Simulation centres prepare soldiers for bloody toll of war

by Jack Weible
Copyright Army Times Publication Company

The U.S. Army's first---and so far, only medical simulation program is gearing up to expand the ability of medics and first responders to respond knowledgeably to battlefield injuries.

Medical Simulation Training Centres (MSTCs) were just a blueprint 2 1/2 years ago but are now established at 10 sites in the continental U. S., along with locations in Alaska, Germany, Kuwait, Afghanistan and Iraq. Three more will be fielded in 2008 on U. S. soil, bringing the total to 18.

"This program didn't exist 2 1/2 years ago," said Maj. Dave Thompson, the assistant product manager for MSTCs at the Army's Program Executive Office for Simulation, Training & Instrumentation (PEO STRI), which oversees the effort.  Because the wars in Iraq and Afghanistan were causing a surge in battle-inflicted wounds, the Army had a decision to make.

"They could do it fast, do it cheap or do it good," Thompson said. The service didn't ignore quality, but speed came first.  At the service's bequest, PEO STRI worked furiously to make the 18 centers a reality.  "By doing that, we've had to sacrifice standardized platforms," Thompson said, and as a result, although the systems provide vital training, it's not the same at every location.

"The useful thing to do is to get at the original requirements and provide standardized training platforms," he said.

The centers cost about $1.7 million apiece and are designed to provide the Army's combat medical advanced skills training for medics and combat lifesaver training for nonmedical personnel.  Each center is about 60 feet by 80 feet (4,800 square feet), can offer both classroom and field instruction, and encompasses four elements.  Thompson describes the MSTC as "a family of systems, with four subsystems and inside each of those subsystems they have components." Those subsystems are:

- The Virtual Patient System.
- The Instruction Support System (ISS).
- Medical Training Command and Control (MT-C2).
- The Medical Training Evaluation and Review System (MeTER).

The four systems are integrated so that each is dependent on the other to operate.

The Virtual Patient System provides the actual patient training devices.  Those devices include patient, airway and dead-weighted tethered mannequins, partial task trainers such as "arms" and "legs," kits for trauma and moulage (makeup materials for creating wounds), and other associated equipment. Medics and combat lifesavers, for example, will find that the dead-weight mannequins weigh 180 pounds plus up to 10 pounds of combat gear.

Training takes place in four so-called "validation rooms" that surround the centralized MT-C2 room where operators can manipulate the environment for the soldiers.  Thompson compared the control room to a board game of Oz, with the operator serving as "the man behind the curtain" who can "manage the training platforms, both inside and outside."

The MT-C2 simulates the stressors that can impede treatment on the battlefield, including hostile and friendly-force engagement, low light, fog, battlefield noise and debris.  "It also has the ability to bring in new training scenarios," Thompson said.

Those existing and new scenarios are done in integration with the Instructor Support System to allow adjustments both to the process and the training devices used.

The ISS, which includes four 400 square foot classrooms for indoor training but also outdoor instruction,  is designed to provide common programs for instruction by way of skilled medical instructors and accompanying administrative, supply and technical support.  It's also designed for virtual training.

Training without review can prove meaningless and that is where the MeTER comes into play.

"It's the metrics capability.  So when you come in, I can give you a test to determine where you are right now.  I can focus your training experience, then after the training sequence, I can retest you and determine what that goodness of traininig did, how much you improved," Thompson said.  "And if you still have needs, I can test you in three areas."

The first is technical medical knowledge--"One plus one equals two," Thompson said--and the second is applying that book knowledge to a live patient.  But most critical is tactical knowledge, he said.  "Can you make those decisions in a tactical environment?  You can be as book smart as you want to be, but if you pop up and you're not supposed to pop up, and you get hit, you're not doing anybody any good.  You've got to be able to combine all three of those pieces.

MeTER allows real-time audio and video reviews and reference points linked to objective data recordings.  That provides a full review of trainees' ability to apply the medical skills they've learned.


Thompson said PEO STRI is taking an "acquisition life-cycle approach" to the MSTCs.  "We are not just interested in widgets on the ground; we're interested in the system and the life cycle of that system."  That means not only providing initial training through the centers, but also reinforcing that training throughout a soldier's career.

The MSTCs have drawn positive reviews everywhere they've been introduced,  Thompson said - "The commander at Fort Drum (N.Y.) has determined that MSTC will be the focal point for medical training for the 10th Mountain Division"- but the task now is to determine how many more centers are needed.  Training and Doctrine Command (TRADOC) officials have indicated that,  eventually,  every soldier coming out of basic training should have combat lifesaving certification, Thompson said, but that's a far bigger load than the existing MSTCs can handle.

Standard training in the MSTC is four days for Army medics and five days for a first responder.  Using the MeTER system, program officials are eyeing an approach at customizing the training experience.

"So we can do a training sequence and if we realize you have a debit in your ability, instead of continuing on with you because we've got to get whole group through, what we need to do is identify that at that moment and then put you back through that particular piece of training," Thompson said.  And although the overall goal is standardized training, each soldier's ability to learn would be customized.

Another promising aspect for the MSTCs is the capability for interdepartmental, joint and coalition training.  "At Fort Lewis, (Wash.), if they have time, they're training (Environmental Protection Agency) personnel.  At Fort Riley, (Kan.), they're training global first responders," he said.  And the Saudi Arabian National Guard has expressed interest in training at a center as well.

While outside groups pay to use the MSTCs, helping the centers sustain themselves, Thompson said he believes the future bodes bigger things.

"What if we train interdepartmentally in medical simulation, so that as we respond to the next catastrophe, we are already training with other departments, such as the Department of Homeland Security?" he said.  "We would know how they operated; they would know how we operated.  Not so much at the strategic level but at the user level."

For now, PEO STRI and Army commands such as TRADOC must determine what the Army's need is for the MSTCs, especially if medical simulation training is to spread beyond the initial target of medics and first responders.

"We know that the original team (of centers) do not meet the Army's training requirements," Thompson said.