Recent Issues and Advances in Aeromedical Evacuation (MEDEVAC)

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1-2 applicability of the TOC applied systems thinking is universal and offers an alternative to traditional approaches of problem identification and resolution. Using this technique, the AMC Surgeon's staff conducted an end-to-end evaluation of the AE system in January-February 1994. This evaluation included identifying the current and future AE system based on shifting requirements. The group focused on four major areas; machinery, manpower, methods and money as depicted in Figure 1. The group concluded that dramatic changes were required for the AE system to meet DoD's anticipated needs in the 21st Century; the changes will be reviewed in some detail later in this paper. MACHINERY MANPOWER Airframe Available Skill MIX Communications Enhanced Cy Established Comprehensive / Accountablllty ForA~~~e/ AE SYSTEM OF ZlSt - CENTURY Training strE;r/ Read1ne:;;T METHODS MONEY Figure 1 Areas of Improvement The theory of constraints concept provides a formal process of review to determine shortfalls or challenges to mission accomplishment, hypothesize what would be the most effective new method of providing mission accomplishment and then defining the change mechanisms required to transition to new, more effective methods for a better system. Those elements of the current way of doing business that are found to be "constraints" are termed "undesirable effects". Each of these need to be critically examined and a "desirable effect" hypothesized for implementation in the future. In the process of identification and formulation of the desirable effect, the process of "transition" is defined; each potential impact to change is reviewed to extract a mechanism to allow for change and obtain a positive outcome for the new way to do business. The change is termed an "injection". an activity that must occur to effect the change required for systemic change. An example of a final view of the process is depicted in Figure 2. Each of the thought processes are critically examined for "sufficient cause" and "necessary condition". E Personnel Are Proper y eel Global AE Requirements Figure 2 "Future Reality Tree - Training" THE CHANGE PROCESS - THE ELEMENTS There are five major elements in the TOC process. (All quoted material is from reference three.) The first element is entitled the "current reality tree" and involves the definition of "what to change". By working through this first step. the group can pinpoint the core probleni ("constraint") and the undesirable effects inherent in the current system. Each of these requires some type of change. The second element is the "conflict diagram". The development of the "future reality tree" or defining "to what to change" involves a bridging process using the "conflict diagram". This technique is "a process that enables a person to precisely present the conflict perpetuating the core problem, and directs the search for a solution through challenging the assumptions underlying the conflict." The "future reality tree" (third element) then "assumes the existence of the initial injection, relies on cause/effect relationships, and predicts the unavoidable outcomes." "Additional injections are added to ensure the realization of the desired effects, and to block potential negative side effects." As a fourth element, the "prerequisite tree" provides the bridge between "to what to change" and "how to cause the change". This tree is a process "that enables the dissection of the implementation task into an array of interrelated, well defined, intermediate objectives". This process relies on the "expertise" of the participants to point out obstacles and to meet these obstacles though development of "intermediate objectives". Once these several elements are achieved. the "transition tree" provides the "how to cause the change". This process is used to
"construct a detailed implementation plan and enables "us to focus on causing a specific change in reality, rather than sticking to a specific action just because we have planned to take it". THE AE STRATEGIC PLAN The detailed systematic review resulted in the publication of an AE strategic plan. Thirty-one specific "injections" or areas where improvements are required werc specified to initiate and create positive change. As described earlier, the four categories of change involve: machinery; manpower; methods; and money. For machinery, the injections include: - Modify the tanker fleet to accommodate aeromedical evacuation use - Modify the AE ship sets to fit on CRAF (other than 9-767) - Contracting can provide strategic AE airframes - Patient movement items (PMI) are flight certified - Logistics support system is available to provide PMI - Patienthpport equipment integrity is maintained - AE medical equipment is deployable and hardened - TRAC2ES is fielded - Portable SATCOM is available for mediundlong range communication - Land Mobile Radios (LMR) provides short range communication - AE communication is compatible with base infrastructure - Tri-service comn~unications standards exist For manpower, the injections include: - AE capability is structured in small manpower packages for immediate taskings - Total force integration provides immediate response capability - AE has acuity staffing tool - AE has organic capability to complement basic crew mix For methods, the injections include: - AE operations structure exists to receive strategic AE mission taski ngs - AE Operations Squadron contains capability to respond to immediate taskings - AEOS collocated with medical centers at designated hubs - Air Reserve Forces (ARC) AE forces use AEOS as training platform - All AE members receive standardized training - Resources are available to support standardized training - Aircraft qualification process is integrated into standardized training program - Training includes enhanced clinical skill upgrade - AE mission support personnel receive contingency training - Interface module is developed and resourced - System AE Concept of Operations published For money, the injections include: - Funding is shifted to primary user - Reimbursement process are authorizedimproved - Readiness cost is defined - Readiness funding is available; business case can be defined 1-3 Each of these injections requires formal task definition, coordination and implementation. These actions are ongoing and will continue to promote positive change in the AE system. And as that change occurs, other opportunities for improvement will continue to be realized. INJECTIONS - CHANGE AGENTS Several of the injections stated above will be further discussed for additional clarity on the aspect of change required. Several issues are self-explanatory and will not be further addressed. INJECTION: Modify the AE ship sets to fit on CRAF (other than 8-767). The USAF has acquired aeromedical evacuation configuration equipment packages to retrofit B-767 aircraft for dedicated strategic AE service. Due to concerns on the number of B-767 that may be available during any contingency operation, it would be prudent to explore fitting tliese equipment packages to other long-range aircraft that may be available. INJECTION: Patient movement items (PMI) are flight certified. PMI includes those items required to move a patient in the AE system. e.g., stretchers. straps, pillows, mattresses, ventilators, etc. Those items that emit an electronic signature need to be tested on the aircraft to ensure they do not interfere with the navigational process. INJECTION: Logistics support system is available to provide PMI. The logistics support system has available or can acquire saicient supplies and equipment in the time frame required to ensure it can be moved to the forward facilities as patients are evacuated. INJECTION: TRAC2ES is fielded. This acronym stands for the TRANSCOM Regulating and Command and Control Evacuation System. It is a globally deployed computer based system to allow medical regulating and intransit visibility of patients throughout the health service support system. The personnel system will be able to access the data base to track individuals for reporting purposes. INJECTION: Portable SATCOM is available for niediudlong range communication. Acquisition of SATCOM communication devises is necessary.
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Page 4 and 5: The Mission of AGARD According to i
Page 6 and 7: Aerospace Medical Panel Chairman: P
Page 8 and 9: Experience Learned from the Spanish
Page 11 and 12: * 1. 2. 3. SYMPOSIUM RECENT ISSUES
Page 13 and 14: Several papers reviewed the intra-
Page 15 and 16: Spencer suggested in Paper #20 that
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Page 21 and 22: are reassessed. The total patient e
Page 23 and 24: epidemiologic characteristics of in
Page 25: PHYSICIAN PARTICIPATION IN THE A.T.
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Page 32 and 33: 2-2 The Canadian Air Force flies si
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Page 69 and 70: SUMMARY The complexity and dynamics
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12-6 practices and values, crews wh
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13-2 The requirement for dedicated
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14-2 road vehicle. At present 3 suc
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- - Civil Reserve Air Fleet-Aeromed
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- SUMMARY FIRST MEDICAL TEST OF THE
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Medical equipment tests The U.S. Ar
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8. Bruckart, J.E. and Licina, J.R.,
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17-2 3 Operational Concepts By the
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- Summ'q htemational Access to Aero
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There are four levels of interface
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20-2 5.2 Power Sources 5.2.1 Extern
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20-4 12. APPLICABILITY OF STANDARDS
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1. INTRODUCTION Mechanical ventilat
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2.4. Ground transportation: The loc
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providers receive training and demo
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22-2 population supported during an
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22-4 ~ Number Reauirement for Onboa
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Care in the Air - A System Analysis
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Regllhlthg: patient Report SfhedOli
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need a pocedure it shouldbe aecompl
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25-4 we found to influence the insp
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26-2 the flight surgeon was largely
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26-4 addition, an increasing number
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26-6 10. Rhee, K.J.; Strozeski, M.;
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26-8 TABLE I.B. RETROSPECTIVE REVIE
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26-10 TABLE 11. TOTAL NUMBER OF U.S
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27-2 A) Historical background of th
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27-4 Aircrafts with Flight Nurses a
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REPORT DOCUMENTATION PAGE 1. Recipi
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