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 fromHalldale Group Editor Marty Kauchak, on behalf of MTM. The surgeon general’sinsights 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.
Source/credit: US Air Force/Ilka Cole

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

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

Respondingto anticipated future readiness requirements calls for different medicalsupport, with new or revised capabilities, platforms, training and logistics. TheAir Force specializes in aeromedical evacuation, and we are developing newtechniques and expanding our global patient movement capabilities to provide robusten route critical care. We are also growing our expeditionary medical platforms,like our ground surgical teams, to make them more flexible to deliver carefurther forward on the battlefield.

Workingwith the Defense Health Agency, we are reorienting our military treatment facilitiesto renew our focus on full spectrum medical readiness. This means ensuring thatour medical personnel are ready, trained and equipped to execute their medicalmission, and all Airmen remain medically ready and optimized to execute theirmission. We are deploying a new squadron type at many facilities, called operationalmedical readiness squadrons, focused solely on Airman readiness to improveavailability 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.
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 ourmedics to practice vital and often complex medical skills in scenarios they mayencounter in a deployed environment. Delivering care in austere locations, whethera battlefield or aboard an airplane, presents unique challenges. Time iscritical, supplies are limited and hearing is difficult. These and other factorsrequire realistic scenarios to prepare our medics. We are effectivelyleveraging simulation capabilities to ensure our medics are ready to perform indifficult environments.

Ourmedical education programs rely on a full range of the newest manikins. Advancedforms of these manikins bring as much reality as possible to the classroom.They talk, blink, move, hemorrhage, react appropriately to administeredmedications, and have measureable blood pressures while mimicking themechanical, thermal and physiochemical properties of human tissue.

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

Immersivevirtual reality helps prepare our medics to provide care in hostileenvironments. The Wide Area Virtual Environment, or WAVE, uses projectionscreens to display an immersive environment, complete with smoke, smells andpyrotechnics, to allow a medical team to provide care under fire in a masscasualty scenario involving high and low fidelity manikins. It can portray manyscenarios, from chemical and biological attacks in an urban subway to afirefight 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.
Source/credit: US Air Force/Airman 1st Class Xiomara M. Martinez)

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

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

Oneexample of how industry worked with the military to meet our needs is thedevelopment of interchangeable manikin components. Previously, manikincompanies created an entire manikin with a variety of features that were desirableand others that were not as functional. This changed with the Advanced ModularManikin concept through the Army Research Lab. The Advanced Modular Manikinallows a company to produce part of a manikin that will work with otherproducts 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 medicalAirmen are trained in the necessary skills to treat patients both in the clinicand downrange.

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

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

Ianticipate more integration of such innovative learning tools as augmentedreality and virtual reality, immersive medical games and simulations, whichwill result in more effective training, retention and student satisfaction.

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

We alsoplan to release a joint website called Joint Medical Simulation InstructionalMethods, 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 andSimulation Training simulation operators, scenarios, and data capture from oursimulation centers. It will be the workhorse for medical modeling and simulationcenters across the enterprise. This program will ensure a consistent level ofsimulation operator training across the enterprise.

MTM: Highlight some of the collaborativetraining efforts USAF medical professionals are engaged in, and pursuing withtheir civilian counterparts in the US.

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

Forexample, each military branch has a training center in several civilian traumacenters across the country. The Air Force Center for the Sustainment of Traumaand Readiness Skills, or C-STARS, program partners with three university affiliatedtrauma centers, the University of Cincinnati, University of Maryland, and SaintLouis University, to give our combat medics additional trauma experience. Thisprogram embeds Air Force providers in high-volume trauma centers, training themon 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.
Source/credit: US Air Force photo/Airman 1st Class Milton Hamilton

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

LtG: The Air Force MedicalService is continuously focused on patient safety through our High ReliabilityOrganization (HRO) journey, termed “Trusted Care”.  Ultimately, Trusted Care boils down to beinga learning and improving organization, in partnership with patients andfamilies, to achieve Zero Harm. Improving patient safety has required us tocreate a culture that values and applies HRO principles, safety behaviors, anderror prevention tools while at the same time being innovative. Developingstandard work and maturing our safety culture will continue to be prioritiesthroughout all the ongoing transformations as we work with the Defense HealthAgency and our sister services.

Standardizationand interoperability are critical to patient safety as our Airmen increasingly workin joint environments. We are working with Defense Health Agency to streamlinepatient safety tools and behaviors across the services to strengthen the jointmedical team both in the clinic and downrange. To do this, we have begunincorporating patient safety training into broader team training scenarios toreinforce those behaviors and tools.

Across theDepartment of Defense, we have been using the Team Strategies and Tools to Enhance Performance and Patient Safetyprogram, or Team STEPPS program, which we used to build our Air ForceTrusted Care culture. TeamSTEPPS builds on best practices across all theservices and focuses on communication skills and tools to help teams improvepatient safety. These tools have been incorporated in various simulation andtraining, as well as in leadership courses. Doing this across all servicesensures seamless safety behaviors across all bases, clinics or deployedlocations.

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

MTM: Anything else to add?

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

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

LtG: You are welcome.