1. 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

2. 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

3. 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

4. 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

5. 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 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

6. 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

7. 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”

8. “On-The-Job-Training” Not An Option8

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. The Future is Upon Us

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. Questions? Col Deb Burgess, MD, FACP Office: (210) 652-9720