Exploiting Learning Technology Innovations to Save Wounded Warriors

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HTE correspondent Marty Kauchak visited the Aeromedical Simulation Training and Education Center at Dobbins Air Reserve Base, Georgia on October 7. The center’s expanding, immersive training environment is sustaining the Air Force aeromedical evacuation and enroute care personnel communities’ operational successes, our New Orleans-based correspondent learned.

At the start of US combat missions in Afghanistan in October 2001 and Iraq in 2003, the US military had a 24% died-of wounds rate – the same level as at the end of the nation’s involvement in Vietnam. “But we do know that for the past four and a half years, we’ve maintained a 98% survival rate, which means a 2% died-of-wounds rate,” LtCol Chad Corliss, the deputy commander at the 94th Aeromedical Evacuation Squadron, pointed out. A confluence of bold, but sometimes late, acquisition and policy decisions contributed to this decrease. In one instance the Pentagon stepped up its acquisition of body armor, up-armored vehicles and new fleets of heavily armored wheeled vehicles. On the low-tech and less costly end of the spectrum, the services expanded the use and availability of tourniquets.

One of the more subtle but significant, contributor to the increased well-being and survivability of wounded warriors since the start of Operations Enduring Freedom (Afghanistan) and Iraqi Freedom, has been the US Air Force. During these hostilities the service has been the Pentagon’s executive agent for patient movement, having oversight on 320,275 patient movement activities. While the US’s combat mission in the two nations has been winding down toward the end of the Obama administration’s second and final term, the service’s aeromedical evacuation community continues to transport injured service men and women. Indeed, since this January 1, 4,317 patient movements have been completed in the two theatres. Beyond the number of patients successfully transported, patients are being moved more quickly to care facilities. Corliss reflected, “If you go back to Vietnam, it took 30 days to move a patient from the combat zone to a larger hospital. Today a patient injured in combat can be moved and back to a tertiary facility, Bethesda [Walter Reed National Military Medical Center], in 72 hours and quicker if necessary.”

Simulation-enabled learning is a pillar of the Air Force’s prowess in aeromedical evacuation (AE) and enroute care personnel missions, and with good reason. Corliss, providing a personal perspective and summarizing the Air Force Reserve’s policy commitment to simulation and other learning technologies, pointed out, “We believe in simulation. I believe in simulation. I believe it’s the right way to train. I believe it is going to make better medics and better nurses, which is going to lead to better survival rates for our people out there. We know that when we teach in a realistic environment, we get better learning and better retention.”


The AE community’s training and education is occurring at the Aeromedical Simulation Training and Education Center (ASTEC). The 6,000-sq.ft. center, hosted by the 94th Airlift Wing at Dobbins, is the first regional training and simulation center to focus on sustaining and enhancing AE skills.

ASTEC’s ready for training date (initial operational capability) was this January.

Corliss attached an imperative to getting ASTEC fully up and running. “We want to keep those skills. We’ve learned a lot in more than 10 years of combat. What we don’t want to have happen in our next conflict is for our new nurses and new medical technicians coming in, not knowing what we’ve learned, and having to learn it all over again.”

ASTEC’s customer base is “total force” in that it includes AE personnel from the service’s three components: Air Force Reserve Command (18 squadrons supporting 60% of the service mission); Air National Guard (nine squadrons supporting 28% of the service mission) and the US Air Force (four squadrons supporting 12% of the service mission). Beyond the number of squadrons, another perspective on the number of individual leaners who will be supported by the center can be gained from the Air Force Reserve. The component has 579 flight nurses and 779 aeromedical evacuation technicians. “That’s just our crew. I have flight nurses and aeromedical evacuation technicians who have to maintain training who are assigned to our operations teams, our liaison teams that are far forward with the Air Force, the Army and the Marines – they have to maintain skills. And just for the crews we are authorized and required to produce – that’s 37 events every six months those crew members have to do. That’s about 50,000 training events every six months – that’s a lot for a part-time force that is in [a training/duty status] two days a month.”

ASTEC’s course offerings are multi-tiered, beginning with didactic training to establish a knowledge base. Corliss continued, “We then take them in the skills lab and watch them perform the skills to make sure they are competent in every skill. And then we put them in the simulator and an immersive environment and tell them to put it together – the application. ‘Here’s the scenario. Here’s your mission. Now execute it.’ Hopefully they get it right. If they don’t it’s OK to get it wrong in this building because it is training.”

The center’s learning technology suite includes 22 high fidelity patient simulators. The inventory includes eight CAE Healthcare iStan advanced wireless patient simulators. The training devices, rated as “Safe-To-Fly”,are used in the simulator described below and on live training missions. CAE also delivered a Caesar trauma patient simulator for point-of-injury training, and other devices.

Beyond CAE Healthcare’s 18 high-fidelity patient simulators supporting the center, the CAE entity further provides its simulation learning management system (CAE Healthcare LearningSpace) and supplies healthcare instructor personnel (aeromedical flight nurse, biomedical technician, and aeromedical scheduler).

CAE Healthcare’s developed AE curriculum will include up to 75 simulated clinical experiences once ASTEC’s full learning program is “live” in March 2017.

Aside from the debriefing rooms, manikins and other capabilities, the crown jewel of ASTEC’s learning technology suite is the AE Aircrew Training Device (AEATD1-130), and enclosed C-130 Trainer (Fuselage Simulator). Some of HTE’s readers will recall that CAE unveiled a cross section of this training device at 2015 I/ITSEC in Orlando. Chris Lilly, a program manager at CAE USA, recalled there “was a ton of international interest” in this new offering during the conference.

The CAE furnished training device delivered earlier this year provides a fully immersive training experience. The AEATD is constructed with real and simulated C-130E/H variant aircraft parts, enabling day and night training. A smoke generator allows the AE team to practice fire drills and patient care in degraded conditions. CAE Healthcare designed and delivered, high fidelity patient simulators also populate the training device, permitting the aeromedical crews to complete a wide range of patient care scenarios, including point-of-injury medical care, critically ill or injured patient medical care and even infant and pediatric medical care.

The training system’s customized medical training curriculum is further supported by a hand-held instructor tablet and instructor operator station.

The C-130E/H AE training system was delivered for about $(US) 6 million.

The service is taking the fidelity of the AE training mission to the next level. A full motion, electric, six degree-of-freedom (DOF) system, will be integrated into AEATD1-130 to offer additional, authentic sensory cues to the AE team for take offs and landings, turbulence and other in-flight events. Three of the motion system’s excursions will include roll (Rx) max. 8.4 deg./ min -8.4 deg.; pitch (Ry) max 8.7 deg./min -8.0 deg. and yaw (Rz) max 5.3 deg./ min -5.3 deg. cues to the training audience.

Amsterdam, The Netherlands-based E2M is on contract to CAE to deliver the motion system. System installation is expected later this calendar year. Lilly emphasized, “This is a high payload motion system.”

The decision to provide an electric system is significant from a life cycle perspective. While hydraulic systems tend to support higher payloads, electric systems provide greater reliability, responsiveness and other attributes for the customer and its training audiences.

The Air Force Reserve is expanding its scope of onboard aeromedical training to support two other aircraft designated for aeromedical missions – the C-17 and KC-135. Accordingly, the component has on order from CAE, a similar AE aircrew training devices for these two aircraft. “They will be on 3-DOF motion systems, have a lightweight aluminum design and will replicate the physical constraints – the lighting, all the ‘touch points’ – oxygen, refill stations and others,” Lilly said.

Metters (Orlando) is on contract to CAE to deliver the devices in 2017. Each new training system has a contract value of about $3 million.


The Air Force Reserve’s Corliss further discussed his service’s returns on investment (ROIs) in ASTEC. Heretofore, AE training has primarily occurred when the C-130 or other aircraft, has been on live missions or when the pilots are completing proficiency training. “We get on the back end and we fly. But there is a cost associated with that. A cost every time a C-130 from this base lifts off and flies – a cost for maintenance and operations of the aircraft; a cost for producing the five members of the front end crew, among others.” According to Corliss, about 12 individuals (crew and AE) support an airborne, live training event. One service estimate placed the cost of a C-130J training mission at $5,300/hour.

Conversely, three simulation operators may be needed to support a scenario at ASTEC. And there are ROIs beyond Air Force operations and maintenance, and personnel accounts’ savings. “We know this can improve patient safety. We know it improves our clinical performance when we are in the simulator,” Corliss emphasized.

Technology improvements and enhancements aside, ASTEC’s learning technology suite will continue to complement AE live training. “We still train, we still fly. That is very important,” Corliss concluded.


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