CDID: Envisioning and Designing Future Medical Formations
Written By MAJ Conrad Wilmoski
Are you curious why and how the Army changes? Have you wondered why and how the Forward Surgical Teams (FST) and Combat Support Hospitals (CSH) are transforming to new units with different capabilities? The Army designates its Centers of Excellence (CoE) as modernization proponents. Within the CoE, the Capabilities Development and Integration Directorates (CDID) lead change. The CDID is responsible for concept development, experimentation, requirements (determination), and capability integration. The Health Readiness Center of Excellence (HRCoE) has its own CDID, which is devoted exclusively to medical modernization. This editorial uses the development of the Forward Resuscitative and Surgical Team (FRST) as a case study to describe the HRCoE CDID and its role in modernizing medical formations.
The basis for future force design resides in understanding the future operating environment.
The basis for future force design resides in understanding the future operating environment. The Multi-Domain Battle: Evolution of combined Arms for the 21st Century (December 2017) Version 1.0 concept describes the future operating environment differently than the previous Air, Land, and Battle Concept, which sought to overcome Cold War threats. The new aspects of multi-domain convergence, divergence, and lethality present new challenges for the Army. Medical considerations in the future operating environment focus on casualty evacuation during windows of opportunity in contested environments, and expeditionary health service support to increase personnel survivability. Creation of the new FRST from the legacy FST is a prime example of how HRCoE realigned a current medical formation with strategic guidance using the force design principles to achieve the demands — capability requirements — for the future operating environment. The new medical formation is expeditionary and more agile than the legacy system and is capable of split-based operations, damage control surgery, and limited post-operative patient holding.
It is important to understand the medical organizations within HRCoE that are involved in the modernization process to describe how CDID leads change. Strategic guidance and requirements drive change; solutions to first-order problems (Army Warfighting Challenges) and force design principles (optimized expeditionary, agile, endurance, adaptable and interoperable
operations) initiate change recommendations. The doctrine, organization, training, materiel, leadership and education, personnel, and facilities (DOTMLPF) domain paradigm guide change. CDID is responsible for designing the force — developing and processing the doctrine, organization, and materiel domain changes; other HRCoE directorates, such as Army Medical Department (AMEDD) Personnel Proponent Directorate and Directorate of Training and Academic Affairs, are responsible for the training, leadership and education, and personnel domains. The United States Army Medical Research and Materiel Command (USAMRMC) has a role in medical capability development as the medical materiel developer for the Army. These proponents work together to produce medical units for the future force.
Development of the FRST capability occurred through a multi-stage process integrating expertise and responsibilities from six CDID divisions: Concepts & Capabilities Division, Army Medical Department Warfighting and Experimentation Division, Requirements Determination Division, Computational Sciences Division, Doctrine and Literature Division, and Medical Evacuation Proponency Division.
The Concepts & Capabilities Division is responsible for envisioning, designing, developing, and integrating Army medical concepts and capabilities across the DOTMLPF domains and is the starting point for shaping future medical formations. Experts use a capabilities based assessment method to identify gaps in capability and potential solutions. In the case of the FRST, CDID experts first used a capabilities based assessment method to identify potential changes to the DOTMLPF domains and any expected gaps in medical capabilities at Role 2 medical treatment facilities.
The study supported a force design update to the legacy FST that could perform split-based operations that resulted in two elements capable of delivering surgical and postoperative capability for a short duration of time. Notable elements of the update include a concept for employment and modification of its personnel and equipment to support split operations.
The AMEDD Warfighting and Experimentation Division validated the new FST operational concept through experimentation. This CDID division uses warfighting simulations, seminars, workshops, and other experimentation exercises to validate medical concepts. The Computational Science Division provided analytic support to evaluate different operational scenarios. Close coordination between Concepts and Capabilities Division and the Computational Science Division and Army Warfighting Experimentation Division resulted in testing and evaluation of the FRST under realistic battlefield injury rate and trend conditions. Their work established sufficient academic rigor to corroborate the new FRST concept and seek approval.
Next, the Requirements Determination Division was responsible for formal staffing of the FRST force design update for approval using the Joint Capabilities Integration and Development System (JCIDS). Modernization recommendations require Army and at times joint service staffing to gain approval depending on the recommended changes. After approval, Requirements Determination Division executed the formal changes to the legacy FST to reflect the new FRST organization, including codification of AMEDD organizational documents, medical manpower requirements, and medical rules of allocation for the Total Army Analysis process. They also
coordinated with USAMRMC and Directorate of Training and Academic Affairs to ensure acquisition, fielding, and new equipment training for new medical devices and equipment sets.
Finally, the Doctrine and Literature Division is developing Army Health System (AHS) support concepts to update doctrine and assist in the development of joint and multinational medical doctrine. Simultaneously, Directorate of Training and Academic Affairs developed education modules to ensure Soldiers receive education and training on how to employ the FRST capability.
Although not closely involved with the FRST force design update, CDID’s Medical Evacuation Proponency Division serves as the Capability Developer for Army Aeromedical Evacuation. They work parallel with the Aviation CoE and are physically located at Fort Rucker within the CoE. The division provides guidance and direction for the development of medical evacuation operational concepts and capability requirements across Unified Land
Operations for the AHS. The division aims to provide advanced air evacuation capabilities with advanced trauma patient care and evacuation from point of injury through Role 3 while achieving a 95% patient survival rate. Limited opportunities for Army aeromedical evacuation in the future operating environment identified the modernization requirements for postoperative
patient care and the split based operating concept in the FRST.
In summary, the future operating environment is foundational in determining the medical capability requirements included in future medical organizations. Medical formations must optimize for warfighting in the Multi-Domain Battle environment. HRCoE is responsible for the holistic modernization process and executes force design through its CDID. CDID leads modernization for the AHS and its formations by using the JCIDS to develop and integrate concepts, requirements, capabilities, and solutions such as the FRST to support the future force to win the Nation’s wars.
MAJ Conrad R. Wilmoski is a MSC Officer (70H) serving as a capability developer studying future warfare concepts and capability requirements for the CDID, AMEDD C&S, HRCOE. He earned a Master of Health Administration and Policy from Uniformed Services University of the Health Sciences, Bethesda, Maryland, and is a graduate of CGSC. His broadening assignments include Capability Developer, HRCOE, and Medical Planning Fellow for the Office of Medical Services, US Department of State.
