The Defense Health Agency’s Defense Medical Modeling & Simulation Office provided subject matter experts to support Exercise Northern Strike 2023, which took place at multiple training areas throughout Michigan, Aug. 12-15, involving more than 7,000 participants from 25 states, one territory, and four international partners.

According to a Michigan National Guard press release, Exercise Northern Strike 2023 is one of Department of Defense’s largest reserve component readiness exercises involving multiple training areas including the National All-Domain Warfighting Center, encompassing Camp Grayling Maneuver Training Center and Alpena Combat Readiness Training Center. Participants also conducted training at Selfridge Air National Guard Base and Oscoda-Wurtsmith Airfield.

Defense Medical Modeling and Simulation Office personnel, within DHA’s Education and Training Directorate, were on-site, observing the use of modeling and simulation during the prolonged care augmentation detachment experiment. Unique to the 2023 exercise design is the integration of intra-theater medical care training, where participants evacuated simulated patients to Fort McCoy, Wisconsin, for follow-on medical treatment.

DMMSO leads the agency’s efforts in centralizing management of the military’s medical modeling and simulation capabilities and solutions supporting medical education and training within the Military Health System.

Ruben Garza, chief of DMMSO, said the team’s mission was to observe and identify gaps that need to be corrected, making the training more realistic and effective, which will help DMMSO with future exercises of this caliber.

“My team provided their simulation expertise regarding use of current simulation technologies and what best fits the exercise training modality, which is important because DMMSO is responsible for all simulation activities in the Medical Health System,” he added. “We identify the correct training technology to be used in both clinical and readiness environments.”

U.S. Army Lt. Col. Margaret Kucia, capability manager of Army Health System’s Medical Capability Development Integration Directorate, Army Futures Command at Fort Sam Houston, Texas, said the Army’s Medical Center of Excellence personnel observed Prolonged Care Augmentation Detachment’s capabilities and its capacity to provide extended medical care during large-scale combat operations before evacuation.

U.S. Army MEDCoE’s Directorate of Simulation is the U.S. Army’s lead agency in medical modeling and simulation policy and strategy, which supports institutional medical training, professional military education, and operational medical readiness. The directorate also serves as the accreditation agency and proponent for all U.S. Army medical simulation centers, facilities, and activities.

“PCADs provide extended care and enroute care capabilities and capacity to Role 2 medical companies and resuscitative surgical detachments operating forward of brigade combat teams when medical evacuation is delayed or denied,” said Kucia, who is also a certified physician assistant. “Role 2 includes a military hospital or clinic where patients are triaged, and trauma management and resuscitation are continued.”

Resources at Role 2 locations include blood, X-ray, laboratory, dental, combat, and operational stress control, operational public health, and when augmented, physical therapy and optometry and can provide patient care for up to 72 hours. PCADs add capability and capacity when augmenting a Role 2 by performing critical care tasks for very seriously ill patients, enroute critical care, and surgical teams in monitoring post-operative patients.

The exercise’s scenario consisted of large-scale combat operations resulting in a high number of casualties that, at times, overwhelmed medical capabilities and due to the tactical environment, casualties were held for a prolonged period far forward of brigade combat teams before evacuation.

“To analyze medical competencies effectively, medical scenarios have to be as realistic as possible,” said Kucia. “This is why medical modeling and simulation experts from DHA were on-site, ensuring Exercise Northern Strike 2023 was successful, ultimately ensuring the success of future exercises—but more importantly, PCADs can perform their missions successfully when it counts.”

During the exercise, the Army’s Medical Capability Development Integration Directorate assessed if the PCAD’s equipment meets the unique requirements and challenges of this level of care. Additionally, the training of assigned PCAD personnel were evaluated, ensuring the training was sufficient to provide prolonged care, assessing the effectiveness of current training programs, and identifying potential areas for improvement.

“Medical simulations allowed us to truly assess how a PCAD would operate, given high-acuity patients, new medical equipment sets, and a patient flow rate that approximates what we expect in future operating environments,” Kucia said. “Medical simulations crucially support experiments with realistic casualty scenarios. By minimizing artificialities, medical scenarios provide a platform to assess clinical skills, equipment use, team coordination, and medical decision making.”