S3E5: Simulation Saves Lives: How DHA Trains Combat Medics for the Battlefield

On the battlefield or in an emergency, military health professionals must make life-or-death decisions under extreme pressure. So how do they prepare to step into a high-pressure trauma scenario without putting real lives on the line? Enter medical modeling and simulation, where virtual reality, augmented reality, high-fidelity mannequins, and other cutting-edge technology are integrated into training to give military health professionals the reflexes and experiences they need to save lives when it matters most. 

The Defense Health Agency (DHA) Defense Medical Modeling and Simulation Office (DMMSO) identifies and adopts these training technologies for the Military Health System. In the latest Empathy Affect episode, DMMSO Chief Ruben Garza shares how advanced simulation tools are strengthening medical readiness and ensuring military medics are prepared for anything. 

Ruben Garza is chief of the DHA DMMSO. He has served in the military for 37 years—first in the Air Force as a medical technician, then standing up a modeling and simulation program in the Air Force. He has since helped centralize joint defense medical modeling and simulation training at DMMSO. 

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Transcript

Melissa Sosinski: On the battlefield, like in any emergency, every second counts. The split-second decisions that military doctors and medics make can mean the difference between life and death.  

How can medics step into a high-pressure trauma scenario—forced to make split-second choices and refine their skills—without putting real lives on the line?   

What tools or technology might be needed?  

Imagine mannequins that don’t stop bleeding until you apply a tourniquet correctly or virtual reality headsets that use haptic feedback to simulate the feeling of providing care in combat.   

Those are just two of the advanced tools that already exist to give military health professionals the reflexes and experiences they need to save lives when it matters most.   

But who's behind pioneering these amazing, life-saving tools?  

It’s the Defense Health Agency’s Defense Medical Modeling and Simulation Office. Tasked with strengthening joint medical readiness, survivability, patient care, and efficiency, DMMSO plays a vital role in preparing military health professionals for the realities of combat and crisis response.  

This is Empathy Affect, Fors Marsh Media’s podcast that explores the human side of government. I’m Melissa Sosinski. Today we’re talking with Ruben Garza, chief of the DMMSO. With 37 years of military service under his belt, he’s helped transform how DHA trains health professionals for combat medicine, disaster response, and beyond.  

How do the training and the technologies they use prepare military health professionals for the chaos of war and the challenges of saving lives? Let’s find out.  

Ruben, welcome to the show. I'm excited to talk to you about your service and work helping to train defense health professionals today. 

Ruben Garza: Good morning, looking forward to it. 

MS: Yeah, so you've spent the last 37 years or so of your career working for the military. First of all, thank you for your service. I wanted to ask, can you share what drew you to serve with the Air Force initially, especially in the field of health? 

RG: Well, good question. I'm from a southern border town in Texas, South Texas. So at that point, I always saw people join the military. Many of my friends joined the Army. I think I wanted to be a little different. So I went and saw the Air Force recruiter. Next thing I know is I'm in. How I got into the medical career field. It was one of those by luck. Positions were open in the medical field. 

My recruiter said, “Hey, would you like to join?” I had no background in medical. I didn't think I was going to be in medical for anything. So I decided to join. I came in in ’88, and it has been a great 37 years. Throughout all this, coming in, I was a medical technician enlisted for about 11 years. I ended up getting my dual master's degree, two masters. With that, I applied for officership to stay in the medical field. So I was a Medical Service Corps another 11 years.  

And [fortunately], I was at my 22-year mark, decided to call it my retirement. I did, and I actually stayed on again to continue on medical side in the Department of Defense. This time a little bit different, working with simulation. That's how I got into this medical modeling simulation world.  

MS: Ruben first started working in medical modeling and simulation by standing up an Air Force simulation program after his deployment. Not long after, he joined the Defense Health Agency, or DHA, to bring simulation and modeling training to other branches, like the Army, Navy, and Marine Corps.  

Through DHA, Ruben could help standardize and centralize training across the board, which is great, but you may be wondering now—what exactly is medical modeling and simulation? And what does it look like for the various people serving in our military?  

RG: Well, it's a type of training modality that we provide to our doctors, nurses, technicians across the board so that way they can go ahead and get into a practical sense and use those muscle memories of what do they need to do if there's an injury, maybe an amputation, and they're bleeding.  

How do we stop that? And then what do we do next? How do we transport them? So with all that, instead of using, like you and me, live actors or individuals that we can bring in that have volunteered, why not use a type of, [for] example, mannequin that we have out there that is human-like, plastic, and they can give some responses. You can give medication, you can put a tourniquet in the way, the bleeding will stop.  

Some of the newer technology mannequins actually talk to you through a voice overwrite that somebody is talking on the other side and they can tell you as you go through the treatment and tell you, “Hey, this is what's going on. My leg hurts. I don't feel good. I'm dizzy,” whatever might be the case. That's that interaction also that gives our providers and our individuals a little bit better understanding of what treatment they have to do.  

And then, plus, the other additional part is that we can throw other environments into maybe they're going to deploy someplace we know—an example would be Afghanistan, Iraq. Maybe the environment behind that would be for them to get a little bit more immersed. That's when we use a mannequin or any other type of technology as we're now immersing ourselves in realities, augmented reality, virtual reality, extended reality, getting those sets and reps for individuals so they can try it once—maybe they make a mistake, provide some feedback, let's try it again, reset and then try it again.  

And then as more training commences, maybe switch it up and throw another type of injury or maybe mass casualty. So that way our individuals are not just focused on one type, but they can sort of get that expanse of across the board of not one type of injury, but multiple injuries. So mannequins play a big part into our medical model simulation, realities, technology. So this is a way for us to get our individuals in the medical field trained and ready. 

MS: With the combination of advanced mannequins, VR, AR, and a variety of scenarios, Ruben’s team can deliver this medical readiness across the branches. The Defense Medical Modeling and Simulation Office becomes a one-stop-shop for training solutions, subject matter experts, and equipment to work toward one joint mission. 

RG: Everybody in the medical model simulation has one mission—how do we help our end users, our trainees, our docs, nurses, techs? That's why we sort of—it's pretty easy for us to come together, work in a joint fashion as much as we can, because no longer are those days that the Air Force only stays with the Air Force, the Navy with the Navy, or the Army with the Army. Now it's more of a joint Army–Navy, Navy–Air Force. It's a mixture of even other three services together. Why not train together? Why not bring everything that we do into one location and then expand that out to all the other services as they go out there and do some joint training events or joint deployments nowadays. So our office stands ready to help as much as possible, providing them whatever help they need, again, within the limits, as much as we can do just to help them out.  

And then the other one, let me just add a little bit more. Not only do we focus on our medical into the military, but we also have partners outside, industry partners, we're always talking to them, making sure that they have the latest and the greatest. Universities outside. We want to know what universities are using so that we can sort of use the same thing and our VA hospitals, same thing. What we do on the military side, Department of Defense sort of seeps over into the veteran side of the house. So we have a good collaboration, communication with them. 

MS: Yeah, it sounds like joint operations, not just in combat, but in readiness from a medical perspective is one pillar, I'm hearing. And then I'm also hearing the nature of partnership beyond the military with those industry partners, with other agencies, with academia to bring the solutions to the table. I'm wondering what unique challenges the defense health space has faced in recent years and how your office has addressed them. 

I know that you were just talking about building joint readiness and trying to find new solutions, but are there any technologies or strategies that you've been applying to help address the challenges that our service members face? 

RG: So the challenges have always been evolution. It's always changing in the military. As you can see, decades ago, we didn't have mannequins. We were just using each other, you know, trying to get the best training that we can. When Iraqi freedom and Afghanistan came, that's when the mannequins were more introduced into the training. And now, as we fast forward into this time, technologies, again, realities play a big part.  

AI is coming around the corner. So I'm anxious. I feel like I'm in my early years of starting this and seeing how that's going to develop. I saw the mannequins develop and improve through the years. We usually just had a mannequin that just laid there. They didn't give you much. And the instructor would go, “He's bleeding.” Put a tourniquet in, you go, “Where's the bleed? I don't see it.” Mannequins improve to the point that they have an amputation, and they start bleeding and you gotta place that tourniquet until the bleeding stops.  

Fast forward, realities, so that way you could be doing a training modality in augmented or virtual reality and then somebody in California and somebody in DC is doing the training with you. So multiplayer so you can feel that join as of training other individuals what they're doing, maybe cross-collaborate and to how you did this, do this this way and then learn from there.  

And then nowadays, two things besides artificial intelligence, the other one is haptics, getting a little better sense. So if you're on a virtual reality, augmented reality, some of the new equipment is tethered, meaning it's hooked up to a computer behind you. So that sort of gets on the way. The gloves are a little bit too big. Sometimes they're too heavy. They get on the way. Making them much simpler—maybe nowadays they're thinking of doing just a small glove that fits over your finger digits and you can still feel that if you're going to get a pin, you actually, there's no pin in front of you, you're actually feeling a pin that your fingers won't come together, but you feel something in between. That dexterity, I'm looking forward to how they're going to be making improvements. And how do we bring that into the medical simulation training?  

We stand ready for that. Our office is always communicate, like I said, with our end users, especially our courses that teach surgical and helping those instructors and give them those top-notch technologies that they have. The future is going to change. It's ever-new evolutions of training. Technology capabilities are always in the forefront. We're always trying to stay with those new changes and then bring them into our central program office and then pushing those out again where our end users are asking for that to make sure that we meet those objectives. 

MS: I'm wondering from the service members’ perspective or people who are on the receiving end of the training, whether it's the personnel delivering the medical care or the people receiving it, what difference has it made to those people? Have you heard anything from colleagues? What kind of stories do they come back to you with? 

RG: Yeah, no, what I've heard from individuals that come in for training, I'm going to give you one example here in San Antonio, Fort Sam Houston, we have Camp Bowler's Readiness Training. I always try to take an advantage and go and see those individuals. Many of them have had training. They go, “Hey, I saw you here 3 years ago.” And they can tell me that after they got that training, and it's not just Camp Bowler's, it's across other locations as well in the military, but quite a few folks that I've seen have told me when they have received that training and then a few months later they deploy, some of that skills that they were doing in the training have paid off in their deployment area, and they have utilized them.  

What they tell me is it makes them a little bit easier, comfortable, not too nervous. Every person that sees something, an injury, they're to have that nervousness of, “Oh my gosh, here they are.” But because of all the training that they received and the sets and reps that we said, they feel more comfortable that they can act, and they do, and it has paid off dividends, especially when they come back and they received that extra training or new updated training. So they're always giving a good feedback, whether they're before they depart or after coming back. And it's always good to hear that whatever training we're using and the equipment we're providing them sort of pays off a little bit into the dividends of return on investment.  

I can tell you when I was in my early Air Force years, and we were doing some training, it was more of a one person to another person or maybe, “Hey, here's a scenario, let me read it to you, this is what you would do.” So we never really acted on it and then you would go someplace and you were not really totally ready.  

Fast forward to now times with the new technologies that we have, the simulator training that we provide, it gives them a little bit more ease of them knowing that they can do the job when it's being called at the right time to save a life and bring those injured individuals back home and be with their family. So it has paid off pretty good and the responses have always been great feedback, especially with these new changes that we do and always adding something into it so that we're there ready for whatever comes up next. 

MS: Yeah, yeah. It sounds like as time has passed, you've built in more effectiveness into the programs you've been doing, whether it's through the different technology adoption or just how you're iterating. And right now in the greater government, there's a focus on effectiveness and efficiency. So I was wondering if you could expand on some of the achievements your office has made in terms of efficiency through the medical simulation and training. 

RG: Yeah, so efficiency always play a big part. How can we not do individual isolated training, but bring it more together? If we have services doing their own training on their own, sort of duplicating what the other services are doing, the Air Force doing the same way the Army and the Navy, but yet they don't communicate, they don't talk to each other, we can find some efficiency because also each of the services are buying equipment and not doing that sort of simulated closed joint together training.  

So our office has brought and made some changes to that. We have standardized the equipment so that way we can use the greatest tool for the right mission and the right requirements and not having organizations or units buy their own stuff, not knowing what they need and later identify that, well, we only using it for this and 80% is just stagnant, they're not being utilized. Why not get the right tool to the right location where they need the training?  

So our office has standardized, made it a little bit easier for services, unit organizations to use the same thing. And now the efficiency and the cost declination that comes in there is instead of a service, Air Force, Navy, and Army buying three sets of equipment, why not bundle all that together? Now we can get a better price. Now we can get something that fits the organization that is the right cost, at the right objective, that meets whatever service users will have to use and then put it at those locations. So the efficiencies have been that our office looks into all that.  

And the other one is new, like I said, new technologies always around the corner. Our industry partners, the companies are always innovative and coming up with new things that they know that we require as the mission changes. And it's our job to look at what type of technology out there fits this mission readiness training or this clinical. And that's where we go with, again, instead of having isolated buys and everybody's sort of buying something different that they're not gonna use, why not bring it together, centralize it, standardize it, and then sort of push it out across the board, because the Air Force training and the Army and the Navy training are very similar. That's a few changes depending on the mission that each of the services have, but overall the foundation is always the same so we can provide the right tool when they need it. So that's why we were created as a central program office. 

MS: You've spent a good chunk of your career now working in building simulations, the modeling, getting the capabilities up to snuff. So what lessons have you learned that you'd like to share with others who may want to adopt medical simulation and training capabilities? 

RG: Yes, so a big lesson learned is always to have your ear open. Listen to the end user. Go to where that training is being done so that way you can better understand, see it, and then gives you a better perspective as to, “Okay, this is the help that they need.” But the communication is always key. You need to have that dialogue open, to make sure that you listen to the end user. 

Sometimes we get into our little isolated bubble and we go, “Oh, we know everything. This is what you need and you're going to use this.” And the end user goes, “You're totally wrong. We don't need that.” Now we have an equipment and then we can't use it to its full potential. So this was the lessons learned through my years as I would have been in the simulation arena is to make sure that I don't just think of the shiny penny, the great mannequin, or the great technology and go, “This is what we need. Let's go forward and place it here, here, here,” without talking to the end user.  

So the communication to the age, the units that will be using this on a day-to-day basis to train those students that come in to get them ready is highly important. So I have learned through my years—been painful at times and I've been sort of hitting myself on the head going, “I should have asked.”  

So always have that open question, ask them, be at the location. If you can individually, maybe have Teams open with a camera, so you can really see the environment and understand and get yourself into that sort of person's mentality of what they need, what you can help them with. My personal challenge has always been to make sure that I have my listening open before I start talking. I love talking and sometimes people go, “Okay, you haven't listened to what I'm saying.” So that dialogue is important. Always communicate, coordinate and collaborate. 

MS: As we're talking, I'm just realizing how passionate you are about this. It's been a long career for you building up your expertise in defense, health, learning what the needs are. For people who maybe are considering joining the military or serving their country—what value has it brought to you, and what do you want to tell them about the value that they can gain from serving? 

RG: Yeah, when I came in, my eyes were more into just exploring outside my city that I lived in and getting that environment of other places. My first assignment was to go from Texas all the way to England, Chicksands Royal Air Force Base. And that was an eye opener. I've never been on a plane for more than an hour. And here I am going 10 hours across the ocean to the European side, to England. From that point on, it was no point of return. I thought this is where I want to be and explore the location.  

And then helping individuals. The camaraderie that the military has, as I went through my years as active duty, you're always finding individuals that you were stationed [with] 10 years ago. And it's always a rotation. You eventually bump into them at a conference, at a location, at a base, and having those friendships develop—and then how your unit as a cohesive unit works towards a mission, and whatever mission it is in the medical field to help out our injured individuals, our beneficiaries, our patients that we call, you family members that come in and having them whatever they come in, ailment, and then stepping out of the facility feeling relieved that we're taking care of them.  

So I always tell new folks, young ones, thinking of coming in, there's other jobs in medical, yes, but in the medical field, again, you're working with somebody, another human being that you're going to be taking care of, one way or the other.  

If I can fast forward towards the end of my active duty years, I was an operations officer in Germany. And my job was to make sure that whoever got injured in Afghanistan, Iraq, or any of those locations, that my job was to bring them back, help the medical individuals that took care of them, move them through the echelons of care, helicopter, or moving them to an airplane, and then having that aircraft come over to Germany and then we could take care of them before we sent them back to the United States, for whatever extra treatment they need.  

Just a sense of feeling that you're accomplishing the movement of somebody that needs your help. And then actually meeting those individuals that you just heard about—explosion, whatever might be the case, get injured, and then you move them into where I was at in Germany and then talking to them and knowing that they're going to be okay. That plays a big part. That was one of many opportunities that I had, and I tell all young individuals that I know of that you don't know what's up ahead but good things are always going to be there if you set your mind and you focus on what your job is and your mission, and you can accomplish that, so it's been like I said a great ride for me I've seen many of things, I've met a lot of individuals. I haven't done it by myself, it's always been a unit a team, working with other colleagues that are smarter than you are. I know I'm not the smartest tool in the shed. That's why I surround myself with smarter people, and everybody has a good sense of what they need and if you combine two individuals—five, 10, 20 individuals—to sort of help on that job. It makes it much easier. 

MS: Yeah, that's so wonderful. I'm hearing camaraderie, collaboration, communication. They're all key to what makes the work you do successful. Ruben, is there anything else that I'm missing today that you'd like to share? 

RG: The only thing, again, as I come to the end of, I am coming to the end of my support for the Department of Defense, it's been a great opportunity to have supported, join my, to support my country, make a difference along the way, get to meet a lot of individuals, do a lot of great things along the way, and sometimes learn along the way that you know, hey, you don't do that do this and you adapt, you evolve, you make things better.  

It's always good, the changes that come ahead. I always look forward to what's next. Focus on what you're doing. But you know that up ahead in a few years a few months, something's gonna change or you're gonna move or something will happen. And then you adapt to that and again you focus at that location. So those are different chapters in a book that you go with. I think I have 37 chapters in my book, and all of them have some different story in there, different paragraphs of things that you've done. From me in 1988 to now in 2025, changes have been evolutionary in a way that have been great. I leave my office and the future to smart individuals that will continue and make things better. And maybe, you know, whatever I did has an impact and eventually that can be adopted and changed and made for the better. 

MS: Yeah, well, thank you so much for your service: 37 years is no small feat. You've praised the people around you for making the change happen, but just know that you've been a part of it. it's been an honor to learn about the work you've done today, your experiences, and best of luck in the next chapter. 

RG: Yes, chapter number 38. Thank you. 

MS: Congratulations again to Ruben as he soon starts his well-deserved retirement, between serving as a military health professional himself to preparing today’s medics for the toughest situations before they ever step onto the battlefield. 

While Ruben’s hanging up his hat, the Defense Medical Modeling and Simulation Office is still pushing the boundaries of what’s possible in military medical training. Check out the show notes if you want to learn more about what they’re up to next. 

Thank you for tuning into Empathy Affect. If you enjoyed this episode, make sure to give us a follow and review us wherever you get podcasts. And go ahead and share this conversation with a friend. Thanks, y’all.