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Readiness Through Research and Development
NHRC Capability Brief AMAL Modernization
IDC Curriculum Review/Conference13 – 15 May 2013
Readiness Through Research and Development
Discussion Points
• NHRC Modeling and Simulation past performance.• Medical Modeling and Simulation research program
goals.• Key aspects of review results.• NHRC’s suite of planning tools.• How are models constructed?• Current projects.
Readiness Through Research and Development
1996 2000 2002 2004 2006 2008 2010 2012 1999 2001 2003 2005 2007 2009 2011 2013
1996 2000 2002 2004 2006 2008 2010 2012 1999 2001 2003 2005 2007 2009 2011 2013
ONR spon
sore
d M
ed L
og st
udy
NHRC beg
an u
pdat
ing
DMSB
TTT
file
s
USMC AM
AL baselined
ESP
devel
oped
IDC/GMO AM
AL evaluated
using ESP
ESP
avai
labl
e on
the
web;
Quarte
rly u
pdat
es p
rovide
d
Included logistics data and
died of wounds algorithm
in TML+
Devel
oped
RSV
P fo
r MCF
subm
issio
ns
Air Force sponsor UTC review
using ESP methodology
Patie
nt d
ata
expa
nded
to in
clude
HA/DR
Mapping PCs to ICD-9s
LMI p
rovide
s ass
essm
ent
of m
edica
l M&S
tool
s (JM
LIS)
EESP for data warehouse
development
Expeditionary Medicine
Knowledge Warehouse
Development History
EESP used to evaluate CNAF
Growler W
ing Capability
PCOF
Tool
acc
redi
ted
for J
oint
use
NHRC Modeling and Simulation History
EMRE
and
CURCIT T
ools
Devel
oped
JMPT Accredited as Joint solution
for medical planning
Readiness Through Research and Development
Medical Modeling and Simulation Research Program Goals
• Develop deliberate and crisis action planning tools for medical providers, planners, and logisticians
• Evaluate current and develop new expeditionary medical capabilities for the range of military operations
• Conduct deployment health studies and develop casualty estimation methodologies and tools using the Theater Medical Data Store (TMDS) and Hybrid Database
Readiness Through Research and Development
Key Aspects of Review Results
Provides a systematic review methodology• Clinical Subject Matter Experts (SMEs) define/validate clinical
requirements and prescribed clinical standards of care• All relevant stakeholders (i.e. clinicians, medical planners, biomedical
repair technicians, logisticians, life cycle managers) are involved in the process
Provides an audit trail for each recommended materiel component• Recommended revisions justified and linked to specific clinical task(s)
and ICD-9(s)• Clinical and logistical impacts of supply and equipment deletions,
additions or changes made visible
Merges clinical and logistics data, all data available for use in other models (JMPT)
Readiness Through Research and Development
Key Aspects of Review Results
NHRC published technical report provides a recommended logistics template based on the validated clinical capability requirements
Methodology shown to be an effective tool used by USMC, USN and USAF in medical material development and management
Relational database is flexible to enable scenario defined computations• EMedKW modifications made by NHRC or by using the maintenance
tool in the program • Casualty rate projections used in other modeling tools • All EMedKW data used in JMPT to conduct medical risk assessment
studies and analysis
Readiness Through Research and Development
EMedKWStore underlying dataStore underlying data
NHRC’s Medical Modeling Suite
Readiness Through Research and Development
First Responder Capability
Forward Resuscitative Capability
Theater Hospitalization Capability
Definitive Capability
En R
oute
Car
e Cap
abilit
yFull range of acute, convalescent, restorative, and rehabilitative care
Modular hospitals with surgical capabilities required to support the theater
Forward advanced emergency medical treatment performed
Medical care rendered at the point of initial injury or illness
Taxonomy Continuum of Health Care Capabilities
Readiness Through Research and Development
Patient Encounter Data Development and Refinement
Readiness Through Research and Development
ICD9 Clinical Basis for Supplies
10
Readiness Through Research and Development
SME Contribution
PresentationData
PASBAAHLTATMDSEtc.
EMedKW
Class SpecificDNBI PCOFs
SMERvw
SMERvw
SMEInput
ConstructAppropriate MTF Model
EnduranceRequirements ROC/POE, etc
SMERvw
Noro-likeDisease Outbreak•PCOF•Rate•Patient stream
Mass CasualtyUNDEX & AIREX
•PCOF•Rate•Patient stream
SMERvw
SMERvw
SMEInput
EstimatingSuppliesProgram
(ESP)
DNBI
- Identify shortfalls, surpluses, redundancies, and obsolescent- Develop Proposed Material Item List- Calculate weight, cost, and volume- Evaluate commonality (Service, JPOC, JDF)
Current AMAL
Task Profiles
PromulgateNewAMAL
SMERvw
SME involvementand participation
is ESSENTIAL
Rate x PARPatient Stream
Task/supply links
Readiness Through Research and Development
Process Flow
DiscoveryPhase
Model and DataDevelopment
Analysis Phase
Kick OffMeeting
DetailedStudy Plan
Material ItemList (MIL) Developed
Customer/SMEReview MIL Refinement
MILAccepted
?
Customer Feedback
ReportingPhase
DeliverFinal TR
Yes
No
30 Days ACA
1-2 Mos ACA
1-2 Mos
4-6 Mos
1-2 Mos
Readiness Through Research and Development
Discovery Phase
This phase includes:
• Review of published journal literature
• Review of official doctrine and policy
• Review of operational requirements documents
• Review of AAR and medical lessons learned
• Discussion with experienced subject matter experts
30 AUG 2012 13
Readiness Through Research and Development
Data Collection
This phase includes:
• Patient presentation data from JTTR, TMDS, AHLTA, and GEMS
• UICs can be used to specify unit types (SME input)
• De-identified patient data analyzed by NHRC statisticians
• Patient data reviewed by appropriate SMEs
30 AUG 2012 14
Readiness Through Research and Development
SME Review: AMAL Considerations
• Is AMAL capability based on PAR or patient load(i.e., 50 casualties)?
• What is the required endurance without resupply(15 days, 30 days, etc.)?
• What is the level of care and skills of the MTF and its personnel?
• Are there weight and cube restrictions?
30 AUG 2012 15
Readiness Through Research and Development
Establish Patient Stream
This includes:
• Patient condition occurrence frequencies (PCOFs) are developed from collected patient data
• The population at risk for a CVN is 5200
• Historically speaking 11% of a PAR reports for a 30 day period, the expected casualty stream is 572
• The patient stream is a function of 572 draws on the PCOF
30 AUG 2012 16
Readiness Through Research and Development
Modeling phase
This includes:
•Development of clinical tasks needed to treat occurring ICD-9s
•Review and validation of clinical task list by SMEs
•Completion of model construction
30 AUG 2012 17
Readiness Through Research and Development
Analysis Phase
This phase includes:
•Multiple model runs will determine any supply excesses or shortages in AMAL.
•Statistical analysis used to determine average usage of each supply item.
•NHRC consults with meets with the customer to determine risk analysis confidence level (normally 85th percentile).
•Decision: are any revisions needed? YES – return to SME review.
NO – new line list is finalized.30 AUG 2012 18
Readiness Through Research and Development
Reporting Phase
This phase includes:
•Authoring technical document documenting the process used to create the AMAL, and a detailed line list identifying supply item additions, deletions, increases or decreases, and the reason for each change.
•Draft report submitted to sponsor while report is vetted by NHRC and BUMED editing process.
•Final report delivered to sponsor.
30 AUG 2012 19
Readiness Through Research and Development
AMAL Modernization Efforts• FY12
– Air Expeditionary AMAL (Prowler/Growler dets, etc) – CNAF– Afloat DNBI Phase One Study (SSN, CG, CVN) – NMLC
• FY13– CVN AMAL Modernization review – CNAF
– AFLOAT AMAL Modernization - NMLC• CRUDES (CG, DDG, FFG)• Small Combatant (MCM, PC, LCS)• Submarine (SSN, SSBN, SSGN)• Amphibious role 1 (LPD, LHD)
• FY14– T-AH AMAL Standardization – FFC?
• Two year effort due to scope– LHA, LPD17 role 2 Modernization – NMLC?– Adaptive Force Packages
• ERSS• AEGIS Ashore
• FY14 and beyond– AMAL Maintenance support
Complete
Complete
In Progress
Start Imminent1 year PoP
Proposed
Status
Readiness Through Research and Development
Backup Slides
Readiness Through Research and Development
Joint Medical Planning Tool Kit
Readiness Through Research and Development
Process Flow and Timeline
Discovery Phase: Determine patient types (wounded in action, non-battle injury, and disease), LOC, FAs, latest AMAL/AS, ROC/POE, new equipment/supplies/TTPs, research lessons learned and each line item; SME review by medical professionals; expected types of injuries and how many of each is likely to occur; SME review.
Model and Data Development Phase: Based on information and data developed during Discovery, appropriate MTF and functional area models built in EMedKW. During this phase patient streams based on PAR, and rate information are derived from PCOF and CRESTT to establish patient stream; reviewed by/with SMEs.
Analysis Phase: Using a deterministic modeling program (ESP) supply estimates based on patient streams, ROC and POE are derived. The Material Item List (MIL) is developed at the NSN level and metrics including additions, deletions, increases, and decreases are provided. Cost, weight and volume changes are computed.
Reporting Phase: A technical report is developed to formally document the process and results of the review. Appendices detail all supplies and reasons for deletion, addition, reduction, and increase.
Readiness Through Research and Development
Why Allowance Standards Need Maintenance
• Changes in standards of care• The forward-deployed environment is dynamic
– Updated tactics, techniques, and procedures– New weaponry, threats, environments– Modified personal protective equipment– Adapted treatment protocols– Introduction of improved medical supplies and equipment
• The imperative to facilitate/advance standardization– Between services and across the ROMO
• Continuous modernization of supplies & equipment– Example: Combat Application Tourniquet (CAT), a one handed, more
effective item named one of the Army’s 10 Greatest Inventions for 2005
Readiness Through Research and Development
Benefits of Modeling and Simulation
• Standardized, science-based, repeatable methodology
• Compatible with MCRW– Provides new/updated baseline PCOFs to MCRW– Capable of filling current shipboard PCOF gap
• Inventories based on clinical necessity– Supports routine AMAL maintenance cycle
• Reduces cost• Enhances standardization (JPOC, JDF, Service)
Readiness Through Research and Development
Medical Equipment & Consumables
Patient Condition Treatment Briefs
Casualty Rates
Patient Record Database
Physiological Models
Navy/USMC Medical Lessons Learned
Doctrine & Mission Requirements
Enterprise Estimating Supplies Program (ESP)
In Development
Re-Supply Validation Program (RSVP)In Development
Expeditionary Medicine RequirementsEstimator (EMRE)
Patient Condition Frequency Occurrence
(PCOF) Tool
NOMI
Mortality Curves
DMMPO
NMLC CTR
TMDS
MCCDC (CD&I)/NWDC
CASEST
FORECAS
Inputs
Outputs
Expeditionary Medical Knowledge Warehouse
Joint Medical Planning Tool (JMPT)
Human Injury and Treatment
(HIT)
Combat Intensity Rate Calculator & Injury Type (CIRCIT) Tool