Team-Based Decision-Making Simulation in Virtual Reality for Forward Deployed Damage Control Resuscitation and Surgery

Operational medicine will grow in complexity in the “future fight” with near-peer competition, low intensity conflict, PE, joint/all-domain operations, and threat of WMD. Under the Agile Combat Employment (ACE) model, disaggregated forces, small teams in austere locations, will conduct operations across a large geographic area and require support from austere resuscitative and surgical care (ARSC) teams capable of providing damage control surgery (DC) to mitigate both operational and strategic risk. The Joint Trauma Service has defined this emerging requirement, “ARSC is advanced medical capability delivered by small teams with limited resources, often beyond traditional timelines of care, and bridging gaps in roles of care in order to enable forward military operations and mitigate risk to the force.”  Damage control surgery is a key capability provided by ARSC and must be deliberately trained and developed to be successful in the operational environment. The principles of DC involve abbreviated surgery to control hemorrhage and contamination in the abdomen, the simultaneous resuscitation of physiology, and delayed definitive surgical care once acceptable physiology has been restored. As medical and operational capabilities continue to evolve, so do the best available tactics, techniques, and procedures (TTPs). Effective and innovative austere damage control training and evaluation are critical to our nation’s medical readiness for near-peer competition. We propose to adapt SimX’s commercial Virtual Reality Medical Simulation System (VRMSS) to answer this call and enable the USAF’s elite military forces to “train how they fight.” SimX has identified proposed adaptations, including 1) the development of complete virtual replicas of mission-appropriate DC, 2) the creation and implementation of realistic and complete medical sets, kits, and outfits (SKOs) that would be available and required for DC response, and 3) the formation of a simulation training curriculum making use of the developed platform adaptations and covering the team-based medical decision-making required during DC medical support.