General Maxwell R. Thurman

The major goals of the Army combat health support (CHS) S&T program are three: first, to prevent illness and injury; second, to sustain optimum military effectiveness; and third, to treat casualties. The greatest payoff from the investment in CHS S&T comes from the identification of medical countermeasures that eliminate health hazards. Preventive measures include biomedical technologies, information and materiel to protect the force from infectious disease, environmental injury, health hazards of combat systems, operational stress, and aggressor weapons (i.e., conventional, chemical, biological, and directed–energy systems).

Biomedical research provides vaccines, pretreatment drugs, and training strategies that maximize the readiness of soldiers to deploy and fight. Biomedical research assists leaders in optimizing warfighting capabilities across the full continuum of conflict, from peacekeeping to high–intensity combat. Biomedical research also provides the means to maximize far–forward diagnosis, treatment, and return–to–duty of combat casualties. Medical contributions unique to the military include such items as field–deployable diagnostic kits, vaccines and antidotes for chemical and biological warfare threat agents, resuscitative devices for field use, and enhanced medical evacuation platforms.

Key points in developing CHS are the scenario and METT–T, as well as the medical intelligence assessment of the battlefield, which includes threats to the health of the soldier. The probability for success of the force during operations will be greater if the force is psychologically, physically, and nutritionally fit; protected from illness through a vigorous vaccination program; and sustained through state–of–the–art medical care as limited by the battlefield environment. As battle and nonbattle health threats are reduced, casualties and force requirements will be reduced correspondingly. Fulfilling the vision of the Army modernization objectives will require significant input from the military CHS S&T community. Examples of biomedical technologies impacting Army operations are: vaccines, pretreatments, and treatments against endemic infectious diseases and CB threat agents; nutritional strategies; medical information products; environmental and behavioral performance models; improved capability for far–forward surgical stabilization of combat casualties; enhanced ground and aeromedical evacuation; and medical telepresence technologies.

The capabilities of CHS S/SU/ACs supporting Army modernization objectives appear in Table III–20.

Modernization efforts are organized into four functional areas: infectious diseases of military importance, medical chemical and biological defense, combat casualty care, and Army operational medicine. Efforts focus on the development of medical materiel, through a DoD drug and vaccine program, for countering potential mission–aborting infectious diseases as well as chemical and biological warfare agents. Such drugs and vaccines are not normally developed by the U.S. pharmaceutical industry, because there is little or no civilian market for them within the industrialized nations and they are typically unprofitable. Additional emphases of the biomedical program include technologies supporting far–forward casualty treatment; individual sustainment (self–aid devices and techniques) to reduce the severity of ballistic injuries; topical

skin protectants; and forward–deployable, transportable medical devices, and multipurpose systems for advanced resuscitation, life support, and resuscitative surgery. The modernization strategy also addresses nutritional, biomechanical, and physiological approaches to minimize the impact of military operational stresses that degrade the capabilities of, or render inoperable, the human component of combat systems.

The development of enabling technologies to maximize the benefits of telemedicine is a further objective of the CHS modernization strategy. In essence, telemedicine represents a horizontal integration of advanced medical technologies, inasmuch as efforts within each of the four functional areas identified above have the potential to contribute to expanded telemedicine capabilities. Present CHS S&T efforts relevant to telemedicine are concentrated in the combat casualty care and Army operational medicine functional areas.

Table III–21 presents a summary of demonstrations and S/SU/ACs listed in the combat health support modernization roadmaps (Figures III–12 through III–15). Army CHS S&T programs support a diversity of nonmateriel advanced development TDs. Unlike most nonmedical TDs, medical TDs must be conducted in a laboratory, rather than in the field, because of the regulatory requirements placed on medical materiel by the Department of Health and Human Services, through the U.S. Food and Drug Administration (FDA).

The FDA requires that medical products (e.g., vaccines, medical devices, drugs) demonstrate preclinical safety and efficacy prior to product evaluation in man. Thus, the medical system acquisition process has led to a tailored life–cycle system management model for medical materiel. It is in the TD phase of the medical materiel life cycle that technology candidates are fully evaluated for preclinical (prior to human use) safety and efficacy. The best candidates are then selected for transition. Descriptions of major TDs are provided on the following pages. Dates provided in the text reflect the timeline of the product from technology base research to development (milestone I), or, in the case of information products, to direct fielding to the user community.

Systems supported within this functional area are infectious disease vaccines, infectious disease pharmaceuticals, and infectious disease–applied medical systems. Vaccines provide a relatively inexpensive, extended protection against infectious disease threats. While they are the preferred mechanism of protection in most cases, and are an ultimate goal, they do not currently provide complete protection against all infectious diseases. Until such vaccines are available, the continual emergence of new resistant strains of infectious diseases necessitates the ongoing development of new antiparasitic drugs to replace existing products. Moreover, improved diagnostic capabilities are needed to enable early far–forward identification and appropriate management of diseases for which there is no current protection, and to facilitate global surveillance of emerging infectious diseases. The modernization roadmap for infectious diseases of military importance is shown in Figure III–12. Future demonstrations, which are shown in the roadmap, are funded, follow–on efforts to current technology demonstrations. Since the technology and direction of the future demonstrations will not be identified until closer to the start date, they are not explained in the following narratives. Innovative diagnostic and vaccine technology development in the infectious diseases functional area also supports and is supported by efforts in the medical, chemical, and biological defense area.

Antiparasitic Drug Program TD (1985–03). The effectiveness and safety of a variety of drugs from differing pharmacological classes will be demonstrated to provide prophylaxis and treatment against established and emerging forms of drug–resistant falciparum and vivax malarias and leishmaniasis. Several classes of drugs are being assessed for treatment and prophylaxis. Supports: Medical Prevention and Treatment of Malaria.

Malaria Vaccines TD (1985–02). Candidate vaccines against falciparum and vivax malarias will be demonstrated. Innovative vaccine technologies are being used to construct protective vaccines, including recombinant vaccines, naked DNA vaccines, and peptide vaccines. Supports: Medical Prevention and Treatment of Malaria.

Combined Malaria Vaccine TD (2003–08). The feasibility of a combined falciparum/vivax malaria vaccine that incorporates advanced vaccine technology, such as DNA vaccines, will be assessed. This vaccine will reduce logistical burden and simplify medical delivery. Supports: Medical Prevention and Treatment of Malaria.

Shigella Vaccines TD (1985–03). Candidate vaccines against each of the three principal causal Shigella species of dysentery will be demonstrated. Traditional vaccine technology using live attenuated (weakened) forms of the pathogen and a new vaccine technology, the proteosome/lipopolysaccharide vaccine system, will be demonstrated. Supports: Medical Prevention of Diarrheal Diseases.

Campylobacter Vaccine TD (1985–01). A vaccine to protect against Campylobacter will be demonstrated, using novel immune adjuvants. Two candidate vaccine strategies are being assessed: a killed, bacterial preparation and a live, attenuated organism. Supports: Medical Prevention of Diarrheal Diseases.

Enterotoxigenic Escherichia coli (ETEC) Vaccine TD (1985–01). Major protective antigens have been identified and recombinant DNA technology is being used to produce these components and combine them with a new form of adjuvant incorporated into biodegradable microspheres. Supports: Medical Prevention of Diarrheal Diseases.

Oral Multidisease Antidiarrheal Vaccine TD (2003–08). The feasibility of producing a more effective, combined oral vaccine to protect against Shigella, Campylobacter, and ETEC will be assessed. Advanced vaccine technology, such as recombinant or naked DNA technology, and advanced mucosal adjuvants will be demonstrated. This vaccine will be easily administered, thereby reducing medical and logistical support requirements. Supports: Medical Prevention of Diarrheal Diseases.

Figure III-12. Roadmap - Combat Health Support: Infectious Diseases of Military Importance
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Common Diagnostic Systems for Biological Threats and Endemic Infectious Diseases TD (1998–02). This demonstration is shared with the medical, chemical, and biological defense functional area. An immunologically based membrane platform will be demonstrated that requires no special instrumentation and is capable of rapidly detecting specific host immune responses to a broad range of etiologic agents, or detecting the antigens or products of these agents in clinical specimens. A polymerase chain reaction (PCR)–microchip system will also be demonstrated. The latter consists of coupling methodology to detect pathogen–unique DNA with microchip technology to produce an electronic readout. These technologies offer the potential to reduce development time and expense associated with individual assays, decrease logistical and training burdens, and improve medical care delivery forward. Supports: Medical Prevention and Treatment of Malaria, Medical Prevention of Diarrheal Diseases, Medical Prevention of Dengue Fever, and Early and Rapid Disease Threat Assessment.

Systems supported within this functional area are CW/BW casualty management, CW prophylaxes and treatments, and BW countermeasures. Efforts focus on the demonstration of medical products for prevention, treatment, diagnosis, and generation of medical knowledge for battlefield management of chemical and biological casualties. Vaccines are generally the products of choice for countering BW agents, owing to their relative simplicity of use and the maximum protection that they provide. In contrast, pharmaceuticals are better suited to counter CW agent threats because, as compared to BW agents, CW agents are much smaller in molecular size. Because of their smaller size, CW agents do not bind tightly to antibodies nor do they induce a protective antibody response.

Figure III-13. Roadmap - Combat Health Support: Medical Chemical and Biological Defense
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Biological Warfare Agent Confirmation Diagnostic Kit (BWCDK) TD (1996–00). Capability to confirm the initial field diagnosis obtained with the forward–deployable diagnostic kit will be demonstrated. This kit will employ immunodiagnostic reagents directed against independent biological markers, and will provide greater specificity and sensitivity. Supports: CW/BW Casualty Management System.

Common Diagnostic Systems for Biological Threats and Endemic Infectious Diseases TD (1998–02). This demonstration is shared with the Infectious Diseases of Military Importance functional area (see description under this functional area). Supports: CW/BW Casualty Management System.

Advanced Anticonvulsant TD (1995–99). Safety and efficacy of an anticonvulsant component for the soldier/buddy nerve agent antidote will be demonstrated. This advanced anticonvulsant will overcome deficiencies in the current anticonvulsant, enhance nonrecurrence of seizures, and protect against nerve agent–induced, seizure–related brain damage. Compounds from a variety of pharmacological classes with known anticonvulsant or other relevant neuroactive properties will be screened to identify a drug with relatively pure anticonvulsant actions for inclusion in the existing treatment regime. Supports: Full–Spectrum Chemical Protection.

Reactive Topical Skin Protectant/Decontamination (rtsp/Decon) TD (1995–01). A reactive component for a topical skin protectant that will provide protection against penetration of agent and will detoxify both vesicant and nerve chemical warfare agents will be demonstrated. Efforts will explore the use of enzymes and other catalytic molecules and resorptive resins. The rtsp/Decon will enable the soldier to fight in a chemical warfare battlefield with more complete protection and to effect decontamination procedures in a CW–contaminated environment. Supports: Full–Spectrum Chemical Protection.

Cyanide Pretreatment TD (1994–99). A methemoglobin formula will be demonstrated as an oral pretreatment to protect soldiers against battlefield levels of cyanide. Methemoglobin preferentially binds cyanide, removing it from the toxic active site, thereby restoring normal cellular respiration. The lead candidate is an 8–aminoquinoline that is undergoing safety tests. Supports: Full–Spectrum Chemical Protection.

Chemical Agent Prophylaxes TD (1995–01). A reactive/catalytic scavenger pretreatment will be demonstrated that reduces chemical agent toxicity without significant physiological or psychological side effects. Although treatment for nerve agent intoxication exists, the soldier is incapacitated following exposure and treatment. Development of an effective catalytic scavenger would relieve the commander and soldier of having to rely on a multidrug approach to treatment of nerve agent exposure, thereby significantly enhancing recovery. Current efforts focus on the use of a molecularly engineered form of butyrylcholinesterase, an enzyme found in blood, which normally binds to nerve agents. Supports: Full–Spectrum Chemical Protection.

Medical Countermeasures Against Vesicant Agents TD (1996–02). New technologies for prophylaxis, pretreatment, and treatment will be demonstrated that will provide significant protection against vesicant injury. This effort will yield a vesicant agent countermeasure that will prevent or decrease the severity of injuries, and substantially reduce casualties and the subsequent medical burden. Protease inhibitors and novel antiinflammatory drugs have shown promising results in early studies and are among the leading candidates for transition. Supports: Full–Spectrum Chemical Protection.

Medical Countermeasures for Yersinia pestis TD (1994–98). Efficacy and safety will be demonstrated for a novel vaccine based on a fusion protein, produced through molecular recombination and expression of the genes for two different proteins of the pathogen. This vaccine will protect 80 percent of immunized personnel against an aerosol challenge of Yersinia pestis. Supports: Multiagent Protective System.

Medical Countermeasures for Brucellosis TD (1994–99). This demonstration will compare two candidate vaccine technologies: a mutant live–cell vaccine, and an acellular vaccine based on surface glycoproteins of the pathogen. Safety and efficacy sufficient to protect 80 percent of immunized personnel against an aerosol challenge of Brucella will be shown. Supports: Multiagent Protective System.

Medical Countermeasures for Encephalomyelitis Viruses TD (1996–00). Efficacy and safety will be demonstrated for a set of vaccines directed against various members of the encephalomyelitis viruses, a group of viruses that cause disorientation, convulsions, paralysis, and death. Site–directed mutagenesis—a molecular biological technique that induces specifically designed mutations in essential genes of the pathogen—will be used to produce organisms that will elicit a protective immune response without causing disease. Supports: Multiagent Protective System.

Medical Countermeasures for Filoviridae TD (1998–03). Safe and effective countermeasures against filoviruses, including Marburg and Ebola viruses, will be demonstrated. Naked DNA vaccine technology is currently one of several technologies offering promise for protection against these and other BW threat agents. This technology uses DNA fragments from pathogens of interest, which are then injected into the cells of the outer layer of skin using gene gun technology. In the skin cells, the cell’s protein production machinery produces proteins from the pathogen DNA, which then elicits an immune response that can later protect against the live pathogen. Because only portions of the pathogen DNA are used in the vaccine, no live organism is produced during the vaccination process, and the injected DNA is later eliminated as skin cells normally slough off. Supports: Multiagent Protective System.

Medical Countermeasures for Variola TD (1997–00). This demonstration will assess the use of human monoclonal antibodies to replace vaccinia immune globulin in providing passive (short–term) immunity. Antiviral drugs for post–exposure treatment will also be screened to identify effective countermeasures. These studies will not use variola itself, but will instead employ an appropriate orthopox virus substitute. Supports: Multi–Agent Protective System.

Medical Countermeasures for Botulinum Toxin TD (1994–98). A vaccine will be demonstrated that will protect 80 percent of immunized personnel against an aerosol challenge of the toxin, provide protection against all significant serotypes, and induce a minimum reactogenicity in immunized soldiers. The vaccine to be demonstrated has been developed using recombinant DNA technology to produce a bioengineered product that has lost its toxic properties, yet still elicits a protective immune response. This bioengineered product is expected to be safer to produce, less reactogenic in man, and more affordable than vaccines produced with other technologies. Supports: Multiagent Protective System.

Medical Countermeasures for Ricin TD (1998–99). This effort will demonstrate efficacy and safety of a second–generation vaccine against ricin. The vaccine candidate is based on a modified portion of the ricin molecule. Supports: Multiagent Protective System.

Recombinant Staphylococcal Enterotoxin B (SEB) Vaccine TD (1994–00). A bioengineered vaccine will be demonstrated that will protect 90 percent of immunized animals against a lethal and incapacitating aerosol challenge of SEB. This second–generation recombinant product will offer potential safety and affordability advantages over the first–generation product. Supports: Multiagent Protective System.

Multiagent Vaccines for Biological Threat Agents TD (1998–02). Vaccine candidates will be demonstrated that will concurrently provide protective immune response against a range of biological threat agents. Combination vaccines offer an approach to immunization that reduces the number of injections, minimizes required medical support, and lowers costs. Recombinant DNA vaccine technology offers the possibility of combining gene products from multiple agents into a single delivery vehicle. Candidate vaccine technologies to be assessed will include naked DNA technologies (as discussed above) and a replicon system. The latter is a vectored system in which portions of the pathogen genes are combined with a portion of viral DNA that allows the bioengineered DNA to be introduced into cells by the normal viral mechanisms and replicated a single time, after which it is eliminated. Supports: Multiagent Protective System.

Blood Loss/Resuscitation TD (1993–04). This demonstration will provide information and transition products to development to enhance capabilities for control of and resuscitation from hemorrhage. This will include the use of commercially available local hemostatic agents, improved thawed or fresh blood preservatives, a field–portable fluid infusion–warming device for the battlefield, an improved platelet preservative or platelet substitute, and a second generation plasma substitute. Supports: Advanced Resuscitation.

Secondary Damage After Hemorrhage TD (1993–04). This demonstration will reduce the complications resulting from massive blood loss or major injuries, including measures to minimize irreversible damage during potentially prolonged evacuation. This will include a pharmacological intervention capable of blocking the early steps in development of brain or spinal cord injury that occur secondarily to trauma, a pharmacological intervention that will reduce ischemia/reperfusion injury, intervention that will prevent or reduce trauma–induced immunosuppression and related sepsis, intervention that interrupts the immunological and biochemical events leading to cell death and organ failure after hemorrhage or major trauma, and intervention for far–forward use that reduces the metabolic demands of casualties. Supports: Advanced Resuscitation.

Forward, Mobile, Digitally Instrumented Surgical Hospital TD (1996–06). This includes the development of the advanced surgical suite for trauma casualties (ASSTC) mobile hospital and systems for casualty management. The ASSTC will allow for surgical intervention in far–forward areas. Supports: Immediate Intervention and Continuum of Care.

Warrior Medic TD (1997–07). This demonstration seeks to integrate various medically oriented, advanced sensor technologies with data integration, calculation, and decision algorithms for the individual soldier, and route the communications through the computer common to all 21st century land warriors (21 CLW). The approach is to develop medical overlays to the tactical computing/communicating capability already under development, to assess injury prognoses, and to compare post–injury to pre–injury data. Supports: Immediate Intervention and Continuum of Care.

Far–Forward Medical/Surgical Devices TD (1993–07). This demonstration includes the life support for trauma and transport (LSTAT), low–temperature sterilization system, self–contained ventilator, electrochemical sterilization system, and far–forward suction apparatus. Supports: Immediate Intervention and Continuum of Care.

Figure III-15. Roadmap - Combat Health Support: Army Operational Medicine
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Continuous Operations (CONOPS) Nutrition and Metabolic Requirements TD (1992–02). This demonstration will include identification of physiological limitations and approaches to extend these limitations during stressful and intensive continuous operations; determination of how to prepare and restore muscle and liver energy stores and how to deliver the optimal metabolic fuels to the soldier to prevent degradation in physical and cognitive performance (e.g., combinations of hormones, drugs, creatine, specific amino acids, carbohydrate drinks); identification of neurotransmitter precursors (e.g., tyrosine food bar) or enhancers (e.g., slow–release caffeine) to sustain soldier cognitive function during stressful and demanding operations in adverse environments; and assessment of the feasibility of enhanced physiological recycling of body water, nitrogen, and minerals to sustain performance and lean mass in isolated adverse environments with minimal resupply. Information will transition to Soldier Systems Command ration developers, the Army Medical Department Center and School (AMEDD C&S), and dismounted battlespace battle laboratories (DBSBLs). Supports: Soldier Survival in CONOPS Without Performance Decrements

Optimization of Biomechanical Performance TD (1992–02). This demonstration will include: determination of soldier physical characteristics (e.g., strength performance and distribution of muscle mass) and ideal equipment characteristics for materiel designed to fit the soldier (e.g., load carriage systems, body armor, combat boots) to optimize physical health and performance; development of specialized physical training programs to enhance performance capabilities and reduce injury of soldiers in specific tasks (e.g., feasibility of neck and back strengthening to accommodate helmet–supported equipment in repetitive jolt environments); identification of factors involved in bone and muscle remodeling during intensive new training; and development of strategies to enhance strength capabilities and reduce stress fractures and other musculoskeletal injuries during training. Information will transition to combat developers, TRADOC, and Soldier systems command. Supports: Soldier Survival in CONOPS Without Performance Decrements.

Wake/Rest Enhancement Strategies TD (1992–99). The efficacy of pharmacological and behavioral interventions to counteract the effects of inadequate restorative sleep and to enhance soldier vigilance and performance during sustained and continuous operations will be demonstrated. Efficacy of new compounds to induce sleep, enhance the restorative value of sleep (e.g., the sleep induction and rapid reawakening system), and resynchronize body rhythms following rapid deployment across multiple time zones (e.g., melatonin) will also be demonstrated. Specifications will be developed for new measurement devices to provide rapid, reliable, and inexpensive means for assessing a soldier’s level of mental fatigue and alertness (e.g., actigraphy, brain wave activity). Efforts will also improve guidance for individual, aircrew, and other unit performance as a function of sleep/wake rest cycles. Supports: Soldier Survival in CONOPS Without Performance Decrements.

Deployment Stress Countermeasures TD (1992–02). This research will provide the means to reduce stress casualties in future deployments by fielding information and biomedical products to counteract the effects of operational stress on military performance, including means to predict, prevent, assess, and treat battle stress casualties. Methods will be developed to give human dimension teams the capability to provide commanders with statistically valid information on unit stress levels within 72 hours of data collection, and give recommendations for use in operational planning, focused command intervention, and focused intervention by combat stress control teams. This information will transition to the AMEDD C&S and the DBSBL. Supports: Real–Time Soldier Effectiveness Models.

Performance Limits in Extreme Environments TD (1992–01). Models will be developed and validated to predict the effects of heat, cold, high altitude, hydration, nutritional status, clothing, and individual equipment on military performance in extreme operational environments. These models will be based on real physiological and psychological data collected during training, as well as operational deployments and advances in the understanding of human responses to multiple stressors. The models will be integrated into command consultation systems in conjunction with the Warfighter Readiness and Sustainability research effort to provide commanders with models for battlefield planning enabling them to "own the environment." New performance criteria will be developed for medical screening based on visual and auditory requirements on the battlefield. Supports: Real–Time Soldier Effectiveness Models.

Warfighter Readiness and Sustainability TD (1996–03). Specifications, physiological models, and algorithms will be developed for a family of wear–and–forget noninvasive soldier sensors that together provide an information system for commanders on the physiological readiness of their own soldiers (e.g., alertness, hydration status, unit integrity). Physiologic sensors connected through a wireless body local area network will be used to establish databases and algorithms for soldier norms and to identify the edge of the health and performance envelope in extreme operational environments. These data will be organized and reduced through a system of knowledge engineering to refine predictive models and to identify the minimal sensor set that will be necessary and compatible with the 21 CLW and follow–on programs. Telemetric transmission of basic medical information from individual soldiers will be made available to commanders in concise form to enhance battlefield situational awareness, and this will form a continuum that transitions to the medic following casualty detection, with telemedicine linkages to far–forward medical assets for early triage of casualties. Supports: Real–Time Soldier Effectiveness Models.

Deployment Toxicology Assessment Methods TD (1998–02). Simple, rapid, and integrated hazard assessment and toxicant exposure tools will be developed, based on biosentinel species and bioassays that are durable in field use. The initial emphasis is on complex mixtures of chemicals with neurotoxic effects that immediately threaten military performance in deployed soldiers. Near–real term bioassays methods will transition to more advanced electronic "canaries" and a family of individual soldier bioelectronic sensors that will provide early warning against health and performance hazards. Supports: Real–Time Soldier Effectiveness Models.

Laser Bioeffects and Treatment TD (1992–02). This research will provide a database of ocular bioeffects for harmful laser frequency/power mixes and guide development of more effective field protection against laser systems. More effective treatments of laser eye injury will be demonstrated, and drugs and medical equipment to assist in treatment of laser eye injury will be identified for fielding. Information will be transitioned to the AMEDD C&S. Supports: Biomedical and Performance Damage Risk Criteria.

Whole Body Blast Bioeffects/Blunt Trauma Models TD (1992–02). A damage risk criteria model for auditory and nonauditory effects of blast will be validated, which will provide scientifically based criteria to support safe fielding of high–powered weapons systems. A finite elements model of blunt trauma will also be developed, which will extend the blast model to provide valid health risk probabilities associated with kinetic nonlethal weapons (e.g., stun grenades, rubber bullets), including torso, head, and extremity injury predictions. Supports: Biomedical and Performance Damage Risk Criteria.

Mechanical Stress and Helicopter Crew Protection TD (1992–02). New safety criteria and countermeasures to biomechanical hazards in the man–machine interface for operational combat crews will be demonstrated, based on head injury impact models and spine compression from vertical impacts typically encountered in helicopter crashes and in repetitive jolt in military vehicles and tanks. A jolt and repeated impact model of neck injury will be validated to improve the safe design of helmet–mounted equipment. Supports: Biomedical and Performance Damage Risk Criteria.

To support the Combat Health Support modernization annex of the AMP, new generations of medical systems and products will be tested for technical feasibility and operational utility. Primary emphasis will be placed on capabilities to minimize casualties through improved protection and prevention, as well as to reduce treatment time for soldiers incapacitated by disease or injury. The relationship of the Combat Health Support S/SU/ACs and other AMP annexes is shown in Table III–22.