Bridging the Gap in Female Casualty Care: Modular Extended Reality Medical Simulation Training using Mixed Reality and High Fidelity Manikins

Operational Medicine will grow dramatically in complexity and in scale in the future fight. In Large Scale Combat Operations (LSCO) against near-peer competitors, efforts to achieve the “Golden Hour” are likely to be overwhelmed by casualty counts incurred from the use of highly effective weaponry employed by nations on a scale not seen in battle by US and partner forces in recent decades. Achieving optimal survivability and recovery under combat situations requires the Joint Force to train more advanced Combat Casualty Care techniques, tactics, and protocols to a wider group of Warfighters. Simulation-based training (SBT) is the most evidence-based approach for highly effective training and is used commonly through a variety of modalities such as high-fidelity manikin simulation (HFMS), screen-based simulation (SBS), and paper-based simulation. This simulation training for battlefield providers must enable them to address trauma in the appropriate context of multisystem injury requiring prioritization and temporization for optimal outcomes. The current modalities for simulation often fail to meet this need. The gap is further compounded in the case of female combat casualty care. Current modalities for simulation training often fail to portray female casualties. This gap leads to reduced readiness for delivering care to injured or ill female warfighters. In addition to the barriers to care for female Warfighters posed by lack of experience and societal taboos, there are also significant anatomical and physiological differences that current instructional modalities do not adequately address, involving both battle and nonbattle injuries. Such differences include but are not limited to thoracic, urogenital, and pelvic external and internal anatomical variation; for example, outside these regions, female extremities are often of a different shape and size, requiring a variation on the typical degree of compression required when using a tourniquet to arrest bleeding, and female airway anatomy can require modifications to commonly used methods for securing the airway. The lack of appropriate training modalities demonstrating these differences further reduce readiness for delivering high-quality casualty care and leading to lower survivability rates in female Warfighters among US and partner force personnel. SimX and its partners and vendors CAE, Laerdal Medical, and Ultraleap (Team SimX) propose a SBIR effort to develop a modular and flexible multi-modality medical simulation training system to provide medical simulation training for female Combat Casualty Care. This effort, which combines the teaming partners’ best-of-breed technologies of today and provides modularity to integrate the technologies of tomorrow, will enable realistic training using virtual, physical, and mixed simulation modalities, enabling the use of the right training tool at the right time.