion virtual reality with Blue Screen technology and haptics to simulate injuries from point of injury through the various levels to care to include CASEVAC, MEDEVAC and CCATT back to CONUS. Also this capability can be used to play CBRN and humanitarian disaster exercises with the University, State and Federal Government. May also use for rehabilitation for TBI and other injuries. Funding will be from alternate sources and will require other materiel solutions beyond current inventory. Will also require and alternate source funding. Innovation Solutions Leadership Joint Service Personnel Service Facilities Tier 1 Sites Distributed Human Patient Simulation Network Joint Simulation Centers: NCR/SAMMC Tier 2 & Tier 3 Sites Where we are now

Questions? Col Deb Burgess, MD, FACP Office: (210) 652-9720 Deborah.burgess@us.af.mil