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Military Operational Medicine: Real-Time Physiological Status Monitoring (RT-PSM)

Azimuth Check


The DOD’s methods for monitoring and managing soldier injuries and operational health impacts how the Army sustains an operational force. A recent study of the Army’s ability to fight and win in large-scale combat operations (LSCO) determined that the Army could not record, monitor, and mitigate real-time multi environmental stressors. Ensuring a ready, lethal and modernized force with the operational reach to fight and win tomorrow’s battlefield requires that the Army must focus on modernization efforts to improve Soldiers’ resilience, prevent and mitigate injury, and improve the capacity to sustain Soldiers’ health and operational effectiveness, to support Combatant Commander (CCDR) priorities and maneuver in multi-domain operations (MDO).

  1. ISSUE:

The future battlefield will be competitive, hosting state and non-state actors pursuing parity over U.S. forces across multiple warfighting domains. According to the MDO concept, U.S. forces deter hostilities by these malign actors. Should deterrence fail, the US must execute offensive combat operations to disintegrate enemy forces and return conditions to the competition below the threshold of armed conflict. The increase in tempo and diverse locations causes multi-environmental stressors. The need to keep our Soldier Combat Ready in warfare has amplified the Army’s need for a wearable integrated real-time physiological monitoring device to monitor the Health Readiness and Performance Status system.

The 2018 National Defense Strategy describes the strategic environment as being “defined by rapid technological change, challenges from adversaries across every operating domain, and the impact on current readiness from the longest continuous stretch of armed conflict in our Nation’s history. The strategy includes as a goal a “more lethal, resilient, and rapidly innovating Joint Force.”[i] Military biomedical research and development (R&D) is a vital national security interest that ensures the readiness of our service personnel in current and future conflicts. The products and capabilities developed by Armed Services Biomedical Research Evaluation and Management (ASBREM) CoIs members, academia, and industry support the entire military medical life cycle, from pre-deployment through deployment, field operations, combat care, evacuation, medical treatment facility (MTF) care, recovery, and rehabilitation.[ii]

The anticipated distance between the battlefield and definitive care sites in potential future operational environments and the development of advanced en route care procedures and medical devices will be critical to the survival of injured warfighters. Developing this capability requires increased R&D in multiple technology areas, from information systems and management (JTCG-1) and the cybersecurity implications (Cyber CoI) to critical care and patient movement (JTCG-6, Autonomy CoI) and physiological and environmental monitoring (JTCG-5, Sensors/ Human Systems CoI).[iii]



The Army will explore potential changes to doctrine, organization, training, materiel, leadership, personnel, facilities, and policy (DOTMLPF-P). DOTMLPF-P solutions are created through the Joint Capabilities Development and Integration Systems (JCIDS), an iterative process that develops improved capabilities and fields them to the operational force. Potential areas of future DOTMLPF-P changes tied to this problem set are outlined below:

Doctrine. Doctrinal changes stemming from the realignment of forces or acquisition of materiel that change the concepts guiding how U.S. forces operate in support of national objectives.

Organization. Organization domain solutions focus on tailoring Army forces into the appropriate structure to accomplish specified tasks. Fielding new capabilities that utilizes biomedical countermeasures effectively against operational stressors and prevents physical and psychological injuries during trainings and operations to maximize service members’ health, readiness, and performance.

Training. Personnel operating / monitoring/ interpreting the device will require specialized training and certifications.

Material. Materiel domain solutions are inherently tied to any modernization effort. The Materiel domain focuses on modifying existing equipment or developing new equipment that provide specific capabilities to achieve national strategic objectives. Developing new high-tech means of monitoring the soldiers’ real-time stressors will allow for early detection of physiological and performance sensors to assess soldiers’ thermal strain, energy expenditure, and cognitive and physical performance. Additionally, they would be essential in providing actionable information to prevent injuries and predict readiness. Further, ongoing research in biomedical research in countermeasures focuses on preventing, mitigating, and sustaining a Soldiers’ health and operational effectiveness, allowing the Army an opportunity to establish new public-private partnerships with the U.S. industrial base that foster American economic growth in support of the National Security Strategy (NSS).

Personnel. Personnel changes will be necessary due to a new Military Occupational Specialty (MOS) for Biomedical Device Interpreters. The technological complexities will require intelligent Soldiers with extensive specialized training.

Facilities. Materiel solutions based on the Military Operational Medicine Research Program (MOMRP) provides the planning, programming, and budgeting (PPB) for biomedical research to deliver products and solutions to service members and families that address readiness, health, and performance throughout the deployment cycle and service member life cycle. Additionally, the MOMRP drives cutting-edge scientific research and delivers Joint solutions to the battlefield and at home in a relevant, timely manner.

  1. Materiel Solution

The Army already has the pre and post-deployment surveys, which has helped to discover some issues. However, the key to the wearable device entails giving the Army up to date readings and to be able to take an appropriate corrective action as soon as possible and to keep the fighting force strong and robust to sustain the assigned operations. Given that most commercially available solutions do not comply with army needs comprehensively, there needs validated algorithms that utilize the real time information obtained from those technologies useful for both the Army and soldiers in the field. Here, the core solution should focus on integrating the wearable devices architectural designs with the soldiers’ technology ecology.

The wearable device development requires intensive investments in iterative efforts that involve biomedical engineers, medical practitioners, and soldier users. The technological application should include the following parameters. Firstly, the Army needs to collaborate with commercial producers of wearable technologies, such as FITBIT, to enhance and personalize performance based on individual solder’s needs and optimizing situational awareness or enhanced individual or team sensing. Secondly, there needs a integration of detection techniques that identifies impeding soldier failure due to injury or medical conditions caused by environmental, psychological, or physical factors.

Also, the technology should be designed to automatically detect threat agent exposure. Fourthly, the wearable devices should manage to detect casualties, aid in triage, and early clinical management of soldiers injured while on field operations. Other benefits that should be integrated in the system include optimizing soldiers’ health benefits including assessing their fitness readiness and health habits. Finally, the technology should focus on the long-term role of monitoring health risk associated exposure and dosimetry.

Achieving these results would also imply working with the capability development team (CAPDEV), which plays an indispensable role in ensuring that all safety and security objectives of the system are integrated in each step of the technology’s life cycle.[iv] The CAPDEV has the mandate to ensure that during materiel solution analysis, system safety is prioritized. For instance, in 2018, Strava, a GPS tracking company produced Global Heat Map that provided satellite information regarding all GPS locations and movements of all its subscribers.[v] With over 27 million subscribers globally, among them being army personnel who wear Jawbone and FITBIT wearable devices, the Global Heat Map revealed a great security loophole especially for soldiers in war zones, as it could reveal information about their location, the military base location, and essentially sensitive details pertaining secret army sites, endangering all soldiers and compromising their operations[vi]. For this reason, the CAPDEV team should ensure appropriate safety measures to prevent such sensitive information from being leaked outside the Army. Here, collaboration with system safety engineers is vital as soon as the wearable device system is perceived appropriate for solving the health issue common while soldiers are in mission.

In case a doctrine change or modification is needed to ensure a seamlessly functioning monitoring system, the CAPDEV team must also consult security experts to establish the security impact such changes can have on the wearable devices solution. While it is common for CAPDEV teams to have safety experts included in their teams, those without such professionals should outsource secondary help from the direct reporting unit (DRU), Army Service Component Command (ASCC), or the Army Command (ACOM).[vii] Inadequate or poorly designed equipment exposes soldiers to higher potential for attacks, increased safety risks, and loss of combat resources. Hence, the CAPDEV is liable for ensuring that they meet the principle system safety responsibility is achieved by articulating soldiers’ safety requirements in every life cycle stage.

When developing the wearable devices, historical lessons must be assimilated in the tradeoff analysis and concept studies. In this case, the materiel solution should entail identifying safety capabilities and minimizing any potential loopholes for failure or mishaps. Secondly, it is important to consider all user safety test criteria and issues. That way, all scenarios that may be perceived as an endangerment to the soldier’s security and safety are eliminated before the operationalization of the devices. Also, once the safety requirements have been materialized, they should be integrated into the capabilities documents. In addition, the CAPDEV team should ensure that they engage soldiers in safety working group to streamline the system’s safety capabilities and operational mission needs. Another essential component that the CAPDEV team must do includes reviewing all decisions regarding risk acceptance and providing concurrence as outline in DODI 5000.02. Taking these measures would meet all the materiel requirements for the need of monitoring soldiers’ health and providing prompt response from medical teams.


           This is not an organizational solution. This is a materiel solution of creating the wearable device that can detect issues and send information to the database, where medical staff and see how to preserve and sustain their fight force. This information can be reviewed, interpreted and recommendations can be given to the soldiers and the Combatant Commander to maintain/ sustain the operational effectiveness of his Soldiers. All echelons could implement this solution; it would be most effective at the unit level and push the information up to the theater level. The unit-level benefited directly from the soldiers’ health, and the over health and operational effects would be seen at the higher levels with reports of trending sick call, return to duty numbers, and time frame of downtime of the soldiers. Overall, this will help maintain high medical readiness levels across the board for the Army. Also, it will help overall Army Readiness meet the needs of the Multi-Domain Operation of 2028. It essentially could help reduce the number of long-term issues that keep a Soldier down or have the Medical retirement out.


           Integrating the RT-PSM concept into the force will be analyzed using Force Integration Functional Area (FIFA) analysis. One FIFA aspect that is key to integrating RT-PSM to the force is equipping. The AMEDD, as the SME for safety and legal matters related to medical technology. Based on their advice, Army Material Command (AMC) will identify a manufacturer and any additional equipment needed to field and maintain them. Maintaining RT-PSM will be a relatively low task requiring specialized training to maintain the system. [viii]The U.S. Army can team up with U.S. Companies that have already started /have developed the technology. Failure to field RT-PSM, the Army to have low Medical Readiness


           Combatant Commanders, especially in projected future conflict regions, provide input to the Secretary of Defense on the concerns and needs of the force. This information feeds into the Services’ budget requests, which ultimately feed into the National Defense Authorization Act, where Congress authorizes funding for the military. Congressional approval of the funding necessary to conduct research and acquire RT-PSM capabilities for future conflicts and crises is foundational to developing, obtaining, and maintaining RT-PSM.

“The Armed Services Biomedical Research, Evaluation and Management (ASBREM) Community of Interests (CoI), (ASBREM CoI), is part of the Reliance 21 framework, an Office of the Secretary of Defense-led effort for joint planning and coordination. The ASBREM organization is structured to ensure flexible and adaptive responses to a wide range of challenges. This construct promotes the coordination and synergy of DoD biomedical R&D efforts to pro­vide medical products and information that are required to protect and sustain the health of Soldiers, Sailors, Airmen, and Marines of the U.S. Armed Forces.”[ix] This is unique in its coordination of the medical materiel acquisition process relative to the integrated life-cycle management of medical products from concept to disposal. The life-cycle management can be viewed from user need and laboratory investigations—through clinical trials, Food and Drug Administration (FDA) approval, and manufacturing processes—to the delivery of the product to the warfighter and warfighter medic/corpsman. The advanced development teams specifically work to transition S&T discoveries and products through clinical trials, FDA approval, and manufacturing, to the materiel delivery community.”[x]

Once funding is allocated and the system’s needs are defined, HQDA G-8 will allocate and monitor the program’s budget to ensure the project does not exceed cost projections and detract from the readiness of the overall force. Army Cross-Functional Teams (CFTs) will play a critical role in the process by assessing the feasibility, suitability, and acceptability of the proposed solutions to keep the process on track. HQDA G3/5/7 will determine the MTOE structure required to field the new units, and HDGA G-1 will work in conjunction with TRADOC and Army Human Resource Command to recruit and man these units.


Through Sustainable Readiness, the Army maintains a tiered level of readiness to respond to global crises across the conflict continuum. At present, CCDRs rely on word of mouth from Soldiers and Medical staff. However, with the integration of RT-PSM technology, it has become possible to gain firsthand information regarding soldier’s health while they are still in the field. An essential factor to appreciate is that engineering technology remains a core enabler for achieving these results. For over five decades, the efforts to monitor soldier’s performance, including heart rates and temperatures has been improving gradually.

Contemporary technologies allows for monitoring even finer actionable details that allows that allows medical staff and CCDRs to make prompt decisions regarding deployed soldiers.[xi] For instance, the army uses chest-worn devices to monitor physiological signals, and these have constantly improved in terms of comfort, weight, size, power, and cost. The efficiency of these devices in terms of accuracy has matured. With that information, the sustainability of such technology is promising as turning physiological data from these devices into actionable data has been a great vision for the US Army.

At the backdrop of these technological milestones, one must appreciate that raw data, such as temperature and heart rate, are not actionable to the CCDR or even a medical team unless when the data is highly refined. For instance, a high heart rate does not necessarily imply a soldier is in distress. Instead, it can indicate a response to an extreme psychological event, cardiac compensation for peripheral vasodilation due to extreme heat or due to hemorrhage, or normal sympathetic activation required when engaging in combative tasks. However, with current research and technological development, it has become clear on how such physiological data can be interpreted to inform of an actual soldier distress due to an injury or medical condition. In reality, some of these discoveries require field examinations rather than laboratory studies to establish the actual physiological extremes when a soldier is injured or unwell when in the field.[xii] These achievements have already been made through research conducted by the U.S. Army Research Institute of Environmental Medicine, and these provide the assurance needed to ensure continuity in advanced monitoring of soldier’s health. Besides, advanced security measures, including strong encryption techniques would also ensure that data from these wearable devices is only accessible to the US Army. That way, the recommended solution meets the requirement for being sustainably ready and having the capability to achieve the desired results.


Hasty solutions to streamline fielding could be using existing technology such as a FITBIT and integrating that technology in the Army’s systems. This can be a bottom-up method of streamlining the process for a CCDR to submit a capability request known as generating Operational Needs Statements (ONS) to HQDA.


           Major Melinda A. Nekervis, USAR, Nurse Corp, melinda.a.nekervis.mil@army.mil





Anand, Santosh and Somnath Sinha. “24X7 Lifeline Chip for Soldiers.” International Conference on Recent Trends in Advanced Computing. 2019, ICRTAC 2019. Procedia Computer Science 165 (2019): 573–581. https://doi.org/10.1016/j.procs.2020.01.029

Armed Services Biomedical Research, Evaluation and Management (ASBREM) Community of Interest (CoI). “Medical Innovation for the Future Force.” Integrated DoD Biomedical Research and Development Strategy:, 2017: 1-44.

“Department of Defense Strategic Medical Research Plan: Repsonse to Section 736 of the John S. McCain National Defense Authorization Act for Fiscal Year 2019.” Public Law 115-232, 2019. 22.

Hoyt, Reed. W and Karl Friedl. “The Future of Wearable Tech.” U.S Army. February 4, 2016. https://www.army.mil/article/161761/the_future_of_wearable_tech

Military applications of soldier physiological monitoring. Journal of Science and Medicine in Sport 21 no. 11 (2018): 1147-1153. https://doi.org/10.1016/j.jsams.2018.06.004

Sly, Liz. “U.S. soldiers are revealing sensitive and dangerous information by jogging.” The Washington Post. January 29, 2018. https://www.washingtonpost.com/world/a-map-showing-the-users-of-fitness-devices-lets-the-world-see-where-us-soldiers-are-and-what-they-are-doing/2018/01/28/86915662-0441-11e8-aa61-f3391373867e_story.html

US Army War College. “Army Force Management Model: 2019-2020 – How the Army Runs: A senior Leader Reference handbook.” (2020). https://ssl.armywarcollege.edu/dclm/pubs/HTAR.pdf

[i] (Department of Defense Strategic Medical Research Plan: Response to Section 736 of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 2019)

[ii] DoD. Armed Services Biomedical Research, Evaluation and Management (ASBREM) Community of Interest (CoI). (2017). Integrated DoD Biomedical Research and Development Strategy Medical Innovation for the Future Force. December 2017.

[iii] Integrated DoD Biomedical Research and Development Strategy: Medical Innovation for the Future Force; Prepared by the Armed Services Biomedical Research, Evaluation and Management (ASBREM) Community of Interest (CoI) December 2017.

[iv] Karl Friedl. Military applications of soldier physiological monitoring. Journal of Science and Medicine in Sport, vol. 21 no. 11, pp. 1147-1153, 2018.

[v] U.S. soldiers are revealing sensitive and dangerous information by jogging. Published by The Washington Post January 2018.

[vi] U.S. soldiers are revealing sensitive and dangerous information by jogging. Published by The Washington Post January 2018

[vii] US Army War College. Army Force Management Model: 2019-2020, How the Army Runs – A senior Leader Reference Handbook.

[viii] Anand, Santosh and Somnath Sinha. “24X7 Lifeline Chip for Soldiers.” International Conference on Recent Trends in Advanced Computing. 2019, ICRTAC 2019. Procedia Computer Science 165 (2019) 573–581.

[ix] Integrated DoD Biomedical Research and Development Strategy: Medical Innovation for the Future Force; Prepared by the Armed Services Biomedical Research, Evaluation and Management (ASBREM) Community of Interest (CoI) December 2017.

[x] Integrated DoD Biomedical Research and Development Strategy: Medical Innovation for the Future Force; Prepared by the Armed Services Biomedical Research, Evaluation and Management (ASBREM) Community of Interest (CoI) December 2017.

[xi] Hoyt R. W and Friedl K. E. The Future of Wearable Tech. U.S Army, 2016.

[xii][xii] Hoyt R. W and Friedl K. E. The Future of Wearable Tech. U.S Army, 2016.


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