Digital Wargames to Enhance Military Medical Evacuation Decision-Making

Medical evacuation is one of the United States Army's most storied and critical mission sets, responsible for efficiently and expediently evacuating the battlefield ill and injured. Medical evacuation planning involves designing a robust network of medical platforms and facilities capable of moving and treating large numbers of casualties. Until now, there has not been a medium to simulate these networks in a classroom setting and evaluate both offline planning and online decision-making performance. This work describes the Medical Evacuation Wargaming Initiative (MEWI), a three-dimensional multiplayer simulation developed in Unity that replicates battlefield constraints and uncertainties. MEWI accurately models patient interactions at casualty collection points, ambulance exchange points, medical treatment facilities, and evacuation platforms. Two operational scenarios are introduced: an amphibious island assault in the Pacific and a Eurasian conflict across a sprawling road and river network. These scenarios pit students against the clock to save as many casualties as possible while adhering to doctrinal lessons learned during didactic training. We visualize performance data collected from two iterations of the MEWI Pacific scenario executed in the United States Army's Medical Evacuation Doctrine Course. We consider post-wargame Likert survey data from student participants and external observer notes to identify key planning decision points, document medical evacuation lessons learned, and quantify general utility. Results indicate that MEWI participation substantially improves uptake of medical evacuation lessons learned and co-operative decision-making. MEWI is a substantial step forward in the field of high-fidelity training tools for medical education, and our study findings offer critical insights into improving medical evacuation education and operations across the joint force.

Semi-Markovian Planning to Coordinate Aerial and Maritime Medical Evacuation Platforms

The transfer of patients between two aircraft using an underway watercraft increases medical evacuation reach and flexibility in maritime environments. The selection of any one of multiple underway watercraft for patient exchange is complicated by participating aircraft utilization history and a participating watercraft position and velocity. The selection problem is modeled as a semi-Markov decision process with an action space including both fixed land and moving watercraft exchange points. Monte Carlo tree search with root parallelization is used to select optimal exchange points and determine aircraft dispatch times. Model parameters are varied in simulation to identify representative scenarios where watercraft exchange points reduce incident response times. We find that an optimal policy with watercraft exchange points outperforms an optimal policy without watercraft exchange points and a greedy policy by 35% and 40%, respectively. In partnership with the United States Army, we deploy for the first time the watercraft exchange point by executing a mock patient transfer with a manikin between two HH-60M medical evacuation helicopters and an underway Army Logistic Support Vessel south of the Hawaiian island of Oahu. Both helicopters were dispatched in accordance with our optimized decision strategy.