467

The Impact of a BIG DATA

Decision Support Tool
on Military Logistics:
MEDICAL ANALYTICS MEETS THE MISSION

Felix K. Chang, Christopher J. Dente,

and CAPT Eric A. Elster, USN

Using big data and predictive analytics, more segments of the U.S. military
will be able to create decision support tools that help them not only to carry
out their missions more efficiently, but also to streamline their logistical
requirements. Within the military’s medical community, the Surgical Crit-
ical Care Initiative (SC2i) created one such tool that enables physicians to
accurately assess the need for massive blood transfusions. To quantify the
impact that tool could have on military logistics, SC2i developed a combat
model that simulated a military campaign between NATO and Russian
forces in eastern Poland and the Baltics. SC2i found that its tool would
reduce NATO’s blood product consumption by 71,459 units, eliminating
the need for 110 helicopter resupply missions and saving 25,740 gallons of
fuel and 129,366 pounds of airlift capacity.

DOI: https://doi.org/10.22594/dau.16-769.24.03
Keywords: Predictive Analytics, Combat Modeling, Decision Science, SC2i
The Impact of a Big Data Decision Support Tool on Military Logistics http://www.dau.mil

Military logisticians have long recognized the efficiency of using deci-

sion support tools to streamline logistical systems. In the 1970s, the U.S.
military began using automated linear-programing software to better stock
and distribute military materiel. Usage of such tools gradually expanded to
include those involved in the acquisition, maintenance, and distribution of
parts for large and complex military systems. Hence, logisticians and those
who were responsible for such systems came to take a leading role in devel-
oping many of the military’s most robust decision support tools.

Logistical Benefits from Nonlogistical

Decision Support Tools
If the U.S. military is to further streamline its logistics, logisticians
should encourage other segments of the military to enhance their own
capabilities through the greater use of big data-driven decision support
tools. Such tools can increase efficiency not only in opera-
tional units, but also in the logistics that support them.
Any reduction in the volume and weight of sup-
plies (particularly perishable ones) needed for
operational units to achieve their missions
imparts added resilience to existing logis-
tical capacity.

Today, the cost and time needed to

develop new decision support tools are
steadily decreasing, especially when
developed with machine-learning
technology rather than human stat-
isticians alone. As a result, many
segments of the military, which have
not historically used big data or pre-
dictive analytics, can more easily do
so now.

One of those segments has been the

U. S. m i lita r y ’s medica l com munit y.
Traditionally, military medical researchers
exclusively focused their energies on improving
the care of wounded warfighters. Now they have
begun to use the growing amount of data from clinical
records, laboratory tests, and electronic medical monitors

470 Defense ARJ, July 2017, Vol. 24 No. 3 : 468–487

 July 2017

to create clinical decision support (CDS) tools that serve dual purposes.
While the new tools still help physicians better treat their patients, what
often goes unnoticed is that those tools also create substantial logistical
benefits. The Surgical Critical Care Initiative (SC2i)—a leading U.S. military
health research program in the development of CDS tools—conducted this
study to describe the medical impetus behind one such tool and to quantify
its clinical and logistical benefits (Buchman et al., 2016; Military Health
System Communications Office, 2016).

Measuring the Benefits of a Clinical

Decision Support Tool
Over the last decade, medical studies have demonstrated how mas-
sive infusions of blood products can improve the clinical outcomes of
patients with traumatic injuries (Allcock et al., 2011; Maciel et al., 2015;
McDaniel, Etchill, Raval, & Neal, 2014; O’Keeffe, Refaai, Tchorz, Forestner,
& Sarode, 2008). Those infusions are called massive transfusion protocols
(MTP). They typically involve the infusion of large quantities of red blood
cells (RBC), fresh frozen plasma (FFP), platelets, and cryoprecipitate in a
fixed ratio.

Recognizing the clinical value of MTPs, military physicians actively used

them to treat wounded warfighters during the latter stages of Operations
Enduring Freedom and Iraqi Freedom (Beekley, Bohman, & Schindler,
2012, p. 25). Fortunately, sufficient blood products were on hand at the Level
III military hospitals supporting those operations to handle the increased
demand. Yet, that was largely because those operations produced relatively
low casualty rates, particularly after 2007. Higher casualty rates would
have quickly drained the blood product inventories of those hospitals, given
their limited blood storage capacities and the perishability of the blood
products themselves.

Further complicating matters, the medical assessment as to whether a

patient needs an MTP is complex to make, even for well-trained physicians.
It is an assessment that forces them to weigh multiple disparate factors
related to a patient’s acuity and mechanism of injury. Many physicians get
it wrong (Wijaya, Cheng, & Chong, 2016). They needlessly activate MTPs
and waste blood products in the process.

To reduce that wastage, SC2i developed a CDS tool that enables physicians
to quickly and accurately identify which patients require an MTP based
on their individual anatomic and biological data. Atlanta’s largest trauma

Defense ARJ, July 2017, Vol. 24 No. 3 : 468–487 471

 center, which annually treats nearly a thousand patients with penetrating
wounds, is now using SC2i’s MTP CDS tool in a prospective observation
trial. A study at the trauma center concluded that such a tool could lower
the MTP activations by as much as 17.9 percent while maintaining posi-
tive clinical outcomes (Dente et al., 2010; Shaz, Dente, Harris, MacLeod,
& Hillyer, 2009).

Such blood product savings clearly make blood banks more efficient
(Haldiman, Zia, & Singh, 2014; O’Keeffe et al., 2008). They also provide the
U.S. military with other benefits, particularly when it is involved in high-in-
tensity combat. Keeping deployed Level III military hospitals, like the
U.S. Army’s combat support hospitals (CSH), fully supplied with blood
products requires a multitude of resources. Enabling physicians to more
accurately decide whether an MTP is necessary means that fewer blood
products would be wasted, which in turn means that military logistics
would need to resupply CSHs less often, freeing up logistical resources that
can support other medical or combat requirements.

Modeling Methods
To fully understand the scale of the benefits from SC2i’s MTP CDS
tool, it must be put into the context of a military campaign. The campaign
scenario that SC2i chose was based on one created for an unclassified
U.S. Department of Defense (DoD) contingency planning study in the
1990s (Tyler, 1992a; 1992b). SC2i’s scenario focused on Russia, the top
security concern of the last two chairmen of the U.S. Joint Chiefs of Staff
(Shinkman, 2015; Stewart & Alexander, 2015). It envisioned a broad-front
NATO military campaign to liberate eastern Poland and the Baltics after
a Russian invasion. That scenario turned out to be particularly relevant,
as variations of it have recently been used as the foundation for NATO’s
Sabre Strike exercise and DoD-sponsored wargaming (Sharkov, 2016;
Shlapak & Johnson, 2016).

SC2i developed that scenario into a combat simulation to estimate the vol-
ume and rate of casualties that a campaign would produce. Those results
were then fed into a casualty relevance model to determine the number of
daily casualties that would likely require an MTP. Finally, those casualty
figures enabled SC2i to assess the difference in daily blood product usage
with and without its MTP CDS tool, and ultimately the tool’s logistical and
operational benefits.

Combat simulation. Like the original DoD study, SC2i employed

Lanchester’s square law force-exchange framework to power its combat

472
simulation (Davis, 1990; Johnson, 1990; Kaufmann, 1992, pp. 57–59). That
framework is embodied in the equations below:

[( ( ]
Bt = B–
r 1/2
R e
(
(rb)1/2 t
+ B–
r 1/2 (
R e-(rb)1/2t .5
b1/2 b1/2

R = [(R– + (R– ].5

t
b1/2 (
B e(rb)1/2t
b1/2
B
( e-(rb) 1/2 t

r1/2
r1/2

B = NATO combat power

R = Russian combat power
b = NATO combat effectiveness
r = Russian combat effectiveness
t = Combat days from the start of the campaign

SC2i did, however, update three of the DoD study’s assumptions to better
reflect the modern combat conditions of its scenario (Table 1). Using those
updates, SC2i’s combat simulation calculated the number of likely casualties
to be generated each combat day (i.e., a day in which all forces are engaged)
over the course of its campaign scenario. In total, the simulation estimated
that NATO would suffer 33,806 casualties, of whom 6,938 would be killed
in action (KIA) and 26,868 wounded in action (WIA), before it achieved
victory over its Russian foe (Table 2).

TABLE 1. COMBAT SIMULATION ASSUMPTIONS

Surgical Critical
U.S. Department
Assumption Care Initiative, Rationale
of Defense, 1992
2017
NATO and Standing militaries in
Russian division NATO and Russia are
equivalents 24 15 smaller today than
modeled in the they were during the
combat simulation Cold War

Technological gap
between NATO
and Russian forces
Combat power
has narrowed,
ratio between
1.4 1.1 because the pace
NATO and Russian
of Russian military
forces
modernization has
oustripped NATO’s
over the last decade

Combat formations
Percentage of
are rendered
enemy forces
100% 50% ineffective well
destroyed to
before they are
achieve victory
completely destroyed

473
474
TABLE 2. COMBAT SIMULATION RESULTS
Russian
NATO Combat Russian Combat NATO NATO Killed in NATO Wounded Russian Russian Killed
Combat Day (t) Wounded
Power (B t) Power (R t) Casualties Action in Action Casualties in Action
in Action

0 16.50 15.00 0 0 0 0 0 0
1 16.35 14.67 1,754 360 1,394 3,286 674 2,612
2 16.21 14.35 1,714 352 1,362 3,255 668 2,587
3 16.06 14.02 1,677 344 1,333 3,227 662 2,565
4 15.93 13.70 1,638 336 1,302 3,199 657 2,542
5 15.79 13.39 1,601 329 1,272 3,172 651 2,521
6 15.66 13.07 1,563 321 1,242 3,145 645 2,500
7 15.53 12.76 1,527 313 1,214 3,119 640 2,479
8 15.40 12.45 1,489 306 1,183 3,093 635 2,458
9 15.28 12.14 1,454 298 1,156 3,068 630 2,438
10 15.16 11.84 1,417 291 1,126 3,044 625 2,419
11 15.04 11.54 1,381 283 1,098 3,020 620 2,400
12 14.93 11.24 1,346 276 1,070 2,998 615 2,383
13 14.82 10.94 1,310 269 1,041 2,974 610 2,364
14 14.71 10.64 1,276 262 1,014 2,953 606 2,347
15 14.61 10.35 1,240 254 986 2,932 602 2,330
16 14.50 10.06 1,206 248 958 2,911 597 2,314
17 14.40 9.77 1,172 241 931 2,891 593 2,298
18 14.31 9.48 1,138 234 904 2,871 589 2,282
19 14.21 9.20 1,104 227 877 2,852 585 2,267
20 14.12 8.92 1,071 220 851 2,834 582 2,252
21 14.04 8.63 1,037 213 824 2,816 578 2,238
22 13.95 8.35 1,003 206 797 2,799 574 2,225
23 13.87 8.08 971 199 772 2,782 571 2,211
24 13.79 7.80 938 193 745 2,766 568 2,198
25 13.71 7.52 906 186 720 2,750 564 2,186
26 13.64 7.25 873 179 694 2,735 561 2,174

Total 33,806 6,938 26,868 77,492 15,904 61,588

 Casualty relevance model. SC2i’s model then iteratively narrowed
down which among those estimated casualties would likely be candidates
for a massive transfusion. First, the model distinguished between all those
casualties who were either KIA or returned to duty (RTD) before they were
treated at a hospital, from those WIA who were treated at a hospital, since
only hospitalized patients could receive a massive transfusion. To ascertain
how many casualties were likely to be KIA, RTD, and treated WIA, SC2i
sought data from a historical campaign wherein its high-intensity
combat mirrored what NATO could expect to encounter during
its campaign scenario. Hence, SC2i selected the experience
of the U.S. First and Third Armies in eastern France
and Germany during World War II. Both armies fought
over terrain and were exposed to the type and volume
of munitions that NATO forces would likely face in
eastern Poland and the Baltics.

From 1944 to 1945, the U.S. First and Third

Armies suffered 752,396 casualties. Of those,
152,359 casualties were KIA (or 20.2 per-
cent of the total) and approximately 150,000
(or 19.9 percent of the total) were RTD. The
remaining 450,037 (or 59.8 percent of the total)
were WIA who were treated at field hospitals
(Holcomb, Stansbury, Champion, Wade, & Bellamy,
2006; Reister, 1975, p. 4). Using those historical per-
centages, SC2i’s model determined the number of
treated WIA each combat day of its scenario.

Second, the model sought to ascertain which among

those treated WIA would have received wounds severe
enough to prompt physicians to consider using a massive
transfusion. To do so, SC2i examined the impact that casu-
alty-causing agents could have in producing such wounds.
Again, SC2i turned to the experience of the U.S. First and Third
Armies. Military records from the two armies revealed that of their
combined 217,070 wounded, 24.6 percent suffered wounds from small
arms, 60.2 percent from shell fragments, 3.2 percent from blasts, 4.9 percent
from bombs, 1.2 percent from burns, and 5.9 percent from all other casual-
ty-causing agents (Beyer, Arima, & Johnson, 1962; Beyer et al., 1962, p. 77).
Judging that small arms, shell fragments, blasts, and bombs would be the
most relevant agents, SC2i used their historical incidence to better estimate
the number of likely MTP candidates.

475
 To improve on that estimate, SC2i studied the likely severity of wounds
based on their physical locations. Once again, SC2i sought data from a
historical campaign. This time, however, it had to choose one in which
American troops were not only engaged in sustained high-intensity combat,
but also equipped with body armor commensurate with that of their poten-
tial modern contemporaries. SC2i chose the experience of the U.S. Eighth
Army during the last year of the Korean Conflict. Of the U.S. Eighth Army’s
casualties who wore body armor, 14.2 percent suffered wounds to the head,
2.7 percent to the neck, 4.7 percent to the chest, 4.0 percent to the upper
back, 9.2 percent to the lower back, 1.6 percent to the abdomen, 34.6 percent
to an upper extremity, 28.4 percent to a lower extremity, and 6.0 percent to
the genitalia (Herget, Coe, & Beyer, 1962, p. 733). SC2i then asked physicians
from Walter Reed National Medical Center and the Uniformed Services
University of the Health Sciences to assess the likelihood that wounds in
those areas of the body would be severe enough to warrant the consideration
of a massive transfusion. The combination of historical data and physicians’
assessments enabled SC2i to further refine its model. Ultimately, it found
that 11,556 wounded—about one-third of the total casualty population—
would be likely MTP candidates.

Logistical benefits model. With an estimate of likely MTP candidates

each combat day, SC2i’s model could determine the daily demand for blood
products. It could also determine the difference in that demand with and
without the use of SC2i’s MTP CDS tool, and thus calculate the blood prod-
uct savings that the tool could generate. However, before the model could
do so, it required a few programmed assumptions. It assumed that NATO,
following doctrine, would assign one CSH to each of its five three-division
corps (Lewis et al., 2010, p. xi). It also assumed that NATO would adopt
SC2i’s MTP blood product ratio of 16.5 units of RBC, 9.8 units of FFP,
0.9 apheresis of platelets, and 7.2 units of cryoprecipitate as its standard
massive transfusion protocol, rather than the U.S. Armed Services Blood
Program (ASBP)’s suggested blood product ratio (Departments of the Army,
Navy, & Air Force, 2011, p. 43). SC2i did so to ensure that its model could
make a clear-cut comparison of blood product demand with and without
the use of its tool.

Moreover, SC2i’s model had to contend with the fact that blood products are
consumed by not only wounded who require MTPs, but also those who do
not. To account for the latter’s use, SC2i assumed that they would consume
the ASBP’s suggested ratio of 3.0 units of RBC, 1.6 units of FFP, and 0.15
apheresis of platelets per patient.

476
SC2i’s model also had to consider the inventory of blood products that
each CSH would initially carry with it in-theater. The model assumed that
each CSH would deploy with an inventory of 300 units of RBC, 100 units
of FFP, 24 apheresis of platelets, and 100 units of cryoprecipitate, which
is consistent with the recommendations found in Emergency War Surgery
(Department of the Army, 2013). Of course, that does not always happen.
When the 31st CSH deployed to Iraq in 2010, it stocked only 180 units of
RBC, 160 units of FFP, and 90 units of cryoprecipitate (Luschinski, 2011).

As the technology needed to capture and analyze

big data becomes more widely available and at
ever-lower cost, even military elements not directly
engaged in logistics can create new decision support
tools—tools that not only enable them to more
efficiently carry out their missions, but also reduce
their logistical footprints.

Even so, given the high casualty rate of its combat simulation, SC2i’s model
expected that all of the deployed CSHs would quickly exhaust their blood
product inventories. As in the past, CSHs would call upon in-theater blood
donors to replenish some of their blood supplies. SC2i estimated that such
“walking blood banks” would provide 1,200 units of RBC every combat day
across all five CSHs. NATO would have to source the remaining blood product
shortfall from outside the theater, most likely from the ASBP’s blood reserve
in the continental United States (Armed Services Blood Program, n.d.).

The task of resupplying the CSHs with fresh blood products would then
fall on U.S. military logistics. Transporting such perishable supplies from
the United States to CSHs near the frontline requires a considerable effort.
It begins with the packaging of blood products into ASBP-standard ship-
ping containers. The containers are then assembled into groups of 120 and
placed on pallets—those carrying RBC weighing 5,400 pounds and those
carrying other blood products weighing 4,680 pounds (Departments of the
Army, Navy, & Air Force, 2007, p. 41; 2011, pp. 45–46). U.S. Air Mobility
Command (AMC) would then transport those pallets into theater airheads
where blood distribution detachments would divide the pallets into smaller
blood product shipments and route them to corps-level airfields. From there,
UH-60 MEDEVAC helicopters would fly the shipments on blood product

477
 resupply missions to individual CSHs, as they have done in every U.S. mil-
itary campaign since the Persian Gulf Conflict (Cholek & Anderson, 2007;
Department of Defense, 1992, p. 463; Department of the Army, 2005, p. H-6).

Since UH-60 pilots are generally required to hold a 20- to 30-minute fuel
reserve, a UH-60 operating at its maximum range would be expected
to consume about 85 percent of its 360-gallon internal fuel load (IHS
Jane’s, 2008; M. Crivello, personal communication, December 26, 2014).
Since not all blood product resupply missions require UH-60s to operate
at their maximum range, SC2i’s model estimated that the average blood
product resupply mission would consume only 65 percent of their internal
fuel load.

According to the ASBP, each UH-60 MEDEVAC helicopter can carry up

to 50 standard shipping containers (Departments of the Army, Navy, &
Air Force, 2011, p. 44). While that might be true for empty helicopters,
MEDEVAC helicopters operating in combat would be loaded with armor,
racks, and medical equipment. Given the large number of wounded that
would require battlefield evacuation during a high-intensity conflict, UH-60
crews are unlikely to reconfigure their helicopters to fly an occasional blood
product resupply mission. Moreover, a veteran pilot revealed that the most a
combat-configured UH-60 MEDEVAC helicopter could carry is 30 standard
shipping containers (Ginn, Ferencz, & Marble, 2008; M. Crivello, personal
communication, May 7, 2015). Hence, that is the number SC2i’s model used.

By linking the blood products’ savings that SC2i’s MTP CDS tool could
produce with the resources that would have been needed to transport the
products to CSHs in the field, SC2i’s model quantified the logistical benefits
that would accrue from the tool over the course of its campaign scenario.

Modeling Results
Impact on blood product usage. Given that SC2i’s MTP CDS tool was
principally designed to support medical decision making, it is no surprise
that the tool improves the treatment of critically injured patients. It allows
physicians to quickly and accurately determine whether such patients
require an MTP, enabling them to reap the full clinical benefit from an early
MTP activation. In so doing, the tool also reduces the number of unneeded
MTP activations and the associated waste in blood products. SC2i’s model
estimates that if NATO’s five CSHs use the tool, they would waste 71,459
fewer units of blood products over the course of SC2i’s campaign scenario.
Those blood products would include 34,144 units of RBC, 20,399 units of
FFP, 1,907 units of platelets, and 15,009 units of cryoprecipitate (Table 3).

478
 TABLE 3. CASUALTY RELEVANCE AND LOGISTICAL BENEFITS MODELS RESULTS
Blood Product Usage Clinical and Operational Savings from SC2i MTP CDS Tool
NATO MTP- UH-60
Combat Relevant Without With Fresh Cryo- Blood Blood Airlift
Day Wounded Wounded SC2i MTP SC2i MTP Red Blood Frozen Platelet Jet-A Fuel Weight
in Action CDS Tool CDS Tool Cell (units) Plasma (units) precipitate Product Product (gallons) Capacity
in Action (units) Containers Resupply
(units) (units) (units) Missions (pounds)

1 1,394 600 19,538 15,830 1,772 1,058 99 779 159 5 1,170 6,735
2 1,362 586 21,628 18,005 1,731 1,034 97 761 154 5 1,170 6,522
3 1,333 573 21,140 17,595 1,694 1,012 95 745 152 5 1,170 6,438
4 1,302 560 20,626 17,163 1,654 988 92 727 150 5 1,170 6,354
5 1,272 547 20,136 16,752 1,617 966 90 711 145 5 1,170 6,135
6 1,242 534 19,635 16,331 1,579 943 88 694 141 5 1,170 5,967
7 1,214 522 19,160 15,932 1,542 921 86 678 138 5 1,170 5,838
8 1,183 509 18,658 15,511 1,504 898 84 661 134 5 1,170 5,670
9 1,156 497 18,196 15,123 1,469 877 82 645 131 5 1,170 5,541
10 1,126 484 17,708 14,713 1,431 855 80 629 127 5 1,170 5,373
11 1,098 472 17,233 14,313 1,395 833 78 613 125 5 1,170 5,295
12 1,070 460 16,770 13,925 1,359 812 76 598 122 0 0 5,166
13 1,041 448 16,295 13,526 1,323 790 74 582 119 5 1,170 5,037
14 1,014 436 15,847 13,149 1,289 770 72 567 116 5 1,170 4,914
15 986 424 15,371 12,750 1,252 748 70 551 113 5 1,170 4,785
16 958 412 14,922 12,373 1,218 728 68 536 109 5 1,170 4,617
17 931 401 14,473 11,996 1,184 707 66 520 106 5 1,170 4,488
18 904 389 14,025 11,619 1,149 687 64 505 103 5 1,170 4,359
19 877 377 13,574 11,241 1,115 666 62 490 100 0 0 4,236
20 851 366 13,140 10,876 1,082 646 60 475 97 0 0 4,107
21 824 354 12,690 10,498 1,047 626 58 460 94 0 0 3,978
22 797 343 12,242 10,122 1,013 605 57 445 89 5 1,170 3,765
23 772 332 11,820 9,767 981 586 55 431 88 5 1,170 3,726
24 745 321 11,384 9,401 947 566 53 416 85 5 1,170 3,597
25 720 310 10,961 9,046 915 547 51 402 81 5 1,170 3,423
26 694 298 10,525 8,680 882 527 49 388 78 5 1,170 3,300
Total 26,868 11,556 34,144 20,399 1,907 15,009 3,056 110 25,740 129,366

479
 Impact on military logistics. Beyond the blood product savings it
could generate, SC2i’s MTP CDS tool also yields a number of operational
benefits. SC2i’s model estimates that the tool’s use would enable UH-60
MEDEVAC helicopters to fly 110 fewer blood product resupply missions
during SC2i’s campaign scenario. Instead, those UH-60s could fly medical
evacuation missions. Given a helicopter’s maximum airlift capacity,
that means existing corps-level UH-60 resources
could evacuate up to 770 more wounded off
the battlefield.

Should no additional wounded

require evacuation, SC2i’s model
estimates that the fewer num-
ber of blood product resupply
missions would save a total
of 25,740 gallons of Jet-A
fuel. Since NATO AH-64
attack helicopters also
consume Jet-A fuel and
have a similar fuel capac-
ity as the UH-60, they
could use the saved fuel to
fly an additional 110 close-
air support missions.

The broader logistical bene-

fits are equally meaningful.
The lower need for blood
products would also reduce
the need for AMC fixed-wing
aircraft to ferry blood prod-
ucts in-theater. That would
free up space and weight aboard
AMC f lights that NATO could
use to carry other military sup-
plies. SC2i’s model estimates that
the lower blood product demand
would mean that the AMC would
have to transport 3,056 fewer blood
product shipping containers. Those con-
tainers have a combined weight of 129,366
pounds. That is equivalent to the combined

480
weight of 308 AGM-114 missiles, 1,463 Hydra 70 rockets, and 92,400
rounds of 30mm ammunition—enough to arm 77 of the additional AH-64
close-air support missions that SC2i’s MTP CDS tool could enable U.S.
Army aviation units to fly (Figure).

FIGURE. SUMMARY OF CLINICAL & LOGISTICAL BENEFITS

FROM SC2I’S MTP CDS TOOLS

Blood Product Savings Jet-A Fuel Savings MEDEVAC Wounded Close-Air Support
Missions
25,740 gallons 770 110

129,366 pounds 308 AGM-114

1,463 Hydra 70
34,144 Red Blood Cell 92,400 30mm
20,399 Fresh Frozen Plasma
1,907 Platelets Airlift Weight Close-Air Support
15,009 Cryoprecipitate Capacity Savings Ordnance

Conclusions/Recommendations
This study illustrated the scale of the benefits that could accrue from
using SC2i’s MTP CDS tool during a military campaign. Although military
medical researchers primarily designed the tool to help physicians make
faster and more accurate decisions as to whether to activate an MTP and
thus improve patient survival and recovery, it served a dual purpose. The
tool’s developers also sought to lower the unneeded expenditure of scarce
blood products, streamlining the logistical requirements of CSHs in the
field.

Past efforts to streamline logistics have largely been led by logisticians and
those who manage large and complex military systems. This study demon-
strates the degree to which all military organizations can make meaningful
contributions to streamlining logistics by using big data and predictive
analytics to improve their own operations. More elements of the military
can and should become involved. As the technology needed to capture and
analyze big data becomes more widely available and at ever-lower cost,

481
 military elements not directly engaged in logistics can create new decision
support tools—tools that not only enable them to more efficiently carry out
their missions, but also reduce their logistical footprints.

SC2i’s model quantified what one decision support tool could do to ease the
burden on military logistics by reducing waste in a single supply category—
blood products. The U.S. military can develop and deploy many more tools
in the future. They and the predictive analytics that underlie them should
be encouraged to flourish.

Acknowledgments
We would like to acknowledge the important contributions of Michael
J. Crivello, Dr. Frederick Lough, and Dr. Benjamin Kyle Potter in the
Department of Surgery at the Uniformed Services University of the Health
Sciences and Walter Reed National Military Medical Center.

482
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 Author Biographies

Mr. Felix K. Chang is the chief strategy officer

of DecisionQ. He is also an assistant professor in
the Department of Surgery at the Uniformed
Services University of the Health Sciences and
Walter Reed National Military Medical Center.
He is also a senior fellow at the Foreign Policy
Research Institute. He previously served as a
senior planner and an intelligence officer in the
U.S. Department of Defense. Mr. Chang earned
his MBA from Duke University and an MA and
BA from the University of Pennsylvania.

(E-mail address: felix.chang@decisionq.com)

Dr. Christopher J. Dente is a professor in the

Department of Surgery at Emory University’s
School of Medicine and deputy chief of Surgery
for Emory at Grady Memorial Hospital. He earned
his MD from the Medical College of Pennsylvania
and completed his general surgical training at
Wayne State University/Detroit Medical Center.
Dr. Dente also completed a trauma/surgical crit-
ical care fellowship at Grady Memorial Hospital.

(E-mail address: cdente@emory.edu)

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CAPT Eric A. Elster, USN, is currently chair-
man/professor of the Department of Surgery,
Uniformed Services University of the Health
Sciences and Walter Reed National Military
Medical Center. He was last deployed as director
of Surgical Services at NATO’s military hospital
in Kandahar, Afghanistan. He has published over
140 scientific manuscripts and received numerous
research grants. CAPT Elster earned his MD from
the University of South Florida, completed a
surgery residency at National Naval Medical
Center, and received an organ transplantation
fellowship at National Institutes of Health.

(E-mail address: eric.elster@usuhs.edu)

487
This content is in the Public Domain.