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?

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

 

This week, we further explored the medical evacuation logistics problem in our beneficiary interviews and found that, in general, this could help 18D’s save time and improve work focus during the right point in time as compared to the standardized clinic set-up. Having a more accessible database of information- ideally with pictures and filters for higher levels of care, such as availability of safe and vetted blood, or sterile surgical equipment, could mean the difference between a med evac 48 hours away versus 12 hours. This eases the burden of shrinking resources on the medic as well as the time the medic would spend sitting on a patient in prolonged field care. The major challenges to this kind of product, though, stem from the need for a database that can be offloaded due to cost and reliability of cell service, security in geo-based products, and implementation among groups so that this information on such a database (on higher levels of care) is constantly refreshed by medics and does not go stale.

 

Interview 1: CPT Amanda Canada

• Testing of new technology could be an essential part
• Better diagnosis, documentation will be beneficial for med eva and database or guide will help make decisions
• Extra work like availability of higher levels of care and prolonged field care slows medic down

Interview 2: SGT Bill Kelly

• It takes 2-5 minutes sometimes 30 or more to figure out med evac logistics
• Clinic set-up is not really a huge need

Interview 3: SGT John Carlson

• Role of medic: Triage, treat, stabilize, delegate, repeat, document
• Need high level of testing to ensure safety in the field

Interview 4/5: General Stanley McChrystal

• Curious about possibility of disconnect between higher ups (Central Command) and individual operations/missions.
• Risk understanding to force, mission, reputation…can be variable and has high effect in decision making.
• Captains tell Central Command that it was high risk and it’s hard to understand what happens when you don’t know the situation.

Interview 6: General Dempsey

• Get specific on what medical scenarios we want to be able to aid medics in treating on the field
• Even solving a niche problem (such as 1 aspect of the med evac logistics) would provide value
• Advised us to get more anecdotal context from our beneficiaries on what they need/want from this product

Interview 7: SFC Chase

 

• Need strong validation- what we see from info online often doesn’t align with reality, and SF’s own clinics often are better than what these hospitals can provide
• Main issues in solving problems that aren’t covered in training, which is why he sees the clinic set-up as a possibly valuable tool for new medics
• Not always about time saving: Increasing survivability in that you’re providing shared understanding of how it’s supposed to work and where they are

 

Interview 8: SOFACC Trainee Michael

• SOFACC Trainee binder is pretty well organized, in a training setting it’s very helpful to have even if it’s more brief and not fully in depth for what may be necessary
• An app solution could be helpful but needs to be really easy to navigate- and a lot of the binder info should be in our heads already anyway so an app would be looked to as the last resort

Interview 9: 18D Mike

How useful would a database be?

• Usually don’t have internet access in austere environments
• A lot of info about local facilities and resources already exists, it’s just about having to find and organize the evacuation based on all that information
  • 18D’s have someone else doing that logistics work as they perform patient care
  • Database/app could be more helpful stateside but wouldn’t be super operable abroad

Interview 10: Army Nurse Josette Noxon

• Medical Evacuation process, what it looks like:
  • Role 1, Role 2, Role 3, Germany, then US Hospital (either DC or San Antonio – where the burn center is)
  • Existing system: A “JSTAR” system currently exists for home theater medical evacuations where patients are tracked and evacuated based on acuity of injury
    • “Med evac” means critically ill patients
    • “Air evac” means less urgent or serious injuries
• The core of the issue is that Role 1/Role 2 facilities can be 8-10 hours away distance wise

Interview 11: Company Physician Assistant – 44th Medical Brigade – US Army Garrison CPT Bob

• Medics need to decide what method of transportation to use (helicopter, ambulance, etc.)
• Be aware of data security concerns

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