Medical Battalion Enhancement Initiative using NHRC Tools

Validation of the Medical Battalion Enhancement Initiative using NHRC Tools in Support of the Marine Corps

2007-03-22 MBCE Med BN Validation Study

Med BN Validation Study• Purpose, Objectives, and Approach• CONOPS• Baseline Case and Excursions• Assumptions• Scenario Description

– Med Bn Capability– Casualty Stream

• Results

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2006-09-07 ERSS Validation Study 2

Purpose, Objectives, and Approach• Purpose: Provide information for the Medical Battalion Capability Enhancement WIPT

and decision makers on the HS OAG COA to restructure the Medical Battalion (MedBn)

• Objectives- Determine if the OAG COA to restructure the MedBn has the capability and capacity to support a

“MEF in the assault” in a MCO Defense Planning Scenario.

- Compare patient outcomes between the OAG COA and the current MedBn in the MCO DPS

- Determine the impact of limiting tactical evacuation on patient outcomes

- Perform other excursions as directed

• Approach- Describe the USMC casualty flow from the MCO DPS

- Provide a descriptive analysis and assessment of the OAG COA and current MedBn in terms of:• Casualty survival rates and patient outcomes (mortality, return to duty) • Define health services laydown (resources for Direct Support, General Support, and patient movement) • Define initial metrics• Define assumptions, base case, excursions

- Iterative Process• Investigate the 1 RCT case to understand issues, then complete 3 RCT case and excursions.• Model base case and excursions in TML+ (Tactical Medical Logistics Planning Tool)• Analyze results using the mean and 95th percentile of multiple TML+ runs• Revise as necessary


CONOPS• Scenario Development

– MCO 30 days high intensity combat operations ashore– 15 days prior to casualty peak, 15 days after– Focused on 3 RCTs conducting operations ashore

GroundCASEVAC

1 hr

30 min

HSS laydown applies to RCT 1, RCT 2, RCT 3

FRSS/STP

BAS FSC TheaterHospital

ERCS

ERCS

1 hr

1.5 hrs

Air CASEVAC

AirCASEVAC

2 hrsAir CASEVAC

5 min

POI

RCT 1RCT 2RCT 3

FRSS/STP from FSC deployed fwd to support RCT.

Baseline

CLR(GS)

Med Sec (H&S)

2 hrs

Air CASEVAC

Mental Health

RTDs/DNBI

1 hrSur

gica

l

FRSS/STP located with the Battalion HQ

FSC with the Regimental HQ

CLB(DS)

POI: Point of Injury

FRSS/STP: Forward Resuscitative Surgical System (FRSS)/Shock Trauma Platoon (STP)

ERCS: Enroute Care System

FSC: Forward Surgical Company

RTD: Return to Duty

DNBI: Disease/Non-Battle Injury

CLC: Combat Logistics Company

CLB(DS): Combat Logistics Battalion (Direct Support)

CLR (GS): Combat Logistics Regiment (General Support)

CLC


• There was no draft CONOPs provided by CD&I describing how the restructured MedBn would support a “MEF in the assault”.

• The CONOPs used for the TML+ modeling was based on:– 1st MedBn’s experience in OIF 1 supporting a “MEF in the assault”– Employment of the MedBn’s capability sets consistent with other

pertinent studies and MAAs— No USMC doctrine on use of the FRSS or ERCS

– Conceptual employment of the CLC, CLB(DS) and CLR(GS)– Employment of a Theater Hospital co-located with the CLR(GS)

based on our OIF1 experience

• What are the casualty survival rates and patient outcomes (mortality, return to duty) for the OAG COA and the current MedBn?

• Are the quantity of capability sets (FRSS, STP, ERCS, Wards, etc.) adequate?

• What are the impacts of decreasing holding capacity on patient outcomes?

Medical Planning Issues


Baseline Case and Excursions

Analyze baseline.Compare baseline with the current Med Bn capability.Investigate excursions.

Cases Name Description

Baseline OAG COA

The OAG COA provides a proposal to restructure the MEDBN to support the new MLG construct and make it more “mobile, scalable, and tailorable”.

Comparison Current Med BnThe "As Is" COA supports the new MLG construct without reorganizing the Med Bn.

Excursions

OAG COA with Nighttime Air Evac

Baseline OAG COA with all air evacuations occurring at night (1800 to 0600).

OAG COA with BAS/STP/FRSS

Baseline OAG COA with STP/FRSS colocated with each BAS.


AssumptionsCONOPS Assumptions• Rapid evacuation under ideal conditions• USMC Patient Evacuation Team (PET) is coordinating tactical helicopter evacuation • Resuscitative surgery should be available within 60 minutes from the BAS• The Forward Surgical Company will relocate with the Regimental HQ and CLB(DS)• The FRSS/STP will relocate with the Battalion HQ and CLC.• The "Medical Section, H&S Company, MedBn", and the Theater Hospital will not relocate

TML+ Modeling Assumptions• BASs are able to handle the casualty stream

– Use 3 BASs per 1 RCT• Tactical evacuation assets are always available when needed

– Unlimited tactical evacuation assets available to evacuate patients from the FRSS and FSC.• If a patient requires an ERCS team, a designated helicopter will be available.• Theater hospital will have sufficient resuscitative surgical capability, holding, and diagnostic capacity to handle the casualty stream.


OAG COA – A Regimental Combat Team (RCT)

SBA.1 1RSP.1 BAS.1

Medical Capability• Med Sec (H&S) provides:

– Surge capacity – If FRSS is closed, evac to FSC.– Treatment of mental health patients – If FSC is closed, evac to theater

hospital.– Temporary holding for RTD and DNBIs

Evacuation• Evacuate patients requiring specialty care (neuro need, etc) to theater hospital.• Evacuate moderate to severe mental health patients from BASs to Med Sec (H&S).• Far-forward evacuation assets will include 2 dedicated CH-53s and 2 dedicated MV-22s per RCT.

– Based at FSC.1 (Co-locate these dedicated evacuation assets with the RCT)– Increase this number as needed to avoid shortfalls in tactical evacuation

• Sufficient ground vehicles to handle all requests from 1RSP to BAS.• Sufficient helos to handle all requests from FRSS and FSC to theater hospital

Maneuver• The FRSS will maneuver with the supported RCT, and will always be within 30 minutes flying time

from the RCT. Two maneuvers will occur. Both during a lull in operations.

FRSS/STP.1 FSC.1SBA.2 1RSP.2 BAS.2

SBA.3 1RSP.3 BAS.3

TH.1

5 min

5 min

Sufficient ground vehicles to handle all requests from 1RSP to BAS.

30 min

Sufficient helos to handle all requests from FRSS and FSC to theater hospital.

1 hr

1 hr

1 hr

1 hr

ERCS

2 hr

2 hr

2x MV-22 2x CH-53

MV-22Speed: 275 mphCapacity (amb, litter): 24 or 12 maxLoad (amb, litter): 2 & 3 minUnload (amb, litter): 2 & 3 minPre-Mission: 30 minPost-Mission: 30 minWait Time: 0 min

CH-53ESpeed: 170 mphCapacity (amb, litter): 19 & 8 combinedLoad (amb, litter): 2 & 3 minUnload (amb, litter): 2 & 3 minPre-Mission: 30 minPost-Mission: 30 minWait Time: 0 min

Route LegendAir CASEVACERCS

Med Sec H&S2 hr

2 hr

30 min

2 hr

2 hr

5 min

5 min

10 min

1 hr

MV-22

Sufficient helos to handle all requests, if necessary.

CLC CLB(DS) CLR(GS)


OAG COA

RCT 1SBA.11RSP.1 BAS.1

5 min

FRSS/STP.1 FSC.1SBA.21RSP.2 BAS.2

SBA.21RSP.2 BAS.2

5 min

5 min 30 min

1 hr

1 hr

1 hr

RCT 2

RCT 3

• Each RCT defined similar to previous 1 RCT case.

SBA.11RSP.1 BAS.1

5 min


SBA.21RSP.2 BAS.2

5 min

5 min 30 min

1 hr

1 hr

1 hr

SBA.11RSP.1 BAS.1

5 min


SBA.21RSP.2 BAS.2

5 min

5 min 30 min

1 hr

1 hr

1 hr

Med Sec H&S

TH.1

CLC CLB(DS)

CLR(GS)


Casualty Flow Details – OAG COA

FRSS/STP

BAS FSC TheaterHospital

POI

Med Sec (H&S)

Specialty Care• Neuro – 25 PCs• Neuropsychiatric – 4 PCs • Ophthalmology – 9 PCs• Optometry – 2 PCs

Surgical – 59 PCs

Mental Health – 12 PCs RTDs/DNBI – 44 PCs •Holding >12 hrs

Surgical – 72 PCsVarious – 237 PCs

ERCS

ERCS

ERC assets are for post-surgical patients who require a ventilator.

CLC

CLB(DS)

CLR(GS)


Current Med Bn – 1 RCT

SBA.1 1RSP.1 BAS.1

Medical Capability• SC- provides:

– More holding (40 beds)– Combat Stress Platoon available– Ancillary support

Evacuation• If SC- “closed” and patient WIA, then evac to theater hospital.• If SC- “closed” and patient DNBI, then evac to Surgical Co in CLR(GS).• Evacuate patients requiring specialty care (neuro need, etc) to theater hospital.• Evacuate moderate to severe mental health patients from BASs to Surgical Co in CLR(GS).• Far-forward evacuation assets will include 2 dedicated CH-53s and 2 dedicated MV-22s per RCT.

– Based at SC-.1 (Co-locate these dedicated evacuation assets with the RCT)– Increase this number as needed to avoid shortfalls in tactical evacuation

• Sufficient ground vehicles to handle all requests from 1RSP to BAS.• Sufficient helos to handle all requests from FRSS and FSC


from the RCT. Two maneuvers will occur. Both during a lull in operations.

FRSS/STP.2 SC-.2SBA.2 1RSP.2 BAS.2

SBA.3 1RSP.3 BAS.3

TH.1

5 min

5 min


30 min

Sufficient helos to handle all requests from FRSS and FSC to theater hospital.

1 hr

1 hr

1 hr

1 hr

ERCS

2 hr

2 hr

2x MV-22 2x CH-53

MV-22Speed: 275 mphCapacity (amb, litter): 24 or 12 maxLoad (amb, litter): 2 & 3 minUnload (amb, litter): 2 & 3 minPre-Mission: 30 minPost-Mission: 30 minWait Time: 0 min

CH-53ESpeed: 170 mphCapacity (amb, litter): 19 & 8 combinedLoad (amb, litter): 2 & 3 minUnload (amb, litter): 2 & 3 minPre-Mission: 30 minPost-Mission: 30 minWait Time: 0 min

Route LegendAir CASEVACERCS

SCCLR (GS)

30 min

2 hr

5 min

5 min

Sufficient helos to handle all requests, if necessary.

MV-22

• CLR (GS) provides: – Surge capacity

1 hr

CLC CLB(DS) CLR(GS)


Casualty Flow Details – Current Med Bn

FRSS/STP

BAS SC- TheaterHospital

POI

SCCLR (GS)


Surgical – 59 PCs

DNBIs when SC- busy

Surgical – 72 PCsMental Health – 12 PCsVarious – 237 PCs

ERCS

ERCSWIAs when SC- busy

CLB(DS)

CLC



OAG COA with BAS to STP/FRSS – 1 RCT

SBA.1 1RSP.1 BAS.1

FRSS/STP.2SBA.2 1RSP.2 BAS.2

SBA.3 1RSP.3 BAS.3

TH.1

5 min

5 min


Sufficient helos to handle all requests from FRSS to theater hospital.

ERCS

Route LegendAir CASEVAC

Med Sec H&S2 hr

2 hr

2 hr

5 min

5 min

10 min

5 min

5 min

FRSS/STP.1

FRSS/STP.3

Medical Capability• Theater Hospital provides:

– Surge capacity– Post surgical support

Evacuation• Evacuate post surgical patients to theater hospital.• Sufficient ground vehicles to handle all requests from 1RSP to BAS to FRSS/STP.• Sufficient helos to handle all requests from FRSS/STP to theater hospital


from the RCT.

• H&S Medical Section : – Full medical capability

CLC CLR(GS)

Post-Surgery to TH

2 hr

2 hr

2 hr


Casualty Flow Details – OAG COA with BAS to STP/FRSS

FRSS

BAS

TheaterHospital

POI

Med Sec (H&S)

Surgical – 59 PCs

STP

All other PCs

Post-Surgical – 59 PCs

All other PCs


CLR(GS)

CLC



Proposed OAG COA Med Bn

Medical Battalion760 PAX

Forward Surgical Company

136 PAX


136 PAX


136 PAX

Headquarters & Service Company

352 PAX

3 STPs / 3 FRSS 30 COTS3 ERCS


3 STPs / 3 FRSS 80 BEDS / 30 COTS3 ERCS


HSS OAG COA 1 Nov.ppt and MBCE HSS COA T_O_Revised.xls


Proposed OAG COA Med BnForward Surgical Company (FSC)

FRSS #18 PAX

FRSS #28 PAX

FRSS #38 PAX

STP #118 PAX

STP #218 PAX

STP #318 PAX

SurgicalPlatoon

Triage/EvacuationPlatoon

Ancillary ServicesPlatoon

X-Ray #16 PAX

AmbulancePlatoon

AMB #13 PAX

ERCS #12 PAX

ERCS #22 PAX

ERCS #32 PAX

ERCSPlatoon

HeadquartersPlatoon26 PAX

DentalSection17 PAX


FSC

Navy Personnel Only.



136 PAX


136 PAX


136 PAX


352 PAX






Ward-411 PAX

Ward-311 PAX

Proposed OAG COA Med Bn – H&S CompanyMedical Battalion

760 PAX


136 PAX


136 PAX


136 PAX


352 PAX

H&S Med Section MEU CLB DETS

H&S Company Section

2 PAX

S-1Section

7 PAX

S-2/S-3Section

9 PAX

Patient Evac Team7 PAX

S-4Section

7 PAX

HeadquartersSection

5 PAX





Prev MedSection31 PAX

ChaplainSection

2 PAX

MEU CLB Dets-120 PAX



FRSS-18 PAX

FRSS-28 PAX

FRSS-38 PAX

STP-118 PAX

STP-218 PAX

STP-318 PAX

SurgicalPlatoon



ERCS-12 PAX

ERCS-22 PAX

ERCS-32 PAX

ERCSPlatoon

DentalSection

6 PAX

Combat StressPlatoon

Stress-16 PAX

Stress-26 PAX

Stress-36 PAX

Lab-16 PAX

Xray-23 PAX

Xray-13 PAX

Lab-26 PAX

Lab-46 PAX

Lab-36 PAX


H&S Company

Ward-211 PAX

Ward-111 PAX

Ward-810 PAX

Ward-710 PAX

Ward-610 PAX

Ward-510 PAX

Navy Personnel Only.


TML+ Modeled Med Bn Capabilities

FSC

FRSS #18 PAX

FRSS #28 PAX

STP #118 PAX

STP #218 PAX

SurgicalPlatoon



X-Ray #16 PAX

AmbulancePlatoon

AMB #13 PAX

ERCS #12 PAX

ERCS #22 PAX

ERCSPlatoon

HeadquartersPlatoon26 PAX

2 STPs / 2 FRSS 2 OR Tables8 Temporary Holding Beds20 COTS2 ERCS

FSC

DentalSection17 PAX



136 PAX


136 PAX


136 PAX


352 PAX





FRSS #38 PAX

STP #318 PAX

SurgicalPlatoon


ERCS #32 PAX

ERCSPlatoon

FRSS/STP

FRSS/STP

1 STP / 1 FRSS 1 OR Table4 Temporary Holding Beds10 COTS1 ERCS


TML+ Modeled Med Bn Capabilities (continued)

H&S Med Section

H&S Med Section

FRSS-18 PAX

FRSS-28 PAX

STP-118 PAX

SurgicalPlatoon



ERCS-12 PAX

ERCS-22 PAX

ERCS-32 PAX

ERCSPlatoon


Stress-16 PAX

Stress-26 PAX

Stress-36 PAX

Lab-16 PAX

Xray-23 PAX

Xray-13 PAX

Lab-26 PAX

Lab-46 PAX

Lab-36 PAX

Ward-810 PAX

Ward-710 PAX

Ward-610 PAX

Ward-510 PAX

1 STPs / 2 FRSS 2 OR Tables8 Temporary Holding Beds40 Beds / 10 COTS3 ERCS

DentalSection

6 PAX

Unused Capability Sets

-1 FRSS

-2 STPs (Total: 20 COTS)

-4 Wards (Total: 40 Beds)



136 PAX


136 PAX


136 PAX


352 PAX






TML+ Modeled Med Bn Capabilities (continued)

Surgical Company Minus

SC Minus

Surg-111 PAX

SST-110 PAX

SurgicalPlatoon



ERCS-12 PAX

ERCS-22 PAX

ERCS-32 PAX

ERCSPlatoon

Lab-16 PAX

Xray-23 PAX

Xray-13 PAX

Lab-26 PAX

Ward-221 PAX

Ward-121 PAX

1 Surgical Sections 40 Beds3 ERCS


Stress-16 PAX

Unused Capability Sets

-2 Surgical Section

-1 Ward

DentalSection

6 PAX


MCO Casualty Stream


MCO Casualty Stream• Casualty Stream from OSD’s Medical Readiness Review (MRR)

– Based on Medical Analysis Tool (MAT) modeling of Level III requirements for each Service in a 2012 MCO DPS– Represents USMC Level III Admissions for 5 RCTs in high intensity combat in MCO DPS

– Focused on 3 RCTs conducting operations ashore– First 180 days of MCO

Admissions at Level III

0

50

100

150

200

250

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170Day

Nu

mb

er

Total

WIA

DNBI

WIAs 1249DNBIs 4020Total 5269

Represents 5 RCTs• 3 Ashore

Our focus was on the 30 days of combat operations ashore (15 days prior to casualty peak and 15 days after)


Casualty Occurrence at Level I (3 RCTs)

0

50

100

150

200

250

76 78 80 82 84 86 88 90 92 94 96 98 100 102 104 106

Day

Nu

mb

er

Total

WIA

DNBI

Admissions at Level III (3 RCTs)

0

50

100

150

200

250

76 78 80 82 84 86 88 90 92 94 96 98 100 102 104 106

Day

Nu

mb

er

Total

WIA

DNBI

Med Bn Validation Casualty Stream• MedBn Validation Casualty Stream

– Based on MBCE Casualty Stream from Medical Readiness Review (MRR)– MCO 30 days (15 days prior to casualty peak, 15 days after)– Casualties evenly distributed across areas of operations– Conversion formulas from admissions to casualty occurrences at Level 1 based on OIF-1 data

—Total WIAs = 1.4 * Level 3 WIAs—Total DNBI = 1.7 * Level 3 DNBIs

– MRR DNBI count split 53% Disease, 35% NBI, and 12% Battle Fatigue

* Level I is First Responder



15 days prior 15 days after

91

15 days prior 15 days after

91


Trauma Category WWII Korea VietnamDesert Storm

USMCOIF-1

USMCOIF-2

Amputations 1.8% 1.4% 1.9% 1.5% 3.4% 3.6%

Burns 1.0% 1.0% 1.4% 3.7% 3.0% 4.6%

Intracranial injuries 1.4% 2.3% 1.3% 1.5% 2.6% 3.3%

Crush injuries 0.0% 0.0% 0.0% 3.0% 1.6% 1.0%

Dislocation 0.1% 0.1% 0.5% 0.0% 2.6% 0.8%

Fractures 21.8% 23.0% 16.3% 17.8% 22.1% 33.0%

Sprains/strains 3.1% 2.8% 1.4% 6.7% 3.8% 1.7%

All wounds/single/multiple 63.7% 67.9% 76.5% 56.3% 54.0% 41.8%

Other 7.1% 1.5% 0.7% 9.6% 6.9% 10.1%

Total 100.0% 100.0% 100.00% 100.0% 100.0% 100.0%

Distribution Among WIA Casualties from Major Combat Operations

Will use USMC OIF-1 distribution to determine Patient Condition Codes (PCCs).

Sources: OIF-1 (19 Mar 03 – 30 Apr 03) data are from Surgical Companies, Personnel Casualty Reports, TRAC2ES data.OIF-2 (1 Mar 04 – 30 Apr 05) data are from Joint Patient Tracking Application.


Distribution Among NBI Casualties from Major Combat Operations

Trauma Category WWII Korea VietnamDesert Storm

USMC OIF-1

USMC OIF-2

Amputations 0.8% 1.0% 1.4% 0.0% 1.2% 0.3%

Burns 6.4% 6.8% 6.0% 5.2% 1.1% 6.0%

Concussions 2.1% 0.9% 2.1% 0.0% 3.0% 1.0%

Crushing/contusions 0.5% 11.8% 4.6% n/a 4.1% 1.4%

Dislocations 2.4% n/a 5.1% 8.6% 11.1% 9.0%

Effects of cold 4.8% 15.8% 3.3% n/a 0.0% 0.0

Effects of heat 1.2% 0.9% 7.4% n/a 1.0% 2.3%

Fractures 19.6% 18.2% 20.1% 33.1% 37.2% 45.5%

Sprains/strains 20.3% 17.0% 13.8% 24.3% 26.2% 17.9%

Wounds all types 34.4% 18.3% 29.8% 18.2% 14.1% 12.3%

Other 7.5% 9.3% 6.2% 10.0% 1.0% 4.3%

Total 100.0% 100.0% 100.00% 100.0% 100.0% 100.0%




Distribution Among DIS Casualties from Major Combat Operations

ICD Category Korea VietnamDesert Storm

USMC OIF-1

USMC OIF-2

Infectious/Parasitic 12.2% 29.2% 5.1% 1.0% 2.8%

Neoplasm 1.6% 1.7% 0.4% 0.0% 1.9%

Endocrine 2.2% 0.8% 1.2% 4.9% 2.1%

Mental Disorders 8.0% 6.9% 5.6% 7.8% 9.4%

Nervous System 8.7% 6.0% 6.2% 6.8% 12.8%

Circulatory 3.4% 2.4% 5.9% 7.8% 3.6%

Respiratory 23.7% 6.3% 8.2% 3.9% 2.8%

Digestive 9.5% 8.4% 15.1% 24.3% 16.2%

Genitourinary 5.5% 3.8% 7.5% 12.6% 7.7%

Skin/Subcutaneous 9.2% 11.6% 10.1% 6.8% 6.2%

Musculoskeletal 4.5% 5.1% 23.1% 12.6% 20.7%

Symptoms/ill-defined conditions 11.1% 17.2% 11.5% 11.7% 13.9%

Total 100.0% 100.00% 100.0% 100.0% 100.0%




Med Bn Validation Casualty Stream – Arrival Times

Casualty arrival randomly distributed based on time of day distribution.– Developed from CTR historical data for OIF-1– Battle Fatigue arrival distribution same as NBI

WIA Time of Arrival Distribution

4%2% 2% 2%

6%

13% 13%

16% 15%

12%

8% 7%

0%

5%

10%

15%

20%

25%

30%

12 to 2am

2 to 4am

4 to 6am

6 to 8am

8 to 10am

10 tonoon

noonto 2pm

2 to 4pm

4 to 6pm

6 to 8pm

8 to 10pm

10 to12 am

Time of Day

Per

cen

tag

e

DIS Time of Arrival Distribution

1% 1% 0% 1%

26%25%

6%

21%

8%

5% 4%2%

0%

5%

10%

15%

20%

25%

30%

12 to 2am

2 to 4am

4 to 6am

6 to 8am

8 to 10am

10 tonoon

noonto 2pm

2 to 4pm

4 to 6pm

6 to 8pm

8 to 10pm

10 to12 am

Time of Day

Per

cen

tag

e

NBI Time of Arrival Distribution

1% 2% 2% 2%

20% 21%

8%

17%

9%7% 6% 6%

0%

5%

10%

15%

20%

25%

30%

12 to 2am

2 to 4am

4 to 6am

6 to 8am

8 to 10am

10 tonoon

noonto 2pm

2 to 4pm

4 to 6pm

6 to 8pm

8 to 10pm

10 to12 am

Time of Day

Per

cen

tag

e


TML+ Estimated Casualty Stream

49%

27%

18%

6%

WIA

DIS

NBI

BF

10%

19%

71%

High

Medium

Low

Percentage of Casualties by Type

Casualties by Mortality Risk

219.965.3

35.8

1883.3

0

400

800

1200

1600

2000

Non-Life Threatening Life Threatening

Num

ber

NLT

High

Medium

Low

87%

13%

Percentage of Life Threatening Casualties

Sources: Modeling Dynamic Casualty Mortality Curves in the TML+ planning tool. NHRC Technical Report 04-31.Simulating Dynamic Mortality within the military medical chain of evacuation and treatment. Proceedings of SCS Spring Sim 2006.

50 Replications

50 Replications

50 Replications

Casualty Type

% Mean95th

Percentile Min Max

WIA 49% 1010.8 1065.1 902 1095

DIS 27% 557.5 592.0 504 599

NBI 18% 369.6 394.6 335 398

BF 6% 126.7 142.3 108 149

Total 100% 2088.9 2173.5 1979 2214

Mortality Risk

% Mean95th

Percentile Min Max

NLT 87% 1808.5 1883.3 1715 1915

LT 13% 280.4 307.1 238 317

Total 100% 2088.9 2173.5 1979 2214

NLT Non-Life ThreateningLT Life Threatening

High Probability LT patient dies in 1st hour without any treatment (>=2/3)Medium Probability LT patient dies in 1st hour without any treatment (>=1/3 and < 2/3)Low Probability LT patient dies in 1st hour without any treatment (<1/3)

Mortality Risk

% Mean95th

Percentile Min Max

High 10% 27.7 35.8 18 39

Medium 19% 54.1 65.3 37 71

Low 71% 198.6 219.9 170 221

Total 100% 280.4 307.1 238 317


17.5%

9.1%7.7% 7.0%

4.7% 4.4%2.7% 2.3% 2.2% 2.0% 1.8% 1.7% 1.7% 1.4% 1.4% 1.3% 1.2% 0.7% 0.4% 0.2% 0.2%

28.2%

0%

5%

10%

15%

20%

25%

30%O

pe

nW

ou

nd

s

Fra

ctu

res

Sp

rain

s &

Str

ain

s

Me

nta

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iso

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Dig

est

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Ge

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uri

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Cir

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Ski

n

Dis

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s

Am

pu

tatio

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Infe

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us

Mis

c

Bu

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Re

spir

ato

ry

Cru

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juri

es

Intr

acr

an

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Inju

rie

s MIW

He

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ng

Ne

op

lasm

Vis

ua

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Bite

s &

Stin

gs

He

at

PC Category

Pe

rce

nta

ge

TML+ Estimated Casualty Stream (continued)

Top 10 Categories

Percentage of Casualties by PC Category

Category % Mean95th

Percentile Min Max

Open Wounds 28.2% 589.0 627.4 541 657Fractures 17.5% 365.8 399.3 313 411Sprains & Strains 9.1% 190.5 213.1 162 218Mental Disorders 7.7% 159.9 179.2 137 191Digestive 7.0% 146.7 166.2 118 167Genitourinary 4.7% 99.0 111.8 85 118Circulatory 4.4% 92.9 109.1 76 119Skin 2.7% 57.3 72.9 41 84Dislocations 2.3% 48.8 59.8 37 65Amputations 2.2% 46.8 59.3 34 65

… … … … … …Total 100% 2173.5 1979 2214

50 Replications

Categories based on ICD-9 classifications and sub-classifications


Results

• Mortality• Casualty Flow Statistics

Summary from Casualty Stream Slides

• Number of casualties from the MCO DPS

• Calculation of Level 1 occurrences from OIF1 data

• Patient condition code distribution from OIF1 data

• Casualty arrival times from OIF1 data


Medical System Effectiveness – Mortality

The OAG COA and Current Med Bn are statistically equivalent for mortality. Deploying the FRSSs with the BAS saves 6% more lives.

Metrics

MCO WIAs

OAG COA Current Med BnOAG COA

Night Air Evac

OAG COABAS to STP/FRSS

DOWPercent (Mean / 95th) 4.6% / 5.9% 4.6% / 5.8% 5.9% / 7.4% 4.4% / 5.4%

Values (Mean / 95th) 47 / 60 47 / 59 60 / 75 44 / 55

Total WIAs Values (Mean / 95th) 1008 / 1066 1008 / 1066 1004 / 1065 1012 / 1067

Metrics

MCO Casualties

OAG COA Current Med BnOAG COA

Night Air Evac

OAG COABAS to STP/FRSS

% DOW Percent (Mean / 95th) 2.4% / 3.0% 2.4% / 3.0% 3.1% / 3.9% 2.3% / 2.8%

Total Casualties

Values (Mean / 95th) 2086 / 2165 2086 / 2165 2083 / 2158 2089 / 2174

The 95th percentile provides the decision maker an extra measure of risk mitigation.

50 Replications

50 Replications


RTDs/DNBI

Casualty Flow Statistics – OAG COA

TheaterHospital

POI

Med Sec (H&S)

88 Pats88 ERC Pats100 Pats

1392 Pats

Treats 748 PatsDOW 0.4RTD 180Evac 568Max Holding 9

632 Pats

Specialty Care

Surgical

Mental Health

Conclusions• Medical personnel and equipment are adequate to handle all patients for all MTFs.• Holding is adequate for all MTFs. • There is minimal waiting at the FRSS and Med Section, and no queuing at the other MTFs. • Total ERC missions is 163 with an average of 1 patient per mission. • Max number of ERC assets at any one time is 9.• Maximum number of ERC assets required in a 24 hr period is 9 at one peak day.

Adms 1361 PatsDOW 8RTD TBDEvac TBDMax Holding TBD

Treats 100 PatsDOW 11Evac 88Max Holding 2

Treats 1392 PatsDOW 13RTD 317Evac 1062Max Holding 5

112 Pats

281 Pats

429 Pats69 ERC Pats

567 Pats6 ERC Pats

50 ReplicationsERC assets are for post-surgical patients who require a ventilator.

Values displayed are mean numbers.

CLB(DS)

CLR(GS)

CLC

BAS – 9x

FRSS/STP – 3x

FSC – 3x


Conclusion

• Given the assumptions, the OAG COA to restructure the MedBn has the medical capability and capacity to support a “MEF in the assault” in the most demanding DPS MCO scenario.

• The OAG COA to restructure the MedBn provides a decrease in the DOWs (6%) compared to the current MedBn in the DPS MCO scenario.

• With tactical evacuation limited to 12 hours per day, the OAG COA has the medical capability and capacity to support a “MEF in the assault” in the most demanding DPS MCO scenario.

• The OAG COA to restructure the MedBn provides increased flexibility to task organize the direct support and general support capability sets.

• Since the TML+ modeling was based on a DPS MCO future scenario, you cannot conclude the restructured MedBn has the medical capability or capacity to support a “MEF in the assault” in the current MCO OPLANs

• Since the TML+ modeling was based on a MCO scenario, you cannot conclude the restructured MedBn has the medical capability or capacity to support other types of operations across the range of military operations

Documents

Medical Battalion Enhancement Initiative using NHRC Tools