As technology evolves, so too must the U.S. military — not only as a means of adaptation, but also in order to absorb the impact of what seem to be almost daily advancements. By that measure, so too must the U.S. Army Medical Research and Development Command's Medical Simulation and Information Sciences Research Program evolve, as it seeks to harness those same capabilities for the ultimate benefit of the U.S. Soldier. On April 6, during a live demonstration of the new PerSim virtual reality device before assembled MSISRP staff, the synergy of technological advancement and medical training took one more step toward its likely end goal.

"Portable augmented reality is a priority," said Dr. Kevin King, the CEO of PerSim developer MedCognition, Inc., who led the demonstration — one which, notably, featured the digital creation of a number of virtual patients seeking treatment for various injuries. "With these tools, there is almost unlimited potential."

According to both federal researchers and corporate partners, portable augmented reality (or, "AR" for short) is, in large part, how the military medical apparatus plans to train Soldiers for future conflicts. In fact, it is likely that in the next several years, the days of gathering a large group of people in a single classroom setting to teach any number of medical skills will be — much like the rotary telephone in this age of digital communication — a thing of the past.

"The long term goal of all of our efforts is the put an end to the need to send Service Members to another location and to be able to provide the training anywhere and anytime," says MSISRP Senior Program Manager Frank Karluk. "In the end, if training can be accomplished in this way during future wars, we will always have a fully trained and ready medical force without the need for just-in-time type of training just prior to a deployment."

In the case of the PerSim — or, as the project is known to MSISRP staff, the "Realistic Portable and Deployable Medical Patient Simulator Using Augmented Reality" — the user dons a pair of Microsoft HoloLens goggles to enter a virtual environment whereby they can interact with (and then treat) a variety of sick and injured patients. Notably, those virtual patients are created by animating a live human model and then "wrapping" that model in a three-dimensional "skin" which can then be adjusted for a number variables depending on what exact malady or injury the patient is ostensibly suffering from at the time. As of now, the computer program can support everything from the application of tourniquets to shrapnel injuries to aiding patients with sucking chest wounds. The entire experience is controlled by an instructor via a tablet computer.

"It's difficult to understand what sick looks like," says King — an eleven-year Army veteran himself and a practicing emergency room physician — referencing the tool's ability to change the aforementioned "skin" to portray a number of different treatment scenarios. "There are important differences."

Late last summer, a dozen Soldiers and Army Reservists participated in a version of the U.S. Army Combat Lifesaver Course at Fort Indiantown Gap by using the AUGMED "extended reality" training tool developed by MSISRP partner Design Interactive, Inc. Much like the PerSim, the AUGMED is a medical simulation tool designed to prepare Soldiers for the application of medical interventions in stressful or unpredictable situations. Both tools use the aforementioned HoloLens goggles and a tablet computer, but to different ends and for different purposes. Both projects stem from an initial funding push from just a few years ago, when the possibilities of medical simulation training were still very much unknown. In the end, both the PerSim and the AUGMED became leaders within the MSISRP stable due to their advanced technical features.

Says Karluk of the interoperability of the two devices and their eventual application to Soldiers, "In short, AUGMED provides the foundational training whereas PerSim builds upon that substantial and sizable infrastructure."

Regardless of new technology, there will no doubt always be a need for just-in-time training — a lynchpin of the military's medical infrastructure. However, it is important to note that investments in so-called "augmented reality" tools will likely lessen the burden of a large medical training gap that has to be handled along with operational training requirements — the latter of which has the higher priority.

Says Darrin Frye, MSISRP portfolio manager, "It is of critical importance that we provide our medical and non-medical military the opportunity to practice casualty care using realistic synthetic combat trauma scenarios, and provide optimal learning experiences in a cost-effective, everywhere, anytime, immersive fashion."

There is still a ways to go, however, before both products reach the finish line. The team at Design Interactive, Inc. is still ironing out the details with the AUGMED tool (using last year's meeting at FTIG as a large-scale beta test of sorts). Beyond that, both the AUGMED and the PerSim are soon slated to be turned over the Defense Health Agency's Program Manager Medical Simulation and Training office, which will arrange for any additional development and funding before the products wind up in the hands of end users. It is likely that in the next year, the outlook for both products will look markedly different.

"[These] products will give commanders the ability to have additional time to train Warfighters in all areas required to accomplish the mission," says Karluk. "While this [effort] focuses on the medical aspect, the technology can and surely will be used in all areas. The uses of the technology are only limited by the imagination."