Recreating the Vigorous Warrior and Clean Care Exercises In Silico: A Proof-of-Concept Study for the Digital Transformation of Military Medical Support

Introduction Computer simulations are becoming increasingly important in addressing the inherent limitations of medical planning for large-scale combat operations (LSCO). This technology offers a unique capability to model complex tactical scenarios that have not been encountered in past operations. The purpose of this study is to examine the use of computer simulations in enhancing military medical support for LSCO. Methods We collected and analyzed data from the NATO Live Exercise (LIVEX) Vigorous Warrior/Clean Care (VW/CC'24), incorporating both quantitative and qualitative observations from the point of injury to various levels of care, including Role 1, Role 2, and Role 2E. Our assessment focused on triage, damage control resuscitation, damage control surgery, and decontamination. The data was employed to recreate the scenario with a discrete-event computer simulator named SIMEDIS. The simulation was developed based on hourly observations recorded by the research team. The placement and capacities of Military Medical Treatment Facilities within the exercise were integrated into the model. Each simulated casualty was assigned injuries and clinical progressions as defined in the LIVEX scenario. Laydown of Military Medical Treatment Facilities within the exercise, along with their capacities, were incorporated. Results Transport, triage, and treatment processes were simulated using procedural guidelines and time estimates derived from observations made during VW/CC'24. The simulation of the LIVEX within SIMEDIS is presented, and the number of ambulances is varied with a direct impact on mortality. Discussion This report focuses on the similarities between the LIVEX and the computer simulation although also identifying gaps relevant to LSCO scenarios. The application of modeling and simulation to a LIVEX aims to establish a precedent for its use in future events beyond traditional table-top exercises, offering a novel methodology based on real field measurements. The objective is to utilize computer simulations to estimate clinical timelines and create a test platform for assessing and evaluating LSCO scenarios in a cost-effective way in a safe-to-fail environment. This approach enhances LIVEX planning by enabling the simulation of large-scale casualty influxes and logistical challenges without the need for extensive personnel mobilization. Conclusion The integration of computer simulations with military exercises offers a powerful method for improving LIVEX preparation to meet training objectives and can also be tailored for medical planning in LSCO. By leveraging data-driven modeling, military planners can better predict, assess, and optimize medical responses and courses of actions, ultimately enhancing readiness for LSCO.