Air Force Medical Service prepares for tomorrow’s conflict - MTM

Air Force Medical Service prepares for tomorrow’s conflict

This 21 May, Lt. Gen. Dorothy Hogg, surgeon general, US Air Force, provided her leadership responses to diverse questions from Halldale Group Editor Marty Kauchak, on behalf of MTM. The surgeon general’s insights are provided in entirety below.    

“…it is vitally important that our medical force receive advanced training opportunities in varied combat environments and scenarios.”

Lt. Gen. Dorothy Hogg, Air Force Surgeon General, talks with a US Navy sailor during a tour of the Air Force’s first Invisible Wounds Center Aug. 30 at the Eglin Air Force Base, Fla. The IWC will serve as a regional treatment center for post-traumatic stress, traumatic brain injury, associated pain conditions and psychological injuries.
Lt. Gen. Dorothy Hogg, Air Force Surgeon General, talks with a US Navy sailor during a tour of the Air Force’s first Invisible Wounds Center Aug. 30 at the Eglin Air Force Base, Fla. The IWC will serve as a regional treatment center for post-traumatic stress, traumatic brain injury, associated pain conditions and psychological injuries.
Source/credit: US Air Force/Ilka Cole

MTM:  Summarize for us how Air Force medicine is following the shift of warfighting focus for your service, from lengthy engagements in Iraq and Afghanistan, to a possible near-peer, or other conflict.

Lt. Gen. Dorothy Hogg (LtG H): Air Force Medicine is engaged in a major transformation on many fronts, with one primary goal – to better serve our warfighters and deliver the medical support required by our combatant commanders. We are developing an Air Force Medical Service that is flexible enough to meet the challenges of today, while preparing for the conflict of tomorrow.

Responding to anticipated future readiness requirements calls for different medical support, with new or revised capabilities, platforms, training and logistics. The Air Force specializes in aeromedical evacuation, and we are developing new techniques and expanding our global patient movement capabilities to provide robust en route critical care. We are also growing our expeditionary medical platforms, like our ground surgical teams, to make them more flexible to deliver care further forward on the battlefield.

Working with the Defense Health Agency, we are reorienting our military treatment facilities to renew our focus on full spectrum medical readiness. This means ensuring that our medical personnel are ready, trained and equipped to execute their medical mission, and all Airmen remain medically ready and optimized to execute their mission. We are deploying a new squadron type at many facilities, called operational medical readiness squadrons, focused solely on Airman readiness to improve availability and be more responsive to shifting operational requirements.

As the Air Force Medical Service transforms to meet this shift in readiness requirements, it is vitally important that our medical force receive advanced training opportunities in varied combat environments and scenarios. We are working with our sister services and the Defense Health Agency to ensure proper joint training opportunities exist, and medical forces are properly integrated into broader Air Force exercises.

Lt. Gen. Dorothy Hogg, 23rd U.S. Air Force Surgeon General, discusses Tactical Casualty Combat Care (TCCC) training with a pair of 374th Security Forces Squadron defenders after a TCCC demonstration at Yokota Air Base, Japan, Jan. 29, 2019. While the Air Force Medical Service is ready to provide medical care in a moment’s notice, having SFS personnel trained in TCCC allows for more immediate care to be provided in the field and ensures casualties make it to medical personnel in better condition.
Lt. Gen. Dorothy Hogg, 23rd U.S. Air Force Surgeon General, discusses Tactical Casualty Combat Care (TCCC) training with a pair of 374th Security Forces Squadron defenders after a TCCC demonstration at Yokota Air Base, Japan, Jan. 29, 2019. While the Air Force Medical Service is ready to provide medical care in a moment’s notice, having SFS personnel trained in TCCC allows for more immediate care to be provided in the field and ensures casualties make it to medical personnel in better condition.
Source/credit: US Air Force/Senior Airman Matthew Gilmore

MTM: Highlight for us how your health care professionals use learning technologies (simulators, simulations, others) in their continuum of training.

LtG H: Advanced training technologies allow our medics to practice vital and often complex medical skills in scenarios they may encounter in a deployed environment. Delivering care in austere locations, whether a battlefield or aboard an airplane, presents unique challenges. Time is critical, supplies are limited and hearing is difficult. These and other factors require realistic scenarios to prepare our medics. We are effectively leveraging simulation capabilities to ensure our medics are ready to perform in difficult environments.

Our medical education programs rely on a full range of the newest manikins. Advanced forms of these manikins bring as much reality as possible to the classroom. They talk, blink, move, hemorrhage, react appropriately to administered medications, and have measureable blood pressures while mimicking the mechanical, thermal and physiochemical properties of human tissue. 

The Air Force is also exploring the use of virtual reality, augmented reality and mixed reality platforms. A tool like the Air Force Medical Modeling and Simulation Training delivers a digital anatomy table to radiology technician students. This device is essentially a life-sized touch screen with an interactive interface that allows students to more quickly achieve an understanding of anatomical relationships.

Immersive virtual reality helps prepare our medics to provide care in hostile environments. The Wide Area Virtual Environment, or WAVE, uses projection screens to display an immersive environment, complete with smoke, smells and pyrotechnics, to allow a medical team to provide care under fire in a mass casualty scenario involving high and low fidelity manikins. It can portray many scenarios, from chemical and biological attacks in an urban subway to a firefight in a remote village. 

These learning technologies are instrumental to our medics’ readiness, allowing them to gain significant proficiency before ever touching a patient. 

US Air Force Lt. Gen. Dorothy Hogg, Air Force Surgeon General, views a medical mannequin during her visit at Misawa Air Base, Japan, Jan. 30, 2019. The mannequins are used to simulate realistic treatments for training scenarios. During her tour, various sections of the 35th Medical Group described their everyday tasks, including the triage, lab and radiology teams.
US Air Force Lt. Gen. Dorothy Hogg, Air Force Surgeon General, views a medical mannequin during her visit at Misawa Air Base, Japan, Jan. 30, 2019. The mannequins are used to simulate realistic treatments for training scenarios. During her tour, various sections of the 35th Medical Group described their everyday tasks, including the triage, lab and radiology teams.
Source/credit: US Air Force/Airman 1st Class Xiomara M. Martinez)

MTM: How can the simulation and training industry better respond to your health care community’s training requirements with products, systems, and other capabilities?

LtG H: The simulation and training industry has been very responsive to our needs, for both traditional graduate medical education needs and as a combat training medical entity. We are working with industry every day to ensure we have access to the training products to meet our specific needs.

One example of how industry worked with the military to meet our needs is the development of interchangeable manikin components. Previously, manikin companies created an entire manikin with a variety of features that were desirable and others that were not as functional. This changed with the Advanced Modular Manikin concept through the Army Research Lab. The Advanced Modular Manikin allows a company to produce part of a manikin that will work with other products from other companies. With the advent of the Advanced Modular Manikin, we can assemble the perfect set of parts for our needs to ensure our medical Airmen are trained in the necessary skills to treat patients both in the clinic and downrange.

MTM: Provide some significant changes your professionals will see in their training programs in the next 24 or so months.

LtG: The largest change that our medics will notice is the introduction of the Air Force Learning Services Ecosystem, which will improve and expand the capabilities of existing learning systems. Air Force Learning Services Ecosystem is a cloud-based learning service with anytime, anywhere access for a catalog of courses, a library service, learner records that track a student’s progress throughout their military career, statistical analysis, learner management services, and scheduling services. This new system marks an innovation in the way that the Air Force thinks about education and is coming on line by the end of 2020.   

I anticipate more integration of such innovative learning tools as augmented reality and virtual reality, immersive medical games and simulations, which will result in more effective training, retention and student satisfaction.

The 711th Human Performance Wing at Wright-Patterson Air Force Base, Ohio, has also developed some amazing projects that we hope to transition to students across the Air Force. One project underway is the Predictive Performance Optimization program. This program predicts learning decay curves, notifying commanders when someone needs additional training to ensure their proficiency.

We also plan to release a joint website called Joint Medical Simulation Instructional Methods, or JMedSim, that will function as a hub for all medical modeling and simulations. The site will include the courses used to train Air Force Medical Modeling and Simulation Training simulation operators, scenarios, and data capture from our simulation centers. It will be the workhorse for medical modeling and simulation centers across the enterprise. This program will ensure a consistent level of simulation operator training across the enterprise.

MTM: Highlight some of the collaborative training efforts USAF medical professionals are engaged in, and pursuing with their civilian counterparts in the US.

LtG: The Department of Defense actively works in concert with civilian counterparts for a variety of types of training, providing active duty members the opportunity to learn from experienced civilian providers and bring that training downrange.

For example, each military branch has a training center in several civilian trauma centers across the country. The Air Force Center for the Sustainment of Trauma and Readiness Skills, or C-STARS, program partners with three university affiliated trauma centers, the University of Cincinnati, University of Maryland, and Saint Louis University, to give our combat medics additional trauma experience. This program embeds Air Force providers in high-volume trauma centers, training them on vital skills they will need in a combat environment.

Additionally, we have partnerships throughout the country that provide valuable exposure to a diverse patient population where Airmen can practice and grow their medical skills. The Air Force, Army and University of Texas at San Antonio has a successful medical and surgical partnership; as does Wright-Patterson Air Force base with the Wright State University School of Medicine; and Travis Air Force Base with the University of California, Davis. The Air Force is actively seeking civilian counterparts for collaboration through graduate medical education, research and medical education.

Senior Airman Victoria Richard, 86th Medical Group En-Route Patient Staging medical technician speaks with U.S. Air Force Lt. Gen. Dorothy Hogg, Air Force surgeon general, during a presentation on Ramstein Air Base, Germany, March, 4, 2019. The 86th MDG/ERPS makes up 61 percent of all patient movement in the Air Force.
Senior Airman Victoria Richard, 86th Medical Group En-Route Patient Staging medical technician speaks with U.S. Air Force Lt. Gen. Dorothy Hogg, Air Force surgeon general, during a presentation on Ramstein Air Base, Germany, March, 4, 2019. The 86th MDG/ERPS makes up 61 percent of all patient movement in the Air Force.
Source/credit: US Air Force photo/Airman 1st Class Milton Hamilton

MTM: Tell us how the US Air Force medical community is focused on improving patient safety.  

LtG: The Air Force Medical Service is continuously focused on patient safety through our High Reliability Organization (HRO) journey, termed “Trusted Care”.  Ultimately, Trusted Care boils down to being a learning and improving organization, in partnership with patients and families, to achieve Zero Harm. Improving patient safety has required us to create a culture that values and applies HRO principles, safety behaviors, and error prevention tools while at the same time being innovative. Developing standard work and maturing our safety culture will continue to be priorities throughout all the ongoing transformations as we work with the Defense Health Agency and our sister services.

Standardization and interoperability are critical to patient safety as our Airmen increasingly work in joint environments. We are working with Defense Health Agency to streamline patient safety tools and behaviors across the services to strengthen the joint medical team both in the clinic and downrange. To do this, we have begun incorporating patient safety training into broader team training scenarios to reinforce those behaviors and tools.

Across the Department of Defense, we have been using the Team Strategies and Tools to Enhance Performance and Patient Safety program, or Team STEPPS program, which we used to build our Air Force Trusted Care culture. TeamSTEPPS builds on best practices across all the services and focuses on communication skills and tools to help teams improve patient safety. These tools have been incorporated in various simulation and training, as well as in leadership courses. Doing this across all services ensures seamless safety behaviors across all bases, clinics or deployed locations.

The Air Force Medical Service commitment to our Trusted Care culture is comprehensive. It affects all levels of care, and requires attention to detail and a focus on high-quality patient-centered care, which is reinforced from training and through the entire continuum of care. Air Force medics treat patients in some of the most challenging and austere environments imaginable, and we are always looking for new ways to improve that care.

MTM: Anything else to add?

LtG: As I mentioned earlier, Air Force Medicine, and the entire Military Health System are going through a time of tremendous change. Our unwavering commitment to our patients and our readiness mission are what will see us through these challenges, and we will need to maintain our strong partnerships with health leaders, like the simulation industry, to continue our success. It is a great honor to care for our men and women in uniform, military retirees, and their families.

MTM: Thank you for taking time from your busy schedule to provide your thoughts and perspectives to MTM.

LtG: You are welcome.