Land Warfare: JP2060: healthcare is on the way, slowly | ADM October 2012

The final phase of JP2060, a project established 16 years ago to deliver a deployable health capability for the prevention, treatment and evacuation of ADF casualties incurred in joint operations, is unlikely to go to tender until the final quarter of 2014.

In disclosing this to ADM, well-informed sources noted that this is a year later than was intended until recently. However, it is well within the 2013-15 band for First Pass approval set in the 2012 Defence Capability Plan (DCP), although this is still two years later than the dates indicated in the 2009 DCP.

As forecast in the 2012 DCP, Initial Operational Capability (IOC) for Phase 3 will now be reached sometime between 2017 and 2021, seven and 11 years respectively later than the date by which the entire project was scheduled to have been completed when it was set up in 1996.

But even this date is open to conjecture, since the DCP states that it will be further refined later in the proposal development process.

Acquisition cost has firmed from the 2009 estimate of $100-500 million to the middle of a $300-500 million band. Budgetary constraints would suggest this figure is more likely to go down than up.

While individual health support capabilities will continue to reside within the three services, Defence says the joint approach to the development of JP2060 will enhance interoperability “and minimise duplication of effort and resources that burden stovepiped service-based health support”.

The project has adopted a “whole of systems“ approach, addressing preventative health, treatment, medical evacuation, health information systems (command, control, communication, intelligence and information management systems), and health service logistics.

A project definition study that was completed in 2003 led to the acquisition under Phase 2A of portable ultrasound systems and medium-fidelity mannequin systems. These purchases were completed in 2008.

Delivery of key items such as imaging systems, Canadian-manufactured modular controlled-environment soft shelters, monitoring instruments, forensic dentistry tools and logistics capabilities has now been completed under Phase 2B.

A new digital imaging system prereleased in August 2010 to equip an ADF medical task force assisting with flood relief in central Pakistan cut patient waiting time from more than 10 minutes to two minutes, while continuing to function in temperatures untenable for wet-film technology. Additional systems were issued to the three services during the remainder of the year.

Enhancements to current capability will be progressively rolled out over the next two years to complete Phase 2B. These will include portable oxygen generators, aeromedical evacuation (AME) equipment suites to modernise the current AME capability across Navy and Army, and medical waste incineration to ensure more efficient compliance with state and territory legislation.

Phase 3 Next Generation Deployable Health Capability is intended to take an integrated systems approach rather than dealing separately with each of the five discrete health operating systems mentioned earlier.

Operational experience

Changes in the pattern of war trauma mean more of the seriously injured are able to be resuscitated and returned to a level of health comparable to that prior to injury. “Enabling this rate of survivability requires immediate first aid, rapid evacuation with specialists providing en-route resuscitation and early surgery in facilities with extensive clinical support capabilities,” Defence states. “The project seeks to deliver this as an integrated network of systems that is flexible, scalable and responsive.”

Clinical interventions will be delivered at the lowest possible level as will improved trauma response, appropriate equipping of evacuation assets for intransit care, and the modernisation and upgrade of surgical capabilities with the ability to provide specialist care in the deployed environment.

Defence says it is currently working with the Australian Red Cross Blood Service to deliver a frozen blood capability. This capability is currently being used by coalition partners but has not been developed within Australia. Additional technologies such as small, easily-deployed pathology testing units are already being developed.

Other innovative technologies under development, as identified by Wing Commander Michael Penman of the Directorate of Future Health Capability in a presentation two years ago, include a noise-immune stethoscope to be used in challenging environments such as helicopters, dried plasma with an extended shelf life and temperature stability for use in cases of massive blood loss, and portable oxygen generators utilising a thin, hot ceramic membrane with a voltage applied that could eventually replace the standard “D” storage cylinder.

Defence said it was unable to facilitate an interview with a subject matter expert to obtain additional information on Phase 3, but ADM has elicited more details from a variety of sources.

These have disclosed that Phase 3 has now been split into two components, the first of which is the Health Clinical Component (HCC). This involves the infrastructure of the deployable capability, ranging from modular soft and hard shelters to sterilisation and laundry facilities and a wide range of medical equipment.

The second component is the Health Knowledge Management (HKM) system. This will encompass health intelligence on geographic and environmental issues and information on deployed personnel ranging from patient tracking and regulating to patient and clinical records, including imagery; case management; the readiness and sustainability of deployed medical capabilities; notification of trauma, deaths, serious illness and injury; and early assistance in the detection of biological/chemical attacks.

The HKM component will also enhance the monitoring and control of health materiel and supplies within a Joint Operations Area (JAO) given the acknowledged deficiencies of existing logistics systems such as MILIS and ROMAN.

IT details

As with other specialist software applications used on operations, the HKM will be hosted on Defence’s Deployed Local Area Network (DLAN) infrastructure. The dedicated communications to support the HKM are to be provided by a number of other Defence projects, including JP2008 – Military Satellite Capability; JP2072 – Battlefield Communications Systems (Land); and Sea 1442 – Maritime Communications Modernisation.

A Request for Information (RFI) for the whole of Phase 3 was released by Capability Development Group (CDG) in 2010. According to the sources, this sought details of various capability elements on an individual basis. Following an overseas study tour by representatives of both CDG and Joint Health Command a second RFI was issued in 2011, this time seeking information from companies interested in acting as a prime systems integrator.

Subsequently a third RFI limited to the HKM system was released in April, this time by DMO’s Electronic Systems Division. Respondents were given four weeks to identify potential COTS-based integrated eHealth solutions and their maturity, together with systems integrators and vendors who have successfully delivered integrated solutions for healthcare, “including other countries’ military organisations in support of their deployed operations.”

“This means they’re going to have to come up with a requirements specification and cost that has the potential to cause more delay to the overall program,” said one industry source who spoke to ADM on the condition of anonymity.

“My feeling is Joint Health Command wants a complete and integrated solution that includes the Clinical IT systems – this would deliver a complete capability and make through-life support far easier to organise than the piecemeal approach followed with Phase 2.”

The Concept of Operations (CONOPS) for Phase 3 includes an aspirational 10-1-2 hour metric. This involves controlling major haemorrhage and a secure airway within 10 minutes of injury; evacuation from the point of injury within one hour by personnel capable of providing enroute advanced resuscitative care; and surgery at hospital level care to commence not later than two hours following injury.

Patients requiring strategic evacuation would normally depart the area of operations within 72 hours of admission; the most critically ill within 24 hours. The strategic AME is intended to be capable of moving up to eight intensive care and 34 lower dependency patients per day at peak demand from three separate theatres, sustained for five days.

The CONOPS segments the health facilities proposed by JP2060 Phase 3 into graduated levels of capability, with R1 resembling a traditional regimental aid post capable of managing minor sick and injured personnel for immediate return to duty, as well as casualty collection from the point of wounding and preparation of casualties for evacuation to a higher level facility. R2 will add to R1 capabilities with triage, medical officer-led resuscitation and the relevant support elements; basic imaging and field laboratory capability; and a limited holding facility for the short term management of casualties until they can be returned to duty or evacuated.

R2 Light Manoeuvre (R2LM) are light, highly mobile surgical facilities used only for initial crisis intervention or war fighting deployments where direct evacuation to R2E/3 facilities are impossible.

R2Es are small hospitals able to stabilise post-surgical cases for evacuation out of theatre without first needing to evacuate to a Role 3. They will also provide casualty decontamination facilities for chemical and biological warfare casualties dependent on the operational risk assessment.

In addition to R2E capabilities, R3 centres will include specialist neuro, maxillofacial and burns surgery, advanced and specialist diagnostic capabilities to support clinical specialists, and major medical and nursing specialities in internal medicine and neurology.

As well as surgical and medical intensive care capabilities required for the seriously ill and injured, the holding capacity will be sufficient to allow diagnosis, treatment and holding of those patients who can receive adequate treatment and be returned to duty within the Joint Operations Area, dependent on the theatre holding policy.

Contenders

Given that the Phase has yet to receive First Pass approval, industry is understandably reluctant to discuss possible offerings.

However, Saab Technologies Australia confirmed to ADM it has responded to all three RFIs. This is not surprising, given that its Swedish parent delivered a sophisticated turnkey deployable medical care solution (MCS) to the Swedish armed forces two years ago which was inspected in the course of the CDG/Joint Health Command study tour.

According to Saab marketing material, the MCS can be mission-tailored according to tasks and climatic conditions. Each tent is self-contained and has common wiring and connectivity with other modules, enabling the capability to be scaled and adapted appropriately for whatever the situation requires.

Medical equipment is all COTS to facilitate support, and the company says it can provide end-to-end backing for the MCS including equipment, operation and maintenance services whenever it is needed and in any location.