Digital Wargames to Enhance Military Medical Evacuation Decision-Making

Medical evacuation is one of the United States Army's most storied and critical mission sets, responsible for efficiently and expediently evacuating the battlefield ill and injured. Medical evacuation planning involves designing a robust network of medical platforms and facilities capable of moving and treating large numbers of casualties. Until now, there has not been a medium to simulate these networks in a classroom setting and evaluate both offline planning and online decision-making performance. This work describes the Medical Evacuation Wargaming Initiative (MEWI), a three-dimensional multiplayer simulation developed in Unity that replicates battlefield constraints and uncertainties. MEWI accurately models patient interactions at casualty collection points, ambulance exchange points, medical treatment facilities, and evacuation platforms. Two operational scenarios are introduced: an amphibious island assault in the Pacific and a Eurasian conflict across a sprawling road and river network. These scenarios pit students against the clock to save as many casualties as possible while adhering to doctrinal lessons learned during didactic training. We visualize performance data collected from two iterations of the MEWI Pacific scenario executed in the United States Army's Medical Evacuation Doctrine Course. We consider post-wargame Likert survey data from student participants and external observer notes to identify key planning decision points, document medical evacuation lessons learned, and quantify general utility. Results indicate that MEWI participation substantially improves uptake of medical evacuation lessons learned and co-operative decision-making. MEWI is a substantial step forward in the field of high-fidelity training tools for medical education, and our study findings offer critical insights into improving medical evacuation education and operations across the joint force.