Medical Simulator

Simulating Division Medical Operations in Large Scale Combat Operations

v28.3.0 · September 2026 paper baseline

Selected Research Anchors

Evidence Alignment

This page is not a full calibration catalog. It shows how selected empirical anchors constrain the model: modern combat-care performance, early trauma mortality timing, 30-day survival shape, delayed-care physiology, and historical-scale casualty volume.

Calibration Claim

BattlefieldMed cannot be calibrated against a single observed LSCO outcome dataset, because that dataset does not exist. Instead, selected model behaviors are compared directly against the best available empirical anchors: Shackelford et al. for combat mortality timing and surgical-delay effect size, and April et al. for resource-limited survival behavior during prolonged trauma care.

Shackelford et al. 2024

Combat casualties alive at evacuation request; 30-day mortality timing and 24-hour surgical-delay association.

Measure Reported Data Simulator Calibration Alignment

April et al. 2026

Resource-limited South African non-compressible torso hemorrhage cohort; 24-hour survival conditional on survival time.

Measure Reported Data Simulator Calibration Alignment

GWOT Calibration Check

August 5 AM density-1 comparator run using the GWOT 25k cohort, Role I at point of injury, permissive forward air access, and shortened evacuation geometry.

Measure Reported GWOT Comparator Simulator Calibration Run Readout
DOW Boundary Test Current Role I Boundary Role II Boundary Surgery-Start Boundary

Interpretation

The close matches shown here are intentional calibration targets and comparator checks, not post hoc curve fitting to every possible output. Shackelford directly anchors early death timing and the central surgical-delay hazard effect. April anchors the magnitude and timing of resource-limited deterioration, especially the importance of the first 3 to 4 hours. The GWOT check asks whether the model returns plausible modern-system CFR and DOW behavior when configured for GWOT-like density, geometry, and evacuation access. Remaining LSCO behavior is extrapolated from these anchors plus the simulated casualty phenotypes, queues, blood demand, and available surgical capability.

Admin

User Access

Create Login

local account
Access Control
Local users

User Logins

local hashed accounts

Monte Carlo Requests

admin execution queue
Workflow

Main Menu

v28.3.0 · September 2026 paper baseline

Menu

workflow
Navigation
Main menu
Step 1 of 13

Force Structure

Brigade count redistributes the selected Division Strength. Ambulance totals remain fixed unless their Count Basis is set to Per Brigade.
Geometry
Standard division

Division Geometry

x frontage, y rearward depth
Step 2 of 13

Medical Units & Capacity

Role II Brigade Locations

primary package by brigade

Supporting Role III Facility

theater capability allocated to this scenario
Medical Network
Default echelon care
Advanced Brigade Overrides per-location surgeons, OR, and holding
Advanced Role Defaults role assignment, surgeon sliders, and capacity response

Surgeon Work-Rest

staffing availability

Applies to surgeon calendars after case completion. This changes effective surgical availability, not casualty generation or routing.

Surgical Duration

gamma by ISS tier

Role III ICU Boarding

pre-op resus to ICU

ICU-sick Role III surgical patients use resus for short OR waits; longer waits board to ICU after the decision delay when a bed is available.

Duration of ICU Need

Role III recovery

ICU need can resolve during a prolonged stay. Patients then require intermediate care while awaiting evacuation; a full ward can delay the move out of ICU. CCATT capacity remains three patients per team.

ICU duration assumptions and variability

Civilian trauma LOS is a provisional proxy for recovery. Positive, skewed durations are sampled once per patient; pending surgery and estimated ventilation prevent premature step-down.

Step 3 of 13

Evacuation Assets

Ground Evacuation Assets

ambulances and call time

Role I to Role II

Forward echelon evacuation leg

Role II to Role III

Rearward decompression leg

Air Evacuation

availability and forward reach
Advanced Evacuation Options movement, loading, windows

Ground Movement

Ground Launch Window

Ground Daily Launch Windows

Times are fixed local clock times. A launch may finish after its window closes.

Handoff and Launch

Air Platform Details

Air Launch Window

Air Daily Launch Windows

Times are fixed local clock times. A launch may finish after its window closes.

Evacuation Network
Ground and air assets

Evacuation Network Schematic

asset totals, capacity, timing, and route access
Step 4 of 13

Operation

Density Sweep
By-Phase Controls 36 phases
Casualty Tempo
Custom phased operation

Operation Casualty Curve

expected casualties per day plus DNBI floor

Historic Density Calibration

source-based battle benchmarks
Step 5 of 13

Enemy Action & Attrition

Operational Threat

Off
Advanced Attrition Assumptions probabilities and delays

Among patients who survive the initial attack-death check, an additional injury is treated as fatal. Original care history is retained; no second injury-care timeline is modeled.

Attrition Sandbox
Disabled

Expected Medical Attrition

expected losses by casualty density

Step 6 of 13

Casualty Cohort Draw

Background Casualties

additive daily rate

Combat Mechanism Mix

Cohort and ISS Calibration V26 template cohort

Combat ISS Prevalence

complete-row reweighting

Target total: 100%

Targets apply to all generated combat casualties, including the rapid pre-MTF stratum. Joint raking preserves the mechanism and rapid-fatality margins while selecting complete phenotype rows.

Casualty Event Clustering
Generation Model
Current cohort draw

Current Draw Mix

active streams and mechanism weights

Cohort Diagnostics

reference priors and branch tables
Evac Signal --
Local Signal --
Surgical ISS --
Mobility --
Combat Events/Day --

Reference Priors

current cohort configuration

Pathway Branches

all-casualty shares

Surgical Demand

Hall composite ISS categories
Step 7 of 13

Blood Accounting

Blood Supply Controller

off
How blood moves Minimum configured time to Role II: 34 h plus ambulance wait and travel
→ → → → →
Patientissue and administration recorded separately
Inventorytracked Patient demandcohort-driven Resupplyroutine WBBenabled Mortality couplingenabled
Role I Enabled · battalion pool · 1 lane · direct use or local storage
Role II / BSA Enabled · BSA population proxy · 2 lanes · bank or direct use
Role III / DSA-Theater Support Enabled · DSA population proxy · 4 lanes · hospital bank or direct use
- - - Emergency orders use the same physical chain. Banked lots are issued oldest collected first; WBB remains a separate forward source.

Mass-expiration protection is automatic in both logistics modes: when 50% or more of a bank’s opening inventory will expire within 24 hours, replacement arrives 12 hours before the cohort expires. Only the units being replaced may be discarded early to make room; ordinary rolling expirations do not trigger this step.

Theater Blood Bank

high-capability source; inbound supply is not modeled

Division Role III

hospital bank
Emergency parcels are not payload limited, but remain constrained by source stock, destination storage, ambulance availability, and travel.

Brigade Role II

forward surgical banks

Role II/III blood-bank capacity

Role III receives the division wave. Role II parcels then compete for EAB ground ambulances; emergency orders create their own ground request. No unit may order beyond its storage capacity after on-hand and in-transit blood are counted.

Forward Blood

WBB enabled
Advanced Ambulance Blood 2 WBE/ambulance

When enabled, Role I banks receive dated lots from their supporting Role II on the division cycle using BSMC ambulances. This is off by default. WBB donors remain a separate finite source.

Walking Blood Bank

finite donor cohorts and collection lanes
Modeled donor-access population per site Role I 700 per BAS · Role II 1,000 per BSA · Role III 2,000 at DSA-theater site

Role II and Role III are derived from the force size below; they are not repeated copies of the battalion roster.

Derived eligible roster; lane timing and one lifetime donation per donor constrain collection.

This random donor cohort is reused until there has been a 12-hour quiet period between activation calls.

Advanced WBB Lifecycle 1-2-4 lanes

Default setup is triangular 5/10/20 minutes, collection/release is 10/15/20 minutes per lane, and Role I/II/III use 1/2/4 lanes. Facility calls collect only the projected bridge to a timely delivery.

Patients are never held for WBB. Completed units remain on site and may be banked or used for later casualties.

Advanced Demand Model cohort rows

These controls shape regenerated/live-generator blood demand. The baseline pre-Role II value partitions planning demand; it is not a clinical cap. Lifecycle execution can move additional units forward during a long Role I dwell.

WBE Tier Definitions

unit ranges

ISS Transfusion Matrix

fallback prior

GWOT calibration uses wound-specific blood indications and dose distributions. This ISS matrix supplies fallback probabilities for cases without a wound-specific rule; changing it does not replace those calibrated rules.

Blood Accounting
WBE demand logged by casualty and location

Division Blood Allocation

controller off
Planned Allocation Off -
Average per Day Off -
Planning Demand Estimate - -
Surplus / Shortfall - -
Resupply - -
Allocation Ceiling - -

Illustrative Bank-Level Preview

controller off

This preview helps compare settings. Completed runs use the real TBB-to-Role III timeline and actual EAB/BSMC ambulance queues, so run results are authoritative.

Brigade Role II Banks

controller off

Division Role III Bank

controller off

Blood Demand Details

stored cohort estimates

Stored Cohort Blood Estimates

GWOT 25k
Entries with a Positive Blood Estimate - -
Non-KIA Combat Entries with a Blood Estimate - -
Estimated WBE per Non-KIA Combat Entry - -
Surgical/Evacuation Entries with a Blood Estimate - -

Forward Source Setup

WBB and Role I stored blood
Role II Pickup Ambulances On
-
Walking Blood Bank On
-
Stored Role I Blood Off
-
Pre-Role II Demand Tracked
-

Fallback ISS Preview

generic severity matrix

Generic ISS Blood Prior

Before injury-specific blood profiles and runtime reweighting

Blood Tier Definitions

whole-blood-equivalent units
Step 8 of 13

Triage & Prioritization

Expectant Care

?
Off

Nonsurvivable Injury Recognition

?
perfect recognition

Resource-Constrained Expectant Triage

?
potentially survivable casualties

Retriage uses the same present-state competition rule as designation. Resource-selected casualties return to active care when no better currently present casualty still needs the binding resource. A casualty identified as intrinsically nonsurvivable is not returned to active care.

Prehospital Clinical Triage

standard

Transport Triage

platform priority

Surgical Triage

queue order

Specialist Behaviors

assist policy
Specialty calendars and assist speed

DCS Takeback

24-72 h
Triage Pipeline
Clinical, transport, and surgical prioritization

Triage Decision Map

what changes patient priority

Queue and Specialist Effects

who gets scarce time first

Advanced Execution Tables

rule audit view

Casualty Flow Priority Rules

decision order

Clinical Triage Effects

observed vs true

Specialty Utilization Policy

behavior and speed
Step 9 of 13

Mortality Calibration

Point-of-injury TCCC

enabled

Trained first responders or medics can treat eligible rapid hemorrhage, airway obstruction, and tension pneumothorax before formal evacuation. Success must occur before the casualty's deadline; it does not guarantee survival. Truncal hemorrhage is excluded.

TCCC calibration optionsclick to expand

The five-minute start and attempt probabilities are explicit expert assumptions. Conditional success probabilities use the attached intervention-specific evidence; each injury row's ? bubble shows the source and limitations. Saved versions retain their own values.

Injury typeAttempt (%)Success if attempted (%)
Advanced Rapid Pre-MTF Fatality Stratum mirrors Casualty Cohort Draw

This mirrors the rapid pre-MTF fatality-proxy control on the casualty page. The Eastridge-calibrated immediate subset consumes no workload; progressive subsets remain alive for minutes to hours and can consume transport, blood, surgery, or critical care before death.

Baseline 30-Day KM

ISS priors

Death Timing

cumulative shares

Combined DNBI KM

nonop aggregate

DNBI stays combined for now. These casualties still enter litter/ambulatory assignment and triage; they do not receive the general/trauma or neurosurgical unmet-capability penalty unless generated as a true surgical NBI case.

Advanced Delay Overlay gen/neuro unmet capability

The sensitivity setting scales the added delayed-care hazards, debt, caps, and residual late-death probability together; it does not change baseline mortality, eligibility, care timing, or untreated phenotype clocks. Legacy mode and all existing penalty components remain on pending reconstruction of their original evidence and calibration history. The optional central mode records exactly one evidence-bounded surgical-delay owner—definitive hemostasis, operative intracranial care, or abdominal source control—and defaults missing component switches off. The preview slider is a what-if; actual runs use simulated wait time.

Advanced ICU Wrong-Level Care Modifier off
Advanced ICW Wrong-Level Care Modifier off
Advanced Blood-Related Mortality off

The progressive test option uses only blood already due and not supplied. It accumulates injury as the deficit becomes deeper and lasts longer; later transfusion stops new accumulation without erasing prior exposure.

The legacy rule applies one capped probability to the final shortfall after the run.

Survival Calibration
Baseline KM, phenotype clocks, and advanced delay overlay

How the Mortality Engine Works

conceptual architecture; one patient outcome

The engine begins with the casualty's injury phenotype and baseline risk, then advances the applicable clocks against events that actually occur. Delay and wrong-level-care effects modify risk only when their eligibility conditions are met.

3. Actual care events and delays movement, triage, blood, surgery, ICU, and intermediate care
4. Applicable modifiers or debt only eligible, enabled pathways; legacy rules are identified separately
5. One outcome death timing or survival through the modeled horizon
Expectant triageindirect: changes allocation and delay; it is not an automatic mortality penalty

These layers do not all simply stack on the KM curve. Integrated pathways share the casualty's mortality threshold; separately retained legacy modifiers are labeled in the status cards.

Kaplan-Meier Preview

baseline vs preview wait
Step 10 of 13

Routing

Alternate Role II

DCS only

After the assigned site reaches its trigger, compare it with the nearest capable neighboring Role II. Distance is measured from the casualty's origin.

Bypass Rules

DCS only
Role II Status Threshold Trigger active

Smart Routing

queue-aware

The PECC sees total waiting cases and separates DCS and other urgent cases from routine surgery. Surgery already in progress still occupies capacity. Visible inbound workload uses the same urgency distinction.

Routing Behaviors

Policy sweep

Active Setup

current controls
Step 11 of 13

STRATEVAC

Decompression Demand

Role III downstream lift
STRATEVAC Plan
Demand tracking off

STRATEVAC Lift Preview

per-sortie loadouts and routine lift
Step 12 of 13

Monte Carlo

Replication Budget

1 = single DES run

Decision Precision

two-stage Monte Carlo

Sets the confidence-interval half-width required for the selected endpoints. Standard targets are ±5% of the selected mean surgery time and ±0.5 percentage points for combat CFR. All-TTS rapid screening uses ±10%; custom targets let you choose the resolution needed for your question.

All TTS covers injury-to-first-incision time among surgical casualties who reach surgery. TTLS covers the prospective urgent or immediate lifesaving-surgery subgroup. Both means exclude patients who never reach incision; review their reported fractions too. Only the selected endpoints determine the run count.

Uses the same replication seeds for policies and layouts at the same density. This can reduce noise in paired comparisons; the current precision plan targets each scenario mean, not the difference between scenarios.

The simulator runs a pilot, estimates the replication count needed for every target, then completes that fixed count. It does not repeatedly peek and stop when a result happens to look stable.

Reproducibility

seeded iterations

This seed reproduces the whole run package. Each scenario cell and iteration receives its own logged seed derived from it.

Replication Control
Single DES pilot run
Mode Single
Runs per Cell 1
Precision Not used
Estimated Runs 6

Precision Method

documented in run outputs

Monte Carlo Precision Audit

targets and reproducibility controls
Step 13 of 13

Scenario Run

Recent Results

open without leaving this screen

Loading available results…

Run Target Current Workbench Settings
Comparisons None

Output Retention

operational by default

Operational mode keeps only the compact data bundle needed to reopen these results screens. Enable diagnostic outputs to retain registries, ledgers, event streams, raw utilization traces, audits, and the full workbook.

Compare Against

optional saved settings

The current workbench settings always run. Select default or saved settings only when you want a side-by-side comparison in the same output folder.

Status
Ready
Day - / - Idle
Elapsed - Iteration -
0 / 0 cells complete Sweep waiting
Cells 0
Best Mean TTS -
Best Median TTS -
Best Combat 30-Day CFR -
Audit Status -

Key Results

one row per result cell; Monte Carlo values are cell aggregates