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US Army Medical Modernization Strategy(AMMS) to counter future medical threats through disruptive technologies

As the Army charts a course to modernize its force by 2035 with a focus on multi-domain operations, the service is also looking to fundamentally transform its medical capabilities to take advantage of and move at the pace of technological advancements. The Army must modernize its medical formations and capabilities simultaneously during medical reform efforts to meet Army and Joint Force capability and readiness requirements for 2035.

Army Futures Command in July 2022 published the Army Medical Modernization Strategy to guide the service’s transformation into a “semi-autonomous, integrated, networked capability” that will support the future of conflict envisioned in its 2019 Army Modernization Strategy.

The future envisioned in the strategy is one where Joint All-Domain Command and Control (JADC2) is pervasive and the formations, commanders and others operating in disparate warfare domains are widely connected. And not only are networks powering the widespread sharing of data to support things like advanced analytics and artificial intelligence for better situational awareness, but the Army also expects by then it will have comprehensively fielded autonomous systems and vehicles and other emerging capabilities, like the Integrated Visual Augmentation System (IVAS) platform, to aid in medical care.

The AHS must have the flexibility and capability to quickly adapt to novel injuries and threats in the future operating environment, the document notes. In anticipation of this future state, as well as the corresponding rapid evolution of medical threats, the Army says it must look beyond the 2030 time frame and begin to invest in the research of disruptive technologies that drastically change how it will operate, and treatment modalities.

Failure to modernize the AHS could result in increased mortality and suffering in future battlefields, greatly reducing operational freedom of maneuver and early culmination across the range of military operations. A lack of focus on the medical readiness and optimized human performance of our Soldiers could result in an Army ill-equipped to handle the physical and cognitive stresses of multi-domain operations. Failure to underpin medical modernization efforts with capabilities that allow for continued operations in degraded or loss network/
cyberspace environments presents risk to mission and risk to force. Finally, the potential for rapid accumulation of casualties on the battlefield immediately stressing the capability and capacity of organic medical assets will likely have negative effects on the Nation’s will to fight.

The Army Health System’s (AHS) current acquisition and modernization processes are antiquated and unable to keep pace with the current threat environment, Lt. Gen. James M. Richardson, acting commanding general of Army Futures Command, says in an introductory message for the strategy.

“Since the last transformation with Air Land Battle over 40 years ago, Army medicine has continuously placed new technology on top of existing doctrine,” Richardson says. “This is no longer adequate. Modernization must be baked in, not bolted on; evolving doctrine to the pace of proven technologies and treatment modalities.”

The 22-page document is meant to guide the Army’s requirements, priorities and direction of medical modernization efforts for 2035 and beyond. A key assumption in the Army’s development of the strategy, among others, is that there will be vast developments over the next decade-plus in medical and non-medical technologies that will affect the Army’s future medical capabilities.

The strategy explains that the Army aims to transform its health system “through 2035 to be a more adaptable medical force capable of harnessing, integrating, and utilizing future technology on the battlefield to save Soldiers.”

“By 2035, the [Army Health System] will transform its organizations into modernized, tailorable and scalable [multi-domain operations, or MDO]-capable formations that are strategically positioned and able to leverage national-level capabilities and authorities,” says the strategy. “The AHS MDO force will combine tailored integrated formations of networked manned and unmanned platforms, sustainment, communications, intelligence, and protection capabilities from the individual to theater.”

Cohesive integration of AHS systems into battlefield networks through a system of systems approach will require increased coordination with diverse battlefield governance. Given the Joint nature of warfare, common data standards and message formats will inform the development of a continuous, seamless link between administrative and tactical systems through the continuum of DoD, VA, civilian hospitals, and coalition partners.

“The ability to establish ‘care webs’ that allow for vertical, horizontal, and digital synchronization and integration for the care of the wounded, ill and injured will be critical to ensure the AHS provides the quickest, most efficient and appropriate care to our soldiers on the battlefield and beyond,” the strategy says.

AHS will also become predictive in nature, leveraging AI-enabled decision making tools for patient regulating to observe casualty flows, monitor resources available, and make evacuation recommendations to retain the greatest combat power far-forward. Finally, AHS will enable the operational force through proactive Force Health Protection monitoring, detection and action to minimize Disease, Non-Battle Injuries (DNBI) – the number one historical degrader of combat power.

While humans are at the center of the strategy, there is a great deal of emphasis on human-machine teaming. Medical formations will “leverage advanced robotics, AI, and optionally-manned systems with humans in- or on the-loop to enable decision making to inform advanced clinical care and prioritize evacuation,” the document says.

“These technologically advanced systems will move casualties to the medic, aid the medic in treatment and movement of casualties, or serve as an evacuation platform with autonomous or human-provided care.” Unmanned aerial systems and unmanned ground vehicles will autonomously transport casualties, execute medical resupply, and conduct applicable operational public health tasks. Medical resupply, medical evacuation, and casualty evacuation will leverage autonomous and semi-autonomous vehicle technology.

The Army must continue to pursue and/or develop medical products and modernize equipment that reduce the size, weight, cube, power requirements and cost per Soldier compared to 2020. Some of these technological breakthroughs could include Dehydrated IV bags/medical-grade water created at the point of-need, airway management, and advanced blood and blood products like shelf stable synthetic blood. Additionally, flexibility
in acquisition and development processes will enhance our ability to identify and treat novel injuries generated by new threat technologies such as directed energy or novel DNBI vectors.

Lastly, a critical piece of medical equipment on the battlefield is the first aid kit issued to every Soldier. To increase the chance of survival of every Soldier in the “Platinum 10” minutes, the Army will have to transform the individual first aid kit to increase the medical capability and capacity of each individual Soldier

It calls for the AHS to prioritize, develop and capitalize on rapid advancements in medical innovation and disruptive technologies. The strategy points to six “disruptive research priority areas” that it will invest in through 2035: human intelligence, bio and human enhancement technology (BHET), data-AI-biotechnology, synthetic biology, additive manufacturing, and quantum technology.

Humanistic Intelligence. Advancements in AI/ML will require enhanced research to explore humanistic intelligence. Humanistic intelligence is the seamless integration of psycho-social-techno systems supporting enhanced human-machine teaming and synergistic behaviors.

The Army will leverage and develop new technologies such as AI and semiautonomous systems to expand the capability and capacity of Soldiers on the battlefield. This will be accomplished through augmented reality care and telehealth-enabled mentorship through systems like the Integrated Visual Augmentation Systems (IVAS) platform. This will further enable AHS capabilities to extend and maintain life in a prolonged care setting where resources will be scarce, and modalities will change based on the extended periods of care.

Through the Soldier Lethality initiatives, the IVAS will transform patient care at night, and allow tie-ins to digital health to allow for AI/Human Assist and talk-through of complex treatment protocols. Enhanced technology and advanced networking capabilities will enable rapid treatment followed by unmanned or semi-autonomous CASEVAC/MEDEVAC to the appropriate healthcare node. Mobile, agile advanced treatment on the move,
aided by predictive technology for informing medical functions (MEDLOG, Public Health/Force Health Protection, evacuation) will dramatically reduce the incidence of preventable death on the battlefield.

Bio and Human Enhancement Technologies (BHET). Biotechnologies use organisms, tissues, cells or molecular
components derived from living things, to act on living things; or, act by intervening in the workings of cells or the molecular components of cells, including their genetic material.

These technologies span the spectrum of biological sciences including:
• Genetic manipulation [e.g., Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) technology – a simple yet powerful tool for editing genomes]. This allows researchers to easily alter DNA sequences to develop novel pathogens or medical countermeasures
• Manufacturing methods exploiting biological processes
• Human enhancement via integrated robotics (e.g., exoskeletons or replacement parts)
• Neural interfaces; enhanced vision; socio-technical symbiosis with AI and autonomous systems
• Pharmacological approaches to cognitive and physical enhancement
• Increased virtualization of the socio-cognitive environment supporting the development of new social, information and organizational structures
• New bio-sensors and bio-informatics, which will increase our understanding of socio-cognitive, physiological, economic and neurological behaviors to improve operational performance and resilience, as well as increase the effectiveness of nonkinetic targeting.

Data-AI-Biotechnology. Data-AI-Biotechnology is AI, in-concert with Big Data and Synthetic Biology. It will contribute to the design of new drugs, purposeful genetic modifications, direct manipulation of biochemical reactions, and living sensors.

Data AI-Biotechnology can:
• Investigate new ways to help the force through quality of life, behavioral health, readiness, resilience, and prevention of training injuries.
• Measure psychological resilience as an indicator to performance/survivability in combat.
• Develop transport systems for seriously injured people using AI.
Synthetic biology. This is a wide ranging area that in future iterations of aligning capability gaps to S&T will provide more focus. Examples include synthetic blood and/or blood products, novel burn treatments, etc. Research in this area provides an arsenal of new tools to gain medical advantages across the spectrum of care.

Additive manufacturing is critical for the generation of healthcare delivery and biomedical applications. Battlefield medicine seeks to address this capability gap through two integrated research thrusts such as pharmacy-on-demand and biologically-derived medicines-on-demand.
Quantum technology and computing could revolutionize the detection and treatment of chronic and infectious diseases with significant opportunities for military medicine application across the spectrum of care. Speed kills on the battlefield and quantum computing will provide leaders the ability to make informed decisions faster.

Materiel development will assist in achieving the goals of medical readiness in human performance optimization, prevention of illness and injury, psychological health and infectious disease prevention. Optimizing human performance will improve performance in extreme environments. Prevention of illness and injury will reduce
musculoskeletal injury while developing vaccines, prophylactic drugs, and health sensors. Prevention also must include maximizing definitive pre-deployment dental treatment.

Rapid diagnostics will facilitate return to duty, prevention/treatment of combat wound infections, pain management, blood products, burn care, and neurotrauma. Semi-autonomous and smart sensing technologies will aid in the development of airway management solutions that optimize outcomes of patients with battlefield trauma.

AHS will also seek to enhance knowledge and development of intellectual skills of the Enhanced Medic and care capability forward through the integration of virtual augmentation, telemedicine, artificial intelligence, and robotics.

“These areas directly nest with the [strategy] and address both required capabilities and capability gaps,” the document says. “We must realign and focus resources in these areas to ensure that the AHS will keep pace with operational advancements and expand treatment modalities to support the future force.”


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