Medical Support for the Next Generation of Military Operations

As more and more American military forces are deployed to remote and dangerous locations around the world, caring for sick and wounded warfighters while they await medical evacuation has become an increasingly urgent priority.

In March, the Johns Hopkins Applied Physics Laboratory (APL), in Laurel, Maryland, hosted an Association of Military Surgeons of the United States regional conference to address the medical demands of the future battlefield, for which prolonged field care — when combat medics must care for a sick or wounded patient for an extended period of time in areas with few medical resources — is expected.

In “Prolonged Field Care Research Approach and Its Relevance to Civilian Medicine,” published Sept. 28 in the journal Military Medicine, APL’s Adam Cohen and Sarah Herman join several co-authors to summarize the major concepts discussed at the conference and propose a more effective approach to prolonged field care research.

Conference organizers aimed to highlight areas where innovation could address gaps in prolonged field care, especially when treating combat-related injuries and illnesses. They looked at contingency planning for medic incapacitation, medical evacuation planning and rehearsals, knowledge of in-country medical assets, and shortfalls in equipment, such as oxygen concentrators, monitors, systems to distribute blood or intravenous fluids, field laboratories and ultrasound devices.

Several sessions focused on medical technology, but the authors assert that other components will be needed to optimize prolonged field care, “including doctrine, organization, training, materiel, leadership, education, personnel and facilities.”

“The exceedingly daunting medical challenges of the future battlefield, on land and at sea, must be addressed to maintain an effective force able to compete with modern highly capable adversaries,” the authors conclude. “Since the human element, and its health, will allow future mission success, we propose here an approach to making soldier health-related research most impactful.”

They drew parallels to prolonged field care investments and advancements that apply beyond the combat environment.

“Although much of U.S. civilian medicine occurs in well-resourced settings, much does not,” they write. “Further, with rapid advancements in digital and mobile health, in concert with other aspects of health technology, medicine will increasingly move toward patients in their own settings, progressively outside hospitals and clinics. Such advancements offer patients, families and available providers more capability to manage health.”

As an example, the authors discuss how the coronavirus pandemic has produced scenarios in which patients and clinicians require support that cannot be delivered within the current health care paradigm. The situation has demanded new methods and modes of communication to bring capabilities to the “forward environment” — that is, to the patient.

“The problems of prolonged field care in the military are analogous to problems across civilian health care — both domains need care to be delivered closer to the patient without traditional resources,” said Cohen, the Army Medical Response program manager for APL’s National Health Mission Area. “Identifying research areas relevant across domains will allow us to focus our strategy, funding and resources toward an increasingly digital future.”

APL is known for its systems engineering approach to solving complex problems, and Herman said that’s exactly how the Lab is confronting the challenge of prolonged field care. “One of the key elements of systems engineering is making a complex system more tractable by segmenting parts of a larger problem,” she said. “Applying this approach to prolonged field care allows us to take a complex issue and break it down into smaller, more feasible steps.”