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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25921.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Prepublication Copy – Subject to Further Editorial Correction Army Medical Research and Development Infrastructure Planning PROCEEDINGS OF A WORKSHOP  Norm Haller, Rapporteur Board on Army Research and Development Division on Engineering and Physical Sciences   PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by Contract W911NF-18-D-0002-0001 with the Deputy Assistant Secretary of the Army for Research and Technology (DASA(RT)). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25921 Limited copies of this publication may be available through the Board on Army Research and Development, 500 Fifth Street, NW, Washington, DC 20001; (202) 334-3942. Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2020 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Army Medical Research and Development Infrastructure Planning: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25921. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.   PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION

PLANNING COMMITTEE ON ARMY MEDICAL RESEARCH AND DEVELOPMENT INFRASTRUCTURE PLANNING1 JOAN BIENVENUE,2 University of Virginia, Co-Chair JOHN D. CLEMENTS, Tulane University School of Medicine (emeritus professor), Co-Chair RUZENA K. BAJCSY, NAE3/NAM,4 University of California, Berkeley ROBERT A. BARISH, University of Illinois, Chicago CLARION E. JOHNSON, ExxonMobil (retired) KENT KESTER, Sanofi Pasteur ANN SALAMONE, NAE, Rochal Industries, LLC MARTÍN-JOSE SEPÚLVEDA, NAM, IBM Fellow PHILIP SPINELLA, St. Louis Children’s Hospital, and Washington University School of Medicine MARY ANN SPOTT, Joint Trauma System Staff WILLIAM MILLONIG, Director, Scholar, Board on Army Research and Development SARAH JUCKETT, Program Officer STEVEN DARBES, Program Officer CAMERON MALCOM, Senior Program Assistant CLEMENT MULOCK, Program Assistant AANIKA SENN, Program Coordinator LINDA WALKER, Program Coordinator CHRIS JONES, Senior Finance Business Partner 1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution. 2 Member, Board on Army Research and Development. 3 Member, National Academy of Engineering. 4 Member, National Academy of Medicine. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION v

BOARD ON ARMY RESEARCH AND DEVELOPMENT KATHARINA MCFARLAND, Retired in January 2017 as Acting Assistant Secretary of the Army (Acquisition, Logistics & Technology) Chair MICHAEL BEAR, Technical Director BAE Systems Vice Chair ANDREW ALLEYNE, University of Illinois, Urbana-Champaign DAVID AUCSMITH, University of Washington JAMES BAGIAN, University of Michigan JOAN BIENVENUE, University of Virginia JOHN V. FARR, United States Military Academy at West Point (emeritus professor) GEORGE T. (RUSTY) GRAY III, Los Alamos National Laboratory WILLIAM HIX, United States Army (ret.) SEAN KIRKPATRICK, National Intelligence University VIJAY KUMAR, University of Pennsylvania DUNCAN MCGILL, Mercyhurst University CHRISTINA MURATA, Deloitte ALBERT A. SCIARRETTA, CNS Technologies, Inc. GEOFFREY D. THOME, SAIC JAMES THOMSEN, Seaborne Defense, LLC JOSEP TORRELLAS, University of Illinois, Urbana-Champaign, and Center for Programmable Extreme- Scale Computing PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vi

Acknowledgment of Reviewers This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We thank the following individuals for their review of this proceedings: Joan Bienvenue, University of Virginia, Mary Ann Spott, Joint Trauma System, and David A. Butler, National Academy of Engineering. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by Kevin Ward, University of Michigan Medical School. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION v

Acknowledgments The U.S. Army, especially the Deputy Assistant Secretary for Army Research and Technology (DASA(RT)), Dr. Philip Perconti, was key to originating this workshop and supporting its work. The Army and the National Academies express their gratitude to the expert speakers whose presentations helped further the dialogue on Army Medical Research and Development Infrastructure Planning. The Army and the National Academies also wish to thank the members of the planning committee for their work in developing an excellent workshop agenda. The planning committee wishes to thank the staff for excellent work in preparing for and conducting the meeting. PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vi

Contents WORKSHOP OVERVIEW 1 SETTING THE STAGE FOR IMPROVING ARMY MEDICAL 3 INFRASTRUCTURE PLANNING APPROACHES FOR IMPROVING ARMY MEDICAL INFRASTRUCTURE PLANNING 11 DISCUSSIONS 21 APPENDIXES A Statement of Task 37 B Workshop Agenda and Attendees 38 C Committee Member Bios 42 D Acronyms and Abbreviations 47 PREPUBLICATION COPY – SUBJECT TO FURTHER EDITORIAL CORRECTION vii

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At the request of the U.S. Army, the Board on Army Research and Development of the National Academies of Sciences, Engineering, and Medicine conducted a 3-day workshop to explore how the Army can improve its strategic medical infrastructure planning with a view to 2035. The workshop, held July 14-16, 2020, brought together experts and key stakeholders from academia, industry, and government. The Army requires fidelity, consistency, and predictability in planning and managing research, development, test, and evaluation resources for medical infrastructure across all appropriation sources to effectively develop, deliver, and respond to military medical capability needs. In response to the Army's requirement, the workshop was designed to address the components of a sustainable, reinforcing enterprise framework (organizational and fiscal). Presentations and discussions examined roles, responsibilities, and coordinating mechanisms among major stakeholders of battlefield medicine; case studies of comparably complex non-government enterprise solutions; and opportunities to link ends, ways, and means for improvements. This publication summarizes the presentations and discussion of the workshop.

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