SMS3 brings together key stakeholders

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A new Directorate of Simulation (DOS) was established at theHealth Readiness Center of Excellence (HRCoE). The directorate is charged withcoordinating and incorporating all medical simulation efforts across the fullspectrum of medical and military operations. Key stakeholders were broughttogether for a Strategic Medical Simulation Synchronization Summit (SMS3) onJoint Base San Antonio-Fort Sam Houston, Texas, from 15-16 May, 2019, to begindeveloping relationships and unity of effort.

HRCoE DOS brought together nearly 50 medical, simulation,training and education experts during SMS3. There were subject matter expertsin attendance from PEO-STRI, DMMSO, Brooke Army Medical Center, U.S. ArmyFutures Command and many other relevant external and HRCoE internalorganizations.

The event, hosted by the HRCoE, was the first of many futuresynchronization events that will grow in both size and scope. The overallpurpose of the event was to ensure representation from as many subject matterexperts as possible, orient DOS to the stakeholders' missions and vice versa,to clearly outline and define the goals set by the command, and to solicit thecollaboration and cooperation that is needed to be successful in this endeavor.

At the summit, Maj. Gen. Patrick D. Sargent, the HRCoEcommander, provided a vision of the future and likened the challenge beforethem as our "go to the moon" opportunity. He told the audience thatthe audacious goal wasn't ensuring a person made it into space and back alive.The audacious goal was to ensure every soldier, sailor, airmen and marine makesit into combat and back alive. Simply put, the goal is zero preventable deathson the battlefield.

Sargent told attendees, "Today, May 16, 2019, is theday the Health Readiness Center of Excellence announces our audacious goal: weare unwilling to postpone our strategic pivot to fundamentally transform andexponentially improve the way we train to save lives on the battlefield throughbetter use of 21st century technology. This is our shot at the moon, and wewant to take all of you with us."

THE PROBLEM

During comments to open the event, James Aplin, deputy director,DOS, highlighted some of the challenges DOS faces as they forge ahead with thisplan. He said, "Having a centralized directorate will mitigate the currentArmy medical simulation environment that consists of fragmented, independentand isolated pockets of non-standardized training scattered across theoperational Army; this will allow us to move further, faster." The SMS3 wasto be an initial step in that effort.

Aplin, who also served as the 12th MEDCOM command sergeant major,leads the US Army Emergency Medical Services Program Management Division (EMS).They serve as the project management division for the Medical SimulationTraining Centers (MSTCs).

MSTCs are a relevant example to highlight the complexenvironment DOS must operate in if they want to standardize medical sustainmenttraining. There are 21 MSTC locations inside and outside of the continental U.S.

Though the MSTC program of record is the responsibility ofEMS, and now DOS, the MSTC facility, as a physical structure, falls under theInstallation Management Command per AR 350-52. MSTC funding is alsoaccomplished through various entities at the operational and installation levelas well as through PEO-STRI contracts and EMS.

Another point of friction with the MSTC is that the programof record does not include manning the MSTCs, so responsibility falls togarrison-level units to ensure the centers are properly staffed. Additionally,MSTC set-up and training scenarios are not standardized among locations, nor isMSTC sustainment training required across the enterprise; how much the MSTC isstaffed and used depends heavily on the operational unit commander'spriorities. Consequently, there are vast differences in training outcomesbetween each facility.

Similar to the MSTCs, the Army's Central SimulationCommittee (CSC) is a MEDSIM capability that is currently fielded at 10 Armymedical treatment facilities (MTFs). These CSC sites are accredited andstrategically aligned with the Army's Graduate Medical Education (GME) trainingprograms and work parallel to MTF education departments. Though the primarymission of the CSC is to support GME MEDSIM training needs, they have expandedtheir mission to training non-GME students and medical professionals within theMTFs.

Lt. Col. Maria Molina, chief of the CSC, discussed the Armysimulation structure and how she sees DOS fitting into that. She also providedattendees with a CSC overview and included an explanation of the overlappingtraining mission and deviation to non-GME related training. Molina, anobstetrics and gynecology physician assigned to Brooke Army Medical Center atJBSA, said, "It would be ideal if DOS could be the centralized button tohelp Army medical simulation be a little more efficient and less disjointedthan it has been."

Funded by MEDCOM until October 2019 when their funding willcome from the Defense Health Agency (DHA), there are 10 Army GME hospitals withapplicable simulators, which also perform non-GME training that overlap withsustainment training done at the CoE, the MSTCs and the units. "We havebeen trying to standardize GME curriculum so that we can start looking ataccreditation as a whole instead of seeking accreditation for each individualsite," explained Molina.

In contrast to the MSTC program, the CSC has its own budgetand funds all 10 GME locations to include equipment, consumables, anadministrator and a simulator operator for each site.

FORGING THE WAY AHEAD

In addition to receiving formal presentations on overlappingfunctions, the working group allowed the diverse group of medical simulationexperts to network, connect names with faces and begin the cooperation thatwill be needed to navigate the complicated process of standardizing training ofexisting capabilities, acquiring new, more advanced STE capabilities andeliminating duplication of effort and inefficiencies that has plagued the fieldto date.

Clarkson, a cardiologist by trade said, "This is why wewanted to conduct this summit. Everyone in this room can help us determine howwe can rehearse relevant medical functions and tasks in a simulatedenvironment, with opportunity for repetition, to ensure a Ready Medical Forceand increase survivability."

On day two of the event, Sargent, who has commanded the HRCoE since June 2018, told the audience that it is not enough for doctors to be fully trained because eliminating preventable deaths on the battlefield depends on ensuring the entire medical team, across the continuum of care, is fully trained. He reiterated that proficiency is assured through standard Individual Critical Task Lists (ICTLs), which lead to a capable team proficient in supporting collective tasks.

Sargent, a medical evacuation pilot, described his visionfor ICTLs and the ability to effectively evaluate the proficiency of medicalsoldiers upon arrival to each operational assignment. The concept, similar toan aircrew training program, would evaluate readiness through a series ofwritten, oral and practical evaluations upon arrival to an operationalassignment.

"It's not enough to call soldiers and providers welltrained if we do not ensure they maintain their proficiency when they go totheir follow-on assignment or MTF," he said.

Sargent sees the opportunity to gain true proficiencies inmedical competencies through advances in STE as a vital element in any futureoperational medicine training program. Currently, pre-deploying individuals ormedical teams are provided optional hands-on Tactical Combat Casualty Care(TC3) training as a three- to five-day immersive refresher before they areconsidered trained and prepared for the rigor of combat medicine.

These courses, like Tactical Combat Medical Care (TCMC) orthe Brigade Combat Team Trauma Training (BCT3), are classified by graduates assome of the most relevant training they could receive prior to a deployment.Still, he says, Army medicine should go further.

"Can you imagine allowing a new pilot to spend a fewdays in a helicopter trying to maintain a steady, 10-foot hover and then checkthem off as fully trained and ready for flight on day five?" askedSargent. "Let's stop justifying what we had to do in the past, purely outof necessity, and focus on establishing new standards through innovativemethods to accomplish standardized, effective training methods and standardswith an operational medicine focus that yields proficiency overfamiliarization."

CHALLENGE ACCEPTED

To close out SMS3, Jay Harmon, deputy to the commanding general,HRCoE, who has direct oversight over the DOS program, thanked attendees forcontributing their valuable time, being transparent and sharing their knowledgeand skills with the team.

Harmon continued, "The CG laid out his vision to theCoE and his challenge to you today. It's now our job, together, tooperationalize that vision."

Harmon outlined how the next steps after the SMS3 are toformalize the team and add anyone else who should be in the room, establish atimeline and then create a plan of action complete with milestones andpriorities. He said the CG believes DOS is starting out behind the power curveand has lost the strategic advantage when it comes to medical simulations.

Ruben Garza, Chief, Defense Medical Modeling and SimulationOffice (DMMSO), Education and Training J7, Defense Health Agency, believesseeking buy-in from MMS Stakeholders is key to this team concept and was thebest thing about the summit.

Garza said, "The summit was perfect. Together we canleverage best practices across the Army, Navy, Air Force and Marines to improvecommunication, collaboration, and coordination for cost efficiencies andimprove medical training at all levels."

The next Strategic Medical Simulation Synchronization Summitis scheduled for September 25 and 26, 2019.

Source: US Army

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