Medical (support) personnel often have limited access to extensive Prolonged Field Care (PFC) training due to a wide variety of factors. Studies to evaluate hospital preparedness have shown that good response plans can be developed for complex medical training scenarios (such as radiation exposure response), and that medical providers can be trained to follow these plans if the given training is realistic in its delivery.

Effective military medical training and readiness for PFC require decision training, performance of individual medical procedures and excellent teamwork skills in austere conditions of fast changing battlefield conditions of large-scale symmetrical conflict or natural disaster. Military medical training based on both computer-generated, hybrid and physical teaching materials creates advantage to development of cost-effective training courses for the military and civilian medical (support) personnel population and paramedics.

European Union has already started its efforts for developing military medics’ innovative training solutions, focused on Field Care and Role 1 scenarios. In order to take full advantage of military medics training simulation, additional operational scenarios and functionalities in a virtual reality environment have to be developed and integrated into a network of federated toolbox which provides interconnection and joint access to simulation systems that are supporting different but mutually complementing simulation methods like mixed, augmented, hybrid, part task trainers, logistics, manikins and medical equipment, but currently are unevenly distributed in the European market for the medical personnel and paramedic training.

Specific objective

The topic aims to address the current operational challenges facing military medical personnel in the EU Member States (MS) and EDF Associated Countries, including in and out of areas of deployment.

Scope:

Proposals must address the development of a prototyped solution for a federation of available and enhanced medical simulation systems that support military medical curriculum and are connected to a (at best AI-based) feedback system (that may include real medical and health-data as benchmarking) that enables to see integrated picture of all training related information.

Proposals must therefore address:

• Medical Training Modules: The Medical Training Modules are designed to impart knowledge in military medicine to trainees. At present, the guidelines are anchored in Tactical Combat Casualty Care, serving as vital training curricula for both medical and non-medical personnel in civilian and military contexts. Looking ahead to future battlefield situations, insights from Ukraine underscore the importance of updating existing guidelines with a Prolonged Casualty Care environments. This adaptation is essential in preparing Europeans to confront diverse battlefield scenarios. Training modules can provide realistic, scenario-based learning experiences covering trauma, infections, and radiation exposure. They extend across various environments, including battlefield tranches, vehicles, and aircraft, offering comprehensive multi-modal and interdisciplinary training. The integration of virtual and mixed technologies elevates the delivery of educational content and learning retention. The overarching focus is effective communication, coordination, and preparedness for non-medical professionals in dynamic settings of the battlefield.
• Supporting elements enabling Military Medical Training Multi-Modular Simulation Federated network: The Military Medical Training Multi-Modular Simulation Federated network employs advanced technologies to create a comprehensive and realistic training environment. This includes cloud-based solutions for simultaneous management of large casualties, integration of digital computer simulated casualties for dynamic scenarios, physical simulated patients for hands-on training, and physical manikin systems replicating human responses. Crucially, seamless data exchange between computer-generated simulations and physical systems ensures a cohesive training experience. The interconnected federated network allows collaborative exercises across different locations, with real-time monitoring and feedback enhancing the learning process. Scalability, customisation, and integration of virtual, mixed, and augmented reality technologies contribute to an immersive and adaptable training platform for military non-medical and medical professionals.
• Integration with Real World: The integration of 5G technology into medical education signifies a transformative approach for European Union medical training centres. This integration facilitates the delivery of educational content with high-speed, low-latency connectivity, enabling real-time and immersive learning experiences. Learning analytics tools add a data-driven dimension, offering insights into individual and collective learning patterns. Augmented reality serves as a powerful teaching aid, particularly for Definitive Surgical Trauma Care, enhancing trainees' understanding through virtual overlays in the real-world environment. This comprehensive integration fosters scalable and distributed training solutions, promotes remote collaboration, and ensures standardisation and quality assurance across diverse training centres. The result is a cutting-edge educational paradigm that leverages advanced technologies to elevate the efficiency, accessibility, and effectiveness of medical training throughout the European Union.

In addition, the proposals must address concept development for interconnectivity of Military Medical VR Training Simulation Modules to a Battle Management System’s simulation, including interface to a MS Battle Management System’s simulation.

Moreover, proposals should address how real data and AI can be used to create an as realistic as possible environment facing medical, medical logistic and C2 challenges and provide suggestions to improve real life scenarios.

In addition, proposals may address the analysis of trainees’ stress levels and hesitations and provides feedback.

Types of activities

The following table lists the types of activities which are eligible for this topic, and whether they are mandatory or optional (see Article 10(3) EDF Regulation):

Accordingly, the proposals must cover at least the following tasks as part of mandatory activities:

1. Medical Training Modules

• Studies:
• Research analyse and define the existing military medical curriculum, focusing on identifying key areas for potential improvements and adaptations to meet the requirements of European Member States. An updated military medical curriculum framework, incorporating interactive and engaging content elements that reflect the diverse training needs and scenarios of EU Member States and EDF Associated Countries.
• Review and assess existing MEDEVAC protocols and procedures, identifying areas for enhancement and integration into the virtual simulation environment, with a specific focus on logistics and casualty flow simulation medical regulating and MedC2.
• Explore current practices and methodologies in Prolonged Field Care (PFC), and prolonged casualty care, focusing on understanding the necessary sustainment skills and training requirements for improving overall preparedness for armed forces medics and paramedics. Tactical Combat Casualty Care must be core of the training module.
• Investigate and analyse various CBRNE scenarios, with a specific emphasis on burn injuries related to radiation exposure, aiming to develop comprehensive training modules that address recognition, decontamination, and effective trauma treatment strategies.
• Design:
• Develop a scalable and dynamic simulation model for MEDEVAC scenarios (with a focus on tactical MEDEVAC manoeuvre elements), incorporating operational environment complexity logistical complexities and casualty flow dynamics to provide an immersive and realistic training experience for military medical personnel.
• Design an integrated Prolonged Field Care (PFC) and Prolonged casualty care, based on the skills and equipment of the medical (support) personnel module within the virtual reality training platform, focusing on the implementation of advanced medical procedures and treatments beyond conventional planning timeframes, emphasising critical decision-making and response strategies.
• Create immersive and detailed CBRNE training simulations, incorporating lifelike scenarios and interactive modules that simulate various aspects radiological incidents, emphasising comprehensive training in recognition, decontamination, and effective treatment protocols.
• Prototyping:
• Develop a functional prototype of the MEDEVAC simulation model (with a focus on tactical MEDEVAC manoeuvre elements), testing its capabilities in simulating realistic logistical and casualty flow scenarios, and validating its effectiveness in providing an immersive training experience for military medical personnel. (expected to reach TRL 7)
• Create a prototype of the Prolonged Field Care (PFC) and prolonged casualty care module within the virtual reality training platform, testing and validating advanced medical procedures and treatments beyond conventional planning timeframes, and assessing its effectiveness in improving critical decision-making and response strategies. (expected to reach TRL 7)
• Build interactive prototypes of the CBRNE training simulation, testing lifelike scenario and interactive module that simulate various aspects of radiological incident, and assessing the effectiveness of the training in recognition, decontamination, and effective treatment protocols. (expected to reach TRL 7)
• Testing:
• Perform rigorous testing of the military medical curriculum framework, assessing its effectiveness in addressing the diverse training needs and requirements of European Member States, and soliciting feedback from key stakeholders for further improvements.
• Test the MEDEVAC simulation model in simulated scenarios (with a focus on tactical MEDEVAC manoeuvre elements), assessing its ability to accurately simulate logistical and casualty flow dynamics, and soliciting feedback from military medical personnel for further enhancements and adjustments.
• Perform comprehensive testing of the Prolonged Field Care (PFC) module within the virtual reality training platform, evaluating its effectiveness in simulating advanced medical procedures, treatments and therefore also the usage of personal and/or vehicle specific medical equipment beyond conventional planning timeframes, and gathering feedback from trainees for further refinements.
• Conduct rigorous testing of the CBRNE training simulation, assessing their effectiveness in simulating realistic radiological incident, and soliciting feedback from trainees to ensure comprehensive training in recognition, decontamination, and effective treatment protocols.

1. Supporting elements enabling Military Medical Training Multi-Modular Simulation Federated network:

• Studies:
• Conduct a comprehensive literature review and analysis of the current state of Military Medical Training Multi-Modular Simulation Federated networks and associated technologies.
• Study the integration possibilities and challenges related to the exchange of data between computer-generated, physical manikin systems and medical equipment, emphasising the development of open standards for seamless data transfer and analysis.
• Research cloud-based solutions for managing large quantities of casualties simultaneously and the combination of digital computer simulated casualties, physical simulated patients and physical manikin systems, with a focus on scalability, efficiency, and resource optimisation within a simulated training environment.
• Design:
• Develop a detailed blueprint and architectural plan for the implementation of the Military Medical Training Multi-Modular Simulation Federated network, outlining the specific technical components and their interconnections.
• Design an integrated data exchange system between computer-generated and physical manikin systems, and physical simulated casualties (with a digital device to simulate a casualty and thereby visible in the trainer) focusing on the development of standardised protocols and interfaces to facilitate seamless data transfer and interoperability between different simulation platforms and in addition to medical equipment.
• Design the architecture of a cloud-based infrastructure for handling large quantities of casualties simultaneously, ensuring efficient resource allocation, data management, and communication protocols for seamless coordination and collaboration among various training centres and facilities.
• Prototyping:
• Develop an initial prototype of the Military Medical Training Multi-Modular Simulation Federated network, integrating essential components and functionalities based on the design specifications and architectural plan (expected to reach TRL 6).
• Construct a prototype of the data exchange system between computer-generated and physical manikin systems, testing its compatibility and effectiveness in facilitating seamless data transfer and interoperability between different simulation platforms (expected to reach TRL 7).
• Develop a functional prototype of the cloud-based infrastructure for managing large quantities of casualties simultaneously, testing its efficiency in resource allocation, data management, and communication protocols for seamless coordination and collaboration among various training centres and facilities (expected to reach TRL 5).
• Testing:
• Conduct extensive testing of the streaming software solution, evaluating its compatibility with 5G technology, and assessing its efficiency in delivering seamless and high-quality data transmission across various training locations and facilities within the European Union.
• Test the cloud-based infrastructure for managing large quantities of casualties simultaneously, evaluating its efficiency in resource allocation, data management, and communication protocols, and soliciting feedback from training centre administrators for further improvements.
• Conduct comprehensive system testing of the Military Medical Training Multi-Modular Simulation Federated network, evaluating its performance, scalability, and interoperability across various simulated training environments and scenarios.

1. Integration with Real World:

• Studies:
• Investigate and evaluate various learning analytics tools and systems, considering their applicability and effectiveness in tracking individual training progress and competency within the simulated environment.
• Study the capabilities and limitations of 5G technology, particularly in relation to its potential integration for scalable and distributed training solutions across the European Union.
• Investigate the current landscape of Augmented Reality surgical simulators and their applicability in providing training to different surgical capability levels (focusing on (r)DCS at Role 2 level, additional up to Role 4), focusing on the enhancement of surgical decision-making skills and techniques based on the specific guidelines.
• Design:
• Design the architecture of a secure and efficient streaming software solution, leveraging 5G technology to enable seamless and high-quality data transmission across various training locations and facilities within the European Union.
• Create a robust and user-friendly Learning Analytics Tool interface, integrating advanced tracking and monitoring features to provide real-time feedback and comprehensive data analysis capabilities for training administrators and instructors, but also the learning loop to use these data to enhance and/or simplify protocols.
• Develop an augmented reality surgical simulation environment tailored to different surgical capability levels (focusing on (r)DCS at Role 2 level, additional up to Role 4) training, incorporating realistic surgical scenarios and procedures based on specific guidelines, emphasising hands-on training and decision-making skills for complex medical interventions.
• Prototyping:
• Develop a prototype version of the streaming software solution, ensuring compatibility with 5G technology and validating its ability to deliver seamless and high-quality data transmission across various training locations and facilities within the European Union (expected to reach TRL 5).
• Build a functional prototype of the Learning Analytics Tool interface, incorporating key tracking and monitoring features to allow for real-time data analysis and visualisation, enabling comprehensive insights for training administrators and instructors (expected to reach TRL 7).
• Build a prototype of the augmented reality surgical simulation environment for training at different surgical capability levels (focusing on (r)DCS at Role 2 level, additional up to Role 4), testing and validating its effectiveness in providing hands-on training and decision-making skills for complex medical interventions based on specific guidelines (expected to reach TRL 6).
• Testing:
• Execute thorough testing of the Learning Analytics Tool interface, validating its tracking and monitoring capabilities, and ensuring its seamless integration with the training platform to provide real-time data analysis and comprehensive insights for training administrators and instructors.
• Perform thorough testing of the data exchange system between computer-generated and physical manikin systems, assessing its compatibility and effectiveness in facilitating seamless data transfer and interoperability between different simulation platforms, and gathering feedback from system administrators and users for further enhancements.
• Conduct comprehensive testing of the augmented reality surgical simulation environment for training at different surgical capability levels (focusing on (r)DCS at Role 2 level, additional up to Role 4), evaluating its effectiveness in providing hands-on training and decision-making skills for complex medical interventions based on the specific guidelines, and gathering feedback from medical professionals for further refinements and adjustments.

In addition, proposals must address the following cross-cutting design activity:

• Design a concept for interconnectivity of Military Medical VR Training Simulation Modules to a Battle Management System’s simulation, including interface to a MS or EDF Associated Countries Battle Management System’s simulation.

Proposals may also address the following cross-cutting activities:

• Study and Design a software decision support system elements, geared towards strategic planning of resource distribution, to training of operators using such resources to address multiple trauma victims in remote or poorly accessible theatres, and to the real-time support of decision making in the wake of an actually occurring accident. The technical specifications ought to include the class (types) of events addressed, the resources to be managed, the timeframe available for cognitive support delivery to the decision-maker. Test-beds, typically simulated (table-top or physical exercises) will have to be described and their relevance to the validation of the product detailed.
• Study and Design and create a stochastic (at its best AI-optimised) training simulation scenario, with multiple victims and realistic distribution of available resources, statistically adherent to disasters effectively recorded or to anticipated battlefield situations. It must include a learning loop on how to update these scenarios by real-life data of such incidents.
• Study and Design methods to augment situational awareness and decision support systems for decision-makers in real-time crisis development.

The proposals must substantiate synergies and complementarities with foreseen, ongoing or completed activities in the field of Simulation and Training, notably those described in the call topic EDIDP-SME-2020 related to Simulation and Training.

Moreover:

• projects addressing activities referred to in point (d) above must be based on harmonised defence capability requirements jointly agreed by at least two Member States or EDF associated countries (or, if studies within the meaning of point (c) are still needed to define the requirements, at least on the joint intent to agree on them)
• projects addressing activities referred to in points (e) to (h) above, must be:
  • supported by at least two Member States or EDF associated countries that intend to procure the final product or use the technology in a coordinated manner, including through joint procurement

and

• • based on common technical specifications jointly agreed by the Member States or EDF associated countries that are to co-finance the action or that intend to jointly procure the final product or to jointly use the technology (or, if design within the meaning of point (d) is still needed to define the specifications, at least on the joint intent to agree on them).

For more information, please check section 6.

Functional requirements

The proposed product and technologies should enable medical (support) personnel and paramedics with regular joint and frequent access to lifelike, secure, immersive training environment from Care Under Fire throughout multiple levels of surgical capability (focusing on (r)DCS at Role 2 level, additional up to Role 4) and being designed to respond to the evolving training requirements for medics and paramedics both at individual and team levels, contributing for their readiness for national and multi-national missions.

The proposed product and technologies should therefore meet the following functional requirements in the following areas:

1. Medical Training Modules:
   • MEDEVAC: Connection between Field Care by MEDEVAC scenario to Role 1 and beyond to provide connection to a constructive simulation tool able to simulate logistics and the casualty flow and the (Med) C2 capability, including at least an interface to a MS battle management system.
   • Prolonged Field Care (PFC)/ Prolonged Casualty Care: Creation of a layer of PFC to the existing virtual reality medical training scenarios to increase training complexity, stress factor for the trainees and improve readiness for the armed forces medics and paramedics. The content of this training should address sustainment skills for Field Care applied beyond doctrinal planning timelines (10-60-120 min) in order to decrease patient mortality and morbidity until the patient arrives at the next appropriate level of care.
   • CBRNE: Developed training scenarios to include CBRNE injury sample with a focus on burn injuries related to radiation exposure to teach how to recognise it, decontamination, trauma treatment and disposition.
   • Large Quantities of Casualties for Simultaneous Care: Developed cloud-based capability to increase the amount of patients with up to 30 or more causalities.
2. Supporting elements enabling Military Medical Training Multi-Modular Simulation Federated network
   • Military Medical Curriculum:

• • Developed Prolonged Field Care military medical curriculum based on the available guidelines and research studies to enable unified set of instruction and ability to update those for the European Member States.
  • Tactical Combat Casualty Care (TCCC) is a critical teaching curriculum that emphasises care under fire, tactical field care, and medical evacuation. Learnings from Ukraine, where prolonged field care has become necessary, underscore the need to adapt the curriculum. This requires incorporating provisions for sustained treatment beyond the initial phase, ensuring that combatants are equipped to handle extended care scenarios effectively.
  • Additionally, the inclusion of Chemical, Biological, Radiological, and Nuclear (CBRN) elements in the curriculum is imperative. This means introducing comprehensive training in Personal Protective Equipment (PPE) usage, decontamination procedures, and the treatment of radiological exposure, to ensure troops are adequately prepared to manage diverse battlefield threats.
  • Furthermore, the evolving protocols for medical evacuation, based on the insights garnered from Ukraine, should reflect a heightened emphasis on accommodating prolonged care scenarios and mitigating the risks associated with dynamic combat environments. This adjustment aims to optimise the efficiency and effectiveness of the evacuation process, prioritising the timely transfer of casualties.
• • Learning Analytics Tool: Developed component to track individual training progress, competency, and proficiency across and between the toolboxes/systems of the federated network able to:
• • Generate adaptive learning experiences that enable individually tailored training programs to increase learning retention and effects;
  • Provide both distributed debriefing and AAR for training centres through the European Union, and an automated learning analytics system at scale for instructors and commanders.
• • Scalability / Distribution via 5G: Developed streaming software from cloud services across European Union with 5G and beyond to integrate products and services into IT systems of end-users.
  • Federated medical training network applying existing open and applicable standards and including the following features:
• • Interoperability: Ensures seamless communication and data exchange between various medical training entities, promoting comprehensive and unified learning experiences.
  • Versatile Learning Modalities: Facilitates diverse learning approaches, including virtual, augmented, mixed, and extended reality, as well as constructive simulations, enabling trainees to acquire practical skills in a simulated environment.
  • Robust Competency Tracking: Enables comprehensive monitoring and assessment of individual progress, competence assertion statements, and on-the-job experiences, ensuring a holistic approach to skill development and evaluation.
  • Integrated Federated Network: Provides a unified ecosystem for medical training across multiple institutions and organisations, fostering collaboration and knowledge sharing among diverse stakeholders.
  • Granular Data Tracking: Offers detailed tracking capabilities, allowing the monitoring of specific skills development, course completion, and individual performance, facilitating targeted interventions and personalised learning paths.
  • Extensive Customisation Options: Empowers users to tailor the platform to specific training needs and organizational requirements, ensuring a tailored and effective learning experience for all participants.

1. • Learning Management System (LMS) should include comprehensive integration and tracking capabilities, ensuring seamless coordination and monitoring of learning activities within the network. The LMS should be fully integrated within the federated medical training network, allowing for streamlined data management and tracking of various learning events, including live events and simulations. Competence assertion statements should be collected through comprehensive after-action reviews, capturing detailed insights into trainee performance and skill development.
   • Individual on-the-job experiences contributing to training and education should be meticulously tracked through the LRS, ensuring a comprehensive understanding of each learner’s professional development. The APIs within the system should be fully open and enable seamless integration with external applications, promoting flexibility and interoperability. Data export functions should be provided to allow for data analysis and reporting outside the system.
   • The results should excel in tracking very granular details, such as specific skills acquisition versus overall course completion, providing a nuanced understanding of trainee progress and proficiency. The results should also generate detailed reports and analytics, including performance metrics, skill mastery levels, and learning outcomes, which can be easily configured to meet the specific needs of different stakeholders.
   • The result should offer extensive customisation options, enabling users to adapt the platform to diverse training requirements and institutional preferences. The result should be able to scale efficiently to accommodate approximately 30 000 concurrent users, ensuring seamless access and smooth user experiences across the network.

1. Integration with Real World
   • Data Exchange Between Computer-Generated and Physical Manikin Systems, physical simulated casualties and medical equipment provided with a digital simulation device. Integration with physical manikins in combination with centralised data analysis and distribution. Open standards and/or other simulation systems or their providers available to transfer scenario data between