MILITARY MEDICAL MODELING AND SIMULATION SHIFTS ORGANIZATIONS WHILE RETAINING FOCUS

By Scott R. Gourley

One significant addition to military health care training across the joint services involved the establishment of the office of Joint Project Manager for Medical Modeling and Simulation (JPM MMS). Created in 2013 by the assistant secretary of defense for health affairs (ASD(HA)) in partnership with the Defense Health Agency (DHA) and the U.S. Army’s Program Executive Office Simulation, Training and Instrumentation (PEO STRI), JPM MMS was created to fulfill the services’ shared medical training requirements across the continuum of care.

Stated goals for the organization included fulfilling the services’ shared medical training requirements, standardizing medical modeling and simulation capabilities, centralizing life cycle management, and establishing a single transition office for medical modeling and simulation science and technology.

As part of a process designed to further expand these activities and capabilities across the continuum of medical care, the summer of 2020 witnessed the “stand down” of JPM MMS, which had been organizationally structured under PEO STRI, and simultaneous activation of the office of Program Manager for Medical Simulation and Training (PM MST), now organized under DHA.

Surgeon Maj. (Dr.) Ian Cassaday, 250th Forward Surgical Team, left, utilizes a Telehealth in a Bag kit and a Transportable Exam Station to simulate a craniectomy (performed by a non-neurosurgeon) during testing of virtual health capabilities in a field and operational environment during Joint Warfighting Assessment 2019.

“We may have changed our name, but the mission is the same,” said Jude M. Tomasello, program manager for medical simulation and training for DHA.

Tomasello, who previously served as deputy JPM MMS, explained that the organizational change reflected, among other things, the fact that the former office, under PEO STRI, was perceived as something of an “Army-centric” organization.

“The office originally planned to migrate to DHA, but we were going to do it more slowly, piece by piece, over a three-year period, eventually culminating in FY 22,” he said. “But the Army, for several reasons, came along and said that they would like us to do that in one year as opposed to three.

“We said, ‘OK, fine,’” he continued. “You know, ‘rip the band aid off.’ There are some advantages to that, so ‘let’s get on with it.’ And so we did. We got all the planning and other arrangements in place. And I am now chartered by Dr. Butler [Barclay P. Butler, PhD, MBA, serves as the J4, Component Acquisition Executive (CAE) and the head of contracting actions for DHA] as a component acquisition executive, and I reside in the CAE organization at DHA.” Noting a few additional organizational changes, he summarized, “In terms of what we do and how we do it, that really hasn’t changed. It’s just a shift organizationally from the Army’s PEO STRI over to the DHA Component Acquisition Executive.”

SIMULATION AND TRAINING EFFICIENCIES

Asked about the advantages of maintaining centralized multi-service medical simulation and training requirements in a single office, Tomasello said, “There is a lot of commercially available technology, especially in the medical simulation field. And there are a few folks out there who might be inclined to ‘do their own thing.’ They’ll go to a trade show. And if their organization happens to have a little bit of money, they’ll buy the shiniest object at that trade show.”

Such an approach might include some “near-term benefits,” Tomasello said. “But if you’re looking at things holistically at an enterprise level, you really need to look at total ownership costs: the acquisition cost, technology, obsolescence, sustainment, economic order quantities, and all those things that a Department of Defense [DOD] program manager is chartered to look after.

Multinational soldiers treat a simulated casualty during the final field training exercise of a sixmonth medical training course hosted by the International Special Training Centre in which 24 special operations forces soldiers from 10 different nations participated, March 1, 2017. The intent of the training course was to raise the competencies and capabilities of the NATO special operations forces medics, further enhancing medical support of our fighting soldiers.

“You really need to look after those things,” he continued. “So centralizing those requirements into a single office gives that DOD advantage in terms of cost and efficiency while also giving users benefits in terms of longer sustainment, planned upgrade cycles, and things like that, to keep their capabilities viable.”

He offered the analogy of an Army base buying different gunnery trainers from different manufacturers with different standards, sustainment requirements, and funding.

“It doesn’t take a rocket scientist to see how inefficient that is all the way around,” he said. “But when you do things from an approach with efficiencies, in the case of hospitals, you’re giving them a product where all they literally do is show up and train on their programs of instruction. They don’t have to worry about whether they have enough money to buy this capability or dedicate one of their clinicians or nurses to run the simulation and do the ordering. That’s all done for them in a centralized manner, just as the Army does for its forces.”

PROGRAM EXAMPLES

Tomasello said that the office supports programs across the medical continuum of care, from Level I, the point of injury on the battlefield, up to Level IV, which involves hospitals.

“I’ve got a whole team of acquisition professionals that can analyze requirements, condense those requirements, get those capabilities on contract, and eventually deliver them,” he said. “And we not only support across the continuum of care, we also support across the acquisition life cycle: from science and technology, through development, and all of the way through sustainment.”

Asked for examples of this ongoing support, he related, “In one case, we’re doing a medical training center for the special forces in NATO. That’s over in Mons, Belgium [NATO Special Operations headquarters]. They basically drew it on a piece of paper, and we said, ‘Yes, we can do that.’”

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Another representative program is the Special Operations Command Purposed Emergency Access Response, Point of Injury and Trauma Simulation (SPEARPOINTS). Government solicitations have outlined the SPEARPOINTS Prolonged Field Care Training System as “provid[ing] a capability for Special Operations Forces (SOF) teams to train collectively on SOF Medical Critical Tasks, in a mission scenario that replicates in-theater safe house/team house environment.”

“SPEARPOINTS is a medical simulation training center at Fort Campbell that is kind of like the Army ‘mystic’ [Medical Support Training Center (MSTC)] on steroids,” said Tomasello. “They are going to use it for training the special ops folks, but they are also going to use it for things like assessments of new equipment, which they tend to do on a regular basis. They will be able to go into SPEARPOINTS and test that equipment out under realworld scenarios.”

Spc. Myles Leedahl, center, an animal care specialist assigned to Public Health Activity- Hawaii, Hickam Branch, and Spc. Olamide Fagbohun, right, a combat medic assigned to Headquarters and Headquarters Company, 2nd Brigade, 35th Infantry Regiment, 25th Infantry Division, inject air into an endotracheal tube to provide breathing assistance for a simulated military working dog during the Canine Tactical Combat Casualty Course at the Medical Simulation Training Center (MSTC), Schofield Barracks, Hawaii. The course is instructed by veterinary technicians and officers from Public Health Activity-Hawaii to offer medics from across the Pacific region an opportunity to train with military working dogs and simulators to become more familiar with canine first aid skills.

As of this writing, he observed that plans are in place to have the SPEARPOINTS contract awarded by late October 2020.

Along with those representative examples, Tomasello pointed to “existing contract vehicles” that were written over the past few years by JPM MMS.

“They’re still active contracts,” he noted. “One, for example, is the Virtual Patient Simulator. That’s where people can come from any element of the Department of Defense or virtually any other government agency and order whole-body high-fidelity manikins as well as canine simulators off of this contract. We also have another contract called MS3, for medical simulation supplies and services. And that was originally developed for the VA [Department of Veterans Affairs] to buy a lot of items, ‘kit them,’ and then send them to the VA hospitals. So that is more like a commodity contract, and we had that available to us if folks need one of those particular products or services.

“As I said earlier, our capabilities run the gamut from [Level I] to [Level IV] and anything from science and technology all the way through sustainment. We’ve got the flexibility and the tools in our toolbox to do that,” he summarized.

THE PM MST TEAM

Tomasello said that service requirements for medical modeling and simulation capabilities are presented to the PM MST office “in a couple of different ways.”

“The SOCOM [U.S. Special Operations Command] representatives tend to come straight to us,” he said. “We have a relationship with them and we work with them directly. Otherwise, if it’s coming through the services, we have an organization within DHA under the J7 education and training folks called the Defense Medical Modeling and Simulation Office [DMMSO]. They serve as our ‘requiring’ activity. They will take requirements from the services or the hospitals and condense those. First, they’ll look at them and they might say, ‘You know, you already have a huge supply of these manikins, so you don’t really need them.’ So they provide that kind of function. If the requirement is validated, then they will send it to us to do the acquisition and to provide the capability. So DMMSO is our partner, just like TRADOC [U.S. Army Training and Doctrine Command] is with PEO STRI. They come up with the requirements and then the materiel developer provides and sustains the capability.”

Noting that some hospitals or training centers might occasionally try to bring requirements directly to his team, he added that, when that happens, they will be referred to DMMSO, “where they will go through the normal requirements vetting process.”

Describing his 15-person team, located in Orlando, Florida, as “small but fierce,” he asserted, “When you’re like that, you tend to do a lot of repurposing. You know, ‘Hey, I know you were working on this one thing, but this other thing came up with a higher priority.’ You don’t have additional people to assign to those projects. So the members of our team are flexible and know that they’re going to need to stay flexible for a while.”

U.S. Army Spc. Echo Lile and U.S. Army Sgt. Rodney Espinal, 307th Brigade Support Battalion, 1st Brigade Combat Team, 82nd Airborne Division, assess and operate on a simulated casualty using the Tactical Combat Casualty Care Exportable (TC3X) model of medical training manikin in the U.S. Central Command region on Feb. 12, 2020. The TC3X is a state-of-the-art medical training device used to simulate an actual casualty that could be found on the battlefield.

The PM MST includes Tomasello – who lacks a deputy – a DHA business manager, six Army civilians who will finish administratively transitioning to DHA civilians by the end of October, engineers, cyber professionals, a logistician, financial and administrative professionals, assistant program managers, and subject matter experts in the form of retired combat medics.

“Those former combat medics are invaluable to us, because many of us, as lifelong acquisition professionals, don’t really have that combat medic experience,” he said. “And we need that.”

Asked about the presence of cyber professionals on the team, he replied, “That’s checking all the blocks and doing everything you need to do. With acquisitions there are statutory requirements that include considering all the cyber elements of a program. That’s a must-do.”

MEETING TOMORROW’S REQUIREMENTS

Summarizing his message to today’s service members about the work being performed by DHA’s PM MST team, Tomasello offered, “DHA is a big place, and the medical health system is a big enterprise. But, as I outlined earlier, whenever some aspect [of that enterprise] involves training or simulation, either as a system or a product or service, we’ve got the skills and experience that we can use to contract for an acquisition. We always say that everything starts with a requirement. So, if that requirement is vetted through the proper channels, we are reactive and responsive to those requirements. I should say that we don’t make our own requirements – what some people have described as the whole ‘self-licking ice cream cone’ thing. But when those properly vetted requirements come along, we have the people with the experience to contract for it. It could be an item like a manikin. Or it could be a complete turnkey solution that would be provided as a service where clinicians or combat medics would only need to show up and train. And we would take care of all the risks and everything in between.”

He concluded, “We’re coming into the Defense Health Agency with a wealth of acquisition experience. And DHA, thankfully so, is already tapping into that. Myself and one of my other team members are on a team to help DHA [get] its arms around becoming an acquisition organization. And there’s a lot to that. It’s training. Its processes. It’s regulations. It’s all of those things that the services have embraced for years. The DHA is still relatively young in the whole acquisition realm. They haven’t really got that foundation built yet. But I’m on a team and a working group that’s helping to do that. And I’m very happy about that. I’m also happy that we’re influencing processes on science and technology transfer. We’ve got a lot of folks doing great things in the labs. But for years, it was just that they would develop something and then it had nowhere to go. There was no transition agent or funding or requirement. And we’re instilling discipline in that process as well, so that the great work that these folks are doing can end up as a capability in the hands of a clinician that really needs this capability.”

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