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Monthly Archives: February 2019

Learning How to Show and Test Value: Week 8

This week, we were able to make some progress technologically, as well as test the product and gather feedback from old and new beneficiaries (within the same beneficiary group of 18D’s). Using Overpass Turbo, a suggestion from one of our tech expert interviewees, and converting those open searches to ArcGIS, we were able to show beneficiaries how we might complete a search for medical facilities, using Morocco as an example. Showing them actively through a screen share during interviews proved to be more effective in clarifying the product’s function than just showing a video of the prototype. Through this, we also received many common suggestions on features beneficiaries would like to see, primarily photo capabilities and a “last verified” date for the information.


We also explored another complication this week in the current medical planning process we hope to alleviate: the sheer number of medical planning resources that 18D’s use, ranging from the National Center for Medical Intelligence to Google searches. We also found that there are also some classified resources, so ideally we would want our product to consolidate at least all unclassified medical asset information. Through this work we found that one possible saboteur could be groups of planners within the Defense Health Agency, whose roles are to identify gaps in military medical resources. It’s possible that they have begun similar projects and, as our mentor suggested, feel that we are overlapping with their jobs- we are planning to speak to DHA members next week though, hear feedback, and engage in discussion.


Interview #1: Rick Hines, Currently Medical Instructor SFMS Refresher and Retired 18D

  • Loves the idea of the product- one issue with the current forms is that if 18D’s don’t know a field to fill out or if it isn’t relevant, they may not submit the information at all- but if you can “skip” a question when filling out information on your assessment, it will make it even easier to keep it updated
  • If kept classified just for 18D’s or within the military, you could add a way to contact whoever updated the information to talk to them directly about a clinic’s capabilities
  • But he sees benefits with making it open to the public- imagines it like Wikipedia where information would be updated enough to be generally accurate over time
  • Product could also be helpful in finding doctors for certain procedures- more specifically:
    • He is, as an 18D, trained to do anesthesia and surgery but if he can find someone who does that regularly, lose limb, etc. then he will pull out all the stops to go to nearest clinic and find any qualified assistance before attempting complicated procedures

Interview #2: Chris, 18D (Repeat)

  • Over time, with a couple of iterations, this could become the primary tool for medical planning, apart from the classified assets that he uses for planning purposes; he would still call the clinics in the area to “verify” the information but he would not have to look at 10 different databases
  • Google Maps satellite map interface would be most intuitive to use, especially if you could zoom in to an area that shows clinics maybe across the border that are easier to get to; if you could also look at the map and have icons for Role 1, 2, 3 facilities that would be helpful
  • Shared story of treating 2 men who were hurt in a sandstorm and had broken pelvises and desperately needed blood- they did a walking blood bank within their camp but eventually decided to use blood from a local clinic because it was a life or death situation
  • This product could help you make those decisions by seeing proximity and resource availability for all kinds of medical situations that you can’t specifically detail on a medical plan- particularly if you can offload the maps

Interview #3, Dennis Jarema, Former 18D and current Assistant Deputy Director SOCM

  • Hosts the prolonged field care podcast and has a deep interest in all things medical care in austere environments
  • Some things to think about with the MVP:
    • Transferability of criteria of civilian hospitals to military medical assets and how they align when searching for a medical asset
    • Possibility of saving your progress when adding clinics- might be useful in environments when you can’t finish a full assessment, but you want to put in any information on a clinic that you did see
    • Be careful about adding options to upload photos, and make sure faces aren’t shown
    • These concerns suggest it might be best to do a limited release to military users first
  • Good concept but there are some challenges to getting it regularly used in the military, ex. Many teams working on the same issue, like his efforts with the PFC resources
  • Value in use because the drudgery of filling out these forms on what 18D’s saw on a mission; many will say “I didn’t see anything” just because the forms are such a pain and this would really make it a lot easier
    • They want to share that info but it’s just kind of hard to do so right now

Interview #4, Benjamin Schwartz, Director of Content at Tesla Government Inc.

  • Overpass turbo allows you to pull from open strings and Wikimaps and pull data sets from there using Python- provided step-by-step tips on how to create these for an area
  • Dig deeper to find what military technology and software we would have access to for this project specifically
  • To keep your customers using the product, need to consider how it will be integrated into their daily workflow and how it will be an easy thing to use- not just make things easier
  • Getting as much feedback as possible will really shape product to where it’s really good- think about how you want to keep testing with a more advanced product each week and who you want to test with

Interview #5, JJ, 18F

  • If this product is deployed in a constantly changing operational environment like Africa, it could be really helpful, if it is regularly updated
  • ArcGIS is used by the military so that would be a good way to compile geospatial data
  • Suggested several improvements and features to make the product easier to use, like hovering over a symbol could show the full information, and differentiating between pharmacies, clinics, hospitals, etc. easily

Interview #6, CPT Liz, Air Force ER DIrector

  • Integrating into training is essential for implanting such a technology and ensuring it is used
  • If open sourcing information on facilities and their assets, maybe a useful feature could be having information that is reviewed and identified as being correct starred (a review mechanism of sorts is absolutely necessary if you open source)
  • Information should include medical services offered and type of medicine practiced

Interview #7, Xiuyuan Hao, Medical Aid team in Morocco

  • Ground Ambulance Services are available in city area. The time for an ambulance to reach to an rural area could be 1-2 hrs
  • Air Ambulance is a new program for emergency launched by the government
  • There are also some commercial companies providing this service, but mostly for prolonged medical care transferring
  • International medical aid teams have better medical capabilities but is harder to assess and update

Interview #8, Jonathan, Former 18D and military consultant for SOCM training AIT group

  • Jonathan has deep knowledge into the implementation and acquisition of military manuals and protocol for AIT Advanced Individual Training (AIT) at Fort Sam Houston to obtain their 68-Whiskey Military Occupational Speciality (MOS) and Airborne School at Fort Benning.
  • His insights on the MVP:
    • Love the visual interface
    • How are these assets vetted?
    • How can I trust the same asset will be there when I return?
    • Interested in testing it on his former SOCM trainees
    • Wondering if there is a fail-safe if data is wrong or corrupt
  • Good start to a complex problem, will likely need testing before 18D’s can use reliably

Interview #9, William, Current 18D transitioned from BCT ranger medic school

  • Graduated the Special Operations Combat Medic (SOCM) program in June 2013 as part of pipeline to become a Ranger Medic. This is a condensed evaluation of the course to give any other Rangers an insight into what to expect.
  • His insights on the MVP:
    • How much would this cost?
    • Interested in seeing if this works in enemy territories
    • Wondering if there is a fail-safe if data is wrong or corrupt?
    • Interested in seeing if existing tech can be used to boost the MVP potential. Used example of AirBnB and Uber.
  • Good start to a complex problem but only valuable if good in enemy zones
  • Wouldn’t use it himself until it’s been thoroughly tested

Interview #10, Larry Mills, Just retired 18D transitioned from Navy SWCC medic

  • Larry was formally a Navy SWCC after-SOCM and transitioned to a different environment entirely. Says 18Ds mission quite physical. As a SOCM you are considered a mid-level provider. He cites his mixed feelings about the steep learning curve that really never ends as an 18D.
  • His insights on the MVP:
    • Love the use of mapping to chart the assets
    • How does this data get updated?
    • How can I trust another 18D will use it in the right way?
    • Interested in seeing if this works in enemy territories
    • Interested in seeing if it would work with the 18D ‘battle buddy’. These are partner medics who may not be as trained as you. This was especially difficult for some new 18Ds who transitioned from civilian careers as a Registered Nurse.
  • Wants to see if this can be vetted with other branches such as Air Force or Navy where land isn’t the only arena of battle. Where would I find a pharmacy in the middle of the Indian Ocean? Islands? How does that work?

Discovering the true value add

Week 7: Mission Achievement


This week we wanted to make sure that we were headed in the right direction and continued to ask our target beneficiaries, 18D’s, about our MVP. We were even able to show the MVP to an 18D in person this past weekend. The responses to the MVP were great ranging from they would absolutely use it or it would make their process of evaluating medical assets so much easier. One quote was “I think what you have is going to be a very simple but effective fix to a problem we have”. This app could solve many problems from minimized work hours to the larger equipment problem. In terms of mission achievement, 18D’s reported it takes them days to come up with a medical plan for these operations and the medical slide has to be presented to the commander before going on a mission. Instead of going through old paperwork, and many do not, 18D’s can look through this app and immediately translate it into the mission. The app can also improve the larger equipment problem because 18D’s can see the equipment available in the region and go without packing it. In terms of access to the app, we still want to make it open source with a veritability option. Our main goals of this MVP is for 18D’s to have easy access to medical asset information and easier collaboration and information flow with medical planners and commanders. We will also address how we are adapting to feedback from 18D’s in our presentation.


Interview 1: CPT Stephen, Battalion PA

  • Spoke about this web portal where medical reports would go and it was a shared website for everyone to pull information. However, it was deleted because the person who made it left. This was pretty helpful, but not there anymore.
  • A different thing: MEDSOC is a medical operating document that is supposed to have every medical asset on the ground. It only has US assets on the ground. No communication between NGOs and US military. Also, it didn’t have any information on local national capabilities.


Interview 2: CPT James, Former Alpha on JED, Current Student at Fuqua

  • Talked about Palantir-Gotham which is a live time track of where everyone is in a general area (this was a new software we were unfamiliar with).
  • Likes the idea of it being open sourced but there are some dangers with that – who runs it?
  • Said it would be great for planning purposes for every team.  All medical planning is deferred to 18D.


Interview 3: CPT Chris, First Group 18D

  • Talked about SODARS which are medical assessments filled out after a trip. They break down everything from where the team stays and lives to partner forces they worked with. However, he never used it and said that people usually want to figure it out for themselves.
  • Feedback on MVP: Said he would 100% absolutely use it. Capabilities is the biggest issue and finding the next best place to go. One of the biggest tasks is going back to assets and validating that this information is still correct. Talked about if we incorporated with telemedicine, would be great.


Interview 4: Paul Loos,

  • Incentivizes the 18D’s who don’t usually keep this information updated because this app makes it so much easier.
  • Sometimes the same clinic is evaluated by multiple 18D’s or teams so the head of surgery or doctors in those clinics become frustrated they see guys in uniform every few months. If there was a way to share this information so it wasn’t always questioned, it eliminates potential of damage to relationships.


Interview 5: SGT Conner, 18D

  • Building trust through efficiency will be key. Show me how I can trust a serviceman/woman’s life with this resource.
  • Accuracy will be the easy-to-understand way to build trust with me. This can decrease inaccurate diagnoses, reduce prescription errors and eliminate many other confusing scenarios. Accuracy also avoids medical malpractice, which is always desirable.
  • My favorite part about the app is the promise of convenience. I want it accurate and efficient, but to have it available right at their fingertips….wow. No longer do they have to travel, search through huge textbooks or run back and forth from patients to computers to access data.


Interview 6: Kevin Iskra, 18D

  • This kind of app makes medical planning much easier because of how easy it is for information to become outdated. The process for verifying medical assets before deployment is very lengthy.
  • The app should have a filter that includes helipad (and other helicopter landing zone locations, i.e. soccer fields) because a huge issue with evacuation is transportation to facilities. Have capability to charter a private helicopter — just need to know where they can land it.


Interview 7: CPT Liz, Special Forces Surgical Team, Air Force ER Doctor

  • This kind of technology has the potential to vastly improve information management which is extremely slow running in the military. Just need to be able to trust it is current and accurate.
  • Security concerns with open-sourcing: minimal, although there should maybe be a barrier to posting information (outsourced verification?) to again keep it accurate. Verification of assets is what takes a long time on medical planning side— so this is crucial.


Interview 8: CPT Bauer, 18D, SOCM instructor

  • The benefits of this technology are quite impressive. I’d want to volunteer my trainees to be end-user testers of this product in a pilot controlled and small setting first before trying it overseas.
  • It would incentivize me to update/contribute data to the database if we could somehow get priority treatment or status at the hospitals/clinics/resources that I endorse. Can my patients be seen faster there? That would be great for us.


Interview 9: CPT Sichel, 18D

  • It would incentivize me to keep the data refreshed in the app if I saw the difference it made if I did so. Show me how a pilot is working well and what benefits I would see with the updated data. That is all it would take to win me over.
  • This app would be a homerun tool if it were translatable to several languages so that we can use it as a training tool with our joint allies. Many of their medics speak only broken English and this would bridge cultural and language gaps.


Interview 10: Sean Harrison, CEO of Wizeview

  • It would be more competitive if you can add AI on the dual-use of MVP
  • The average cost of develop AI could under 30,000 dollar based on a open source service.


Identifying the Right Problem is More than Halfway to a Solution

This week, the team spent some time talking to course advisors to gather feedback on our progress. We had been a little concerned about whether the product was technologically feasible, as well as if we were making progress at the right pace- should we have something developed at this point, and other similar questions had popped up. But in hearing from advisors, it seems like our work in identifying if information gaps on medical assets is a core problem plays a significant role in the timeline of product development. We also heard that it would be helpful to develop some sort of prototype, like a user interface screen, to continue testing with beneficiaries, as something visual would help them understand what we are thinking about as well. This week, we asked beneficiaries questions on how important usability with partner forces was, as well as offloading capabilities, and found that yes, both parts would be ideal.


Here is our current MVP below- we plan to continue testing it out with more beneficiary-focused interviews next week.

Interview #1: Dillon Buckner, Course Advisor

  • Often the military has a lot of information that may not be communicated clearly due to access restrictions or changing needs of data, so when investigating similar product(s) that already exist, try to think about all the ways the information from those similar products isn’t getting to the end user
  • To hear more specifically from your beneficiaries about their daily lives and responsibilities, try to understand their group’s mission as much as possible
  • Then, in these interviews, you can show them what you know- which will help them open up to you more about the challenges they have or the feedback on your product


Interview #2: Xinwen Zhang, General Surgeon in Algeria

  • Even in smaller cities, they have capabilities to address local diseases like malaria- and you will be able to trust them because these clinics/assets know how to deal with these diseases
  • The medical resources allocate regionally, according to the population and economy, so large national hospitals only exist in the big cities.
  • Some epidemic disease such as Brain Malaria may cause to death


Interview #3 Kevin Iskra, Former 18D

  • Since a big issue is information gaps over situations that develop and change rapidly, the product will need to address that and update information just as quickly to really add value
  • He would use this product in austere environments, if it did have regular information updates and could operate offline
  • Think about how this could help build relationships with local partners- often, they rely on money to get information
  • In planning for med evac, one challenge is communication with partners outside of the US military, so if this product could help streamline that chain of command it would save a lot of time/effort


Interview #4 Jon Andrews, Former 18D

  • Information management is the biggest issue with technological adaptation in military
  • Knowing there is a higher purpose that my adapting will serve helps me do things I don’t necessarily agree with/want to do
  • Communication is absolutely necessary with partner forces –– they don’t have prior knowledge of our work and what we can share is very limited by bureaucratic processes (any app should must work around that)


Interview #5: Yuyun Yang, Emergent Surgeon in Algeria

  • Pre-communication of Medic evaluation could save half hour for repetitive work
  • Mutant Malaria could be difficult to diagnose even with pre-communication efforts, so time is very important
  • Could not communicate with English but French- highlighting importance of additional languages or easy-to-understand pictures in the product


Interview #6: Dr. Jared Dunnmon, Course Advisor

  • Use the progress you have made so far to make a prototype to show beneficiaries- but you don’t need to have a finished, tangible product by the end
  • When you’ve identified a key core problem, you are more than halfway to the solution
  • With the product idea here, definitely doable from a technology standpoint, especially if something similar exists in the military system that you can improve or build on
  • Think about product life beyond the initial data scraping though- are there other ways to maintain it in addition to medics inputting information?


Interview #7: J.R. Caldwell, Civil Affairs Officer

  • When gathering medical information (i.e. for clinic assessment forms) you want to be inconspicuous, so think about that in product development
  • Think about adding a method to take pictures within the app- adds lot of value
  • Differences in medical information Civil Affairs might collect or value versus an 18D


Interview #8: Connor, 18D

  • Key role players in arranging for a med evac are: lead medic, asst. lead, platoon physician, SOFACCs, JCET medics
  • How can you get buy-in on this product and improve it so that it won’t take 10 years+ as usual military innovation does to get people using it?
  • Maybe running it or testing it in civilian usages before using it in the military because that helps speed up the process by half


Interview #9: Samuel, 18D

  • Interface looks nice and ties in with what gaps in information we might have on medical assets but you may want to test in civilian settings first
  • Think about how it might work with partner forces though, because a lot of what SF medics and SF missions deal with is building relationships with partner forces
  • Maybe these partner forces would be better at gathering information on medical assets because they are from that place, but they would need language capabilities or images to best input that information


Interview #10: Leo MacKay, SVP at Lockheed Martin

  • Preparing for military operations inherently introduces a dual-use system of products
  • Even in the processes, systems, and logistics you can get dual-use whether it’s planned or not, but one example of planned systems is disaster relief
  • It makes sense then to deploy certain technologies and innovations through the military because you know they will be maintained and they will be used (vs. Dept of State)
  • Dual Use and two sets of purpose- you need to consider that when you think about the size of the DoD budget and how that dual-use benefit is almost intangible with innovation that comes from or works with military needs


Proceeding with Caution

The biggest lesson for us from this week is that information on medical evacuation and procedures to access it exist — but the root of the problem is how to organize & update information so that it is actually used in a way that cuts down on-the-field med evac logistics planning time. Our interviewees shed some light on it below:


  1. Ron Aplin, Technical Liaison at Teleflex Inc.

Provided an experience-based perspective on designing and bringing to market medical products for use by military beneficiaries

  • Whenever you are designing products for military beneficiaries, you need to try your best to relive their daily lives because it’s so different from product design in civilian world
  • Example is sterilized equipment- put a lot of effort into that for civilian medical products but you see that for medical equipment in the military, soldiers will strip off all the packaging and toss it into their bags
  • 3F’s: Form, Fit, and Function and consequences of not fulfilling that
  • The worst case scenarios are hearing customer complaints from military customers because of the heightened circumstances in which your product failed


  1. Estban Barfknekt, Sergeant First Class

Medical evacuation is a complicated, multi-step process but the toughest part is working with local facilities in austere environments.

  • Go to a hospital and they don’t trust you because you don’t have the “Doctor” title in front of your name, don’t understand your capabilities, don’t trust US military
  • In the field planning (contingencies/surprises) done by putting in information requests with JMRC: Joint Multinational Readiness Center where all info of regional resources is aggregated
    • When this isn’t enough, next step is contacting US embassies or in-person scoping out
  • Medic training is needed to provide quality of life care (beyond just maintaining a life) for lower level officers


  1. Ham, Sergeant First Class

Discussed how important a higher level of care is when the medic has done all they can do.

  • “We always look into certain areas where there’s medical clinics, do follow-ons with other teams, when we’re replacing teams, we have a hospital or clinic here” – Discussed the importance of going out and talking to local medical personnel and how visiting these clinics and hospitals and providing them with some assistance goes a long way.
  • Medics never stop being medics.
  • Going out to clinics is one of the most time consuming ventures


  1. CPT Joe

Brought up a great point about not being able to access medical evacuation or medical facilities while in enemy territory.

  • From an 18A’s perspective, a medic’s main role is knowing how to deal with a casualty and the 18A needs to make sure the medic saves that person’s life. Second job of a medic is to teach partner forces how they deal with injuries and illnesses.
  • From an 18A perspective, by spending time on setup (3-4 hours for basic medical equipment to 8 hours for something more extensive), they are giving up doing assessments on partner forces or training partner forces.


  1. Stephen, Ret. Army Surgeon

Discussed his experience in Vietnam working as an army surgeon in three different capacities.

  • No road and no boats and therefore had to always take the helicopter 30-50 miles from the next highest levels of care, making it difficult when weather conditions were bad
  • Transportation was very important; when you’re thinking about major trauma, need to consider the “golden hour” and getting the patient to the right facility within an hour can save the patient
  • Major injuries require a team approach, cannot rely on just one doctor and it can take 16 hours to get a seriously injured patient stabilized


  1. Rose Ann, Ret. Army Reserves Nurse

Discussed how she would set up and take down a “blow-up hospital” every weekend and how difficult it is for one person to do alone.

  • Set-up of mobile hospitals would take 4-5 hours, unload all the cases and it would be ready to set up patients – super heavy material, huge wooden boxes, used a large area of land to set up. Everyone kind of knew where everything was supposed to go – no plan.
  • 4-5 hours again to take down, wasn’t part of repacking or loading up but said it probably also took hours. However, this set-up and take-down took about the whole company – 50 people.


  1. Darrell Owens, PA

Discussed a similar product: JRAMP, that exists using a Google Earth overlay, however this product is classified, unsure of its accessibility/efficiency

  • The medical planner is responsible for the logistics organization of med evac and keep what is essentially a spreadsheet of contacts of all US medical personnel and those of partner forces (usually French in regions like Africa)
  • JRAMP has to be updated through chain of command, lengthy process


  1. Jarred Coughlin, 18D MarSOC SOCM trainee IP SO

Planning logistics alongside providing medical care is cumbersome. An app to access evacuation database could ease the process of making plans when new situations arise

  • Wishes usually to have done better job with diagnosis and documentation after patient is moved to higher care
  • Medical decision making time is slowed down when logistics have to be organized/approved
  • Data security is a concern for the training period of implementing such a device  


  1. Rosie Chamberlain, 18D SOCM trainee TIP SO

Evacuation app could help with documentation, but could take away more time from medical care instead of giving more time for it?

  • Documentation is a big problem in a time of chaos and confusion
  • In general, are carrying 70-90 lbs of gear so any solution needs to be light and easily transported


  1. Esteban Ruiz Sarc, Navy SWCC SOCM Medic

Provided insights on technical hurdles, i.e. solution has to be interoperable with current tech.

  • Logistics are a huge strain, usually takes 20-30 minutes to organize them
  • Barriers to implementation would include: funding, testing, translatability, ease of use


Advisor interviews with Jared Dunnmon and Dillon Buckner are scheduled for next week.