NHRC Capability Brief AMAL Modernization IDC Curriculum Review/Conference 13 – 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
NHRC Modeling and Simulation History m ub s on i ss i s ed to i l nc e ud CF d an Development History 1996 e us ed p lo t e in S) ev nt LI Jo D e r p M s m JM fo ol ex or ss ls ( f d e o a To s P ite at IT as to SV ed td s S r R n RC e d cc id M& tie R CU pe la ov cal Pa A/D d o r i lo p d e an H To I ev E F M me D R L f O o PC EM E Q SP ua a rt va er ila ly b l up e o da n te the s pr we ov b; id ed dy TT tu B T s g S Lo DM ed g M tin a d ed d pe or up s n lo on a ve sp beg de R P N C ES O HR N es fil 2000 2002 2004 2006 2008 2010 2012 1999 2001 2003 2005 2007 2009 2011 2013 Expeditionary Medicine Knowledge Warehouse AM AL se ba AF CN te ty ua ili al ab ev ap n to C tio g lu ed in so us r W t in SP le Jo EE w ro as g G d in ite nn ed la cr l p Ac ica PT ed JM r m fo se ou eh ar w ta s da t r en -9 D fo pm IC SP lo to EE ve ew s vi de PC re ng TC y pi U og r ol ap M so od on th sp me e d rc SP an Fo g E r ta thm Ai in da ori us s ic alg st gi ds lo un ed wo ud of cl + In ed L di TM d in te ua al ev AL AM O M P G ES C/ g ID in us ed lin C M US 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 q 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 q 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 q Merges clinical and logistics data, all data available for use in other models (JMPT) Readiness Through Research and Development
Key Aspects of Review Results q NHRC published technical report provides a recommended logistics template based on the validated clinical capability requirements q Methodology shown to be an effective tool used by USMC, USN and USAF in medical material development and management q Relational database is flexible to enable scenario defined computations • EMed. KW modifications made by NHRC or by using the maintenance tool in the program • Casualty rate projections used in other modeling tools • All EMed. KW data used in JMPT to conduct medical risk assessment studies and analysis Readiness Through Research and Development
NHRC’s Medical Modeling Suite EMed. KW Store underlying data Readiness Through Research and Development
Taxonomy Continuum of Health Care Capabilities Theater Hospitalization Capability Modular hospitals with surgical capabilities required to support theater En Ro u te Ca re Ca pa bil ity Full range of acute, convalescent, restorative, Definitive and rehabilitative care Capability Forward Resuscitative Capability Forward advanced emergency medical treatment performed First Responder Capability Readiness Through Research and Development Medical care rendered at the point of initial injury or illness
Patient Encounter Data Development and Refinement Indentify Reliable Data Sources Provide Analysis Apply Refinements Validation of the ICD-9 Coded Encounters Recode where needed SOAP Review Identify Representative ICD-9 s Data Mining Key Word Search Readiness Through Research and Development
ICD 9 Clinical Basis for Supplies Readiness Through Research and Development 10
SME Contribution Construct Appropriate MTF Model Rate x PAR Patient Stream SME Rvw DNBI Presentation Data Class Specific DNBI PCOFs EMed. KW PASBA AHLTA TMDS Etc. Task Profiles Task/supply links SME involvement and participation is ESSENTIAL Promulgate New AMAL SME Rvw Endurance Requirements ROC/POE, etc SME Rvw Estimating Supplies Program (ESP) SME Rvw Current AMAL SME Input Noro-like Disease Outbreak • PCOF • Rate • Patient stream Mass Casualty UNDEX & AIREX • PCOF • Rate • Patient stream SME Input - Identify shortfalls, surpluses, redundancies, and obsolescent Develop Proposed Material Item List Calculate weight, cost, and volume Evaluate commonality (Service, JPOC, JDF) Readiness Through Research and Development
Process Flow Material Item List (MIL) Developed Kick Off Meeting Detailed Study Plan Discovery Phase Model and Data Development Analysis Phase 30 Days ACA 1 -2 Mos 4 -6 Mos Customer/SME Review MIL Accepted ? Yes MIL Refinement No Reporting Phase Deliver Final TR Readiness Through Research and Development 1 -2 Mos Customer Feedback
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 Readiness Through Research and Development 13
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 Readiness Through Research and Development 14
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 Readiness Through Research and Development 15
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 Readiness Through Research and Development 16
Modeling phase This includes: • Development of clinical tasks needed to treat occurring ICD-9 s • Review and validation of clinical task list by SMEs • Completion of model construction 30 AUG 2012 Readiness Through Research and Development 17
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 85 th percentile). • Decision: are any revisions needed? § YES – return to SME review. § NO – new line list is finalized. 30 AUG 2012 Readiness Through Research and Development 18
Reporting Phase This phase includes: • Authoring technical 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 Readiness Through Research and Development 19
AMAL Modernization Efforts • – – • Status FY 12 Air Expeditionary AMAL (Prowler/Growler dets, etc) – CNAF Afloat DNBI Phase One Study (SSN, CG, CVN) – NMLC FY 13 – – • 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) Complete In Progress Start Imminent 1 year Po. P FY 14 – – – • Complete T-AH AMAL Standardization – FFC? • Two year effort due to scope LHA, LPD 17 role 2 Modernization – NMLC? Adaptive Force Packages • ERSS • AEGIS Ashore FY 14 and beyond – AMAL Maintenance support Readiness Through Research and Development Proposed
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 EMed. KW. 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
Expeditionary Medical Knowledge Warehouse Inputs Medical Equipment & Consumables NMLC Patient Condition Treatment Briefs Physiological Models Mortality Curves DMMPO Patient Record Database CTR TMDS Navy/USMC Medical Lessons Learned NOMI Casualty Rates Doctrine & Mission Requirements CASEST FORECAS MCCDC (CD&I)/NWDC Enterprise Estimating Supplies Program (ESP) In Development Re-Supply Validation Program (RSVP) In Development Outputs Expeditionary Medicine Requirements Estimator (EMRE) Patient Condition Frequency Occurrence (PCOF) Tool Combat Intensity Rate Calculator & Injury Type (CIRCIT) Tool Human Injury and Treatment (HIT) Joint Medical Planning Tool (JMPT) Readiness Through Research and Development
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