1. Warrant Officer Advance Course
SHOW SLIDE: Overview of the Casualty Rate Estimation Tool
SHOW SLIDE 51: OVERVIEW OF THE CASUALTY RATE ESTIMATION TOOL (CREstT)
Military medical planners and logisticians have lacked a science-based, repeatable, and standardized methodology for predicting the likelihood of injuries and illnesses, for creating casualty estimates and the associated patient streams, and for estimating the requirements relative to theater hospitalization to service that patient stream. These capability gaps undermine planning for medical support that is associated with military operations.
Overview of the Casualty Rate Estimation Tool
February 2019
Advanced Officer Training Division
Adjutant General School

2. Overview of the Casualty Rate Estimation Tool (CREstT)
Medical Planners’ Toolkit
(MPTk)
Provides medical support planning across the ROMO with a suite of tools; a DoD-accredited tool
Patient Condition Occurrence Frequency (PCOF)
Determines injuries and illnesses
Casualty Rate Estimation Tool
(CREstT)
Forecasts casualty rates during military operations
Expeditionary Medical Requirements Estimator (EMRE)
Estimates high-level requirements for theater hospitalization
Estimating Supplies Program
(ESP)
Forecasts medical supply requirements; accreditation planned for 2016
Joint Medical Planning Tool
(JMPT)
Provides medical risk assessment and course of action analysis; a DoD-accredited tool
SHOW SLIDE 51: OVERVIEW OF THE CASUALTY RATE ESTIMATION TOOL (CREstT)
Military medical planners and logisticians have lacked a science-based, repeatable, and standardized methodology for predicting the likelihood of injuries and illnesses, for creating casualty estimates and the associated patient streams, and for estimating the requirements relative to theater hospitalization to service that patient stream. These capability gaps undermine planning for medical support that is associated with military operations.

3. Medical Planners’ Toolkit (MPTk)
Patient Condition Occurrence Frequency (PCOF) tool
Casualty Rate Estimation Tool (CREstT)
Expeditionary Medicine Requirements Estimator (EMRE)
Estimating Supplies Program (ESP)
SHOW SLIDE 52: MEDICAL PLANNERS’ TOOLKIT (MPTk)
1. While no two military contingency operations are identical, they share certain similarities that allow planning for future engagements based on empirical data from past operations. The Naval Health Research Center (NHRC) has developed the MPTk to close the capability gap by combining a suite of tools into a single desktop application. The MPTk consists of the:
a. Patient Condition Occurrence Frequency (PCOF) tool.
b. Casualty Rate Estimation Tool (CREstT).
c. Expeditionary Medicine Requirements Estimator (EMRE).
d. Estimating Supplies Program (ESP).
2. This suite of tools provides planners with an end-to-end solution for medical support planning across the range of military operations, from combat operations to humanitarian assistance.

4. Benefits of MPTk
Authoritative estimates are obtained quickly and efficiently
Results are based on empirical data and SME knowledge
Formulas and algorithms are fully documented
SHOW SLIDE 53: BENEFITS OF MPTk
1. Logisticians and medical planners obtain authoritative estimates quickly and efficiently using an integrated, desktop application.
2. Results obtained are based on recent empirical data and subject matter expert (SME) knowledge.
3. All formulas and algorithms are fully documented to assist in verification and validation.

5. What is CRestT? Provides capability to emulate the operational plan
Functionality is integrated with the PCOF tool
Provides quantile estimates and mean value estimates
SHOW SLIDE 54: WHAT IS CREstT?
1. CREstT provides the capability to emulate the operational plan using a 180-day palette to calculate the battle and non-battle injuries (NBI) and illnesses that are expected during military operations.
2. This functionality is integrated with the PCOF tool, which provides the patient distributions used to develop patient streams.
3. CREstT uses stochastic methods to generate its estimates and can, therefore, provide quantile estimates in addition to mean value estimates.

6. CREstT (1) SHOW SLIDE 55: CREstT (1)
1. CREstT provides the capability for planners to emulate the operation plan to estimate the combat and non-combat injuries and illnesses that would be expected during military operations.
2. Casualty estimates can be generated for ground combat, fixed facilities, and natural disasters.

7. CREstT (2) SHOW SLIDE 56: CREstT (2)
1. CREstT has an interface with the PCOF tool and uses those distributions to produce patient streams based on the casualty stream. It’s stochastic implementation provides planners with percentile as well as average results to enable risk assessment.
2. Output from CREstT is compatible with the EMRE, ESP, and Joint Medical Planning Tool (JMPT).

8. CREstT (Fixed Based) SHOW SLIDE 57: CREstT (FIXED BASE)
1. The Fixed Base tool was designed to generate casualties resulting from various weapons used against a military base. The tool simulates a mass casualty event as a result of these attacks.
2. Along with generating casualties, the tool also creates a patient stream based on a patient condition occurrence estimation (PCOE) developed from empirical data.
3. This tool gives medical planners an estimate of the wounded and killed to be expected from a number of various weapon strikes.
NOTE: Weapon Types include: Artillery, Bomb, Mortar, Ground Missile Attack, and User Defined.

9. CREstT (Disaster Relief – Earthquake or Hurricane)
SHOW SLIDE 9: CREstT (DISASTER RELIEF – EARTHQUAKE OR HURRICANE)
1. The Disaster Relief casualty generation algorithm generates a patient stream for either an Earthquake or Hurricane, based on the PCOF table, severity of the event, location of the event, and arrival day.
2. The model helps the planner determine what types of injuries and illness to expect upon arrival.

10. CREstT (Humanitarian Assistance)
SHOW SLIDE 10: CREstT (HUMANITARIAN ASSISTANCE)
1. The Humanitarian Assistance casualty generation algorithm generates a patient stream based on a selected PCOF table and the expected average number of patients expected to be treated per day.
2. The model helps the planner determine what types of injuries and illness to expect upon arrival.

11. CREstT (Ground Combat) (1)
SHOW SLIDE 11: CREstT (GROUND COMBAT) (1)
1. The Combat casualty rate estimates are based on empirical data spanning World War II through Operation Enduring Freedom (OEF).
2. Wounded in Action (WIAs), NBIs, and Diseases are estimated on a per day basis based on the environment, population at risk (PAR), and battle intensity.
3. Outputs are daily casualty counts and a patient stream by day with assigned patient conditions for up to a 180 day event.

12. CREstT (Ground Combat) (2)
SHOW SLIDE 12: CREstT (GROUND COMBAT) (2)
1. PAR – The troops by day or period per the Time, Phase, Force, Deployment, and Data (TPFDD) flow.
2. Three Troop types:
a. Combat Arms – includes infantry, armor, artillery, anti-tank and other combat arms.
b. Combat Support – artillery, combat engineers, snipers, other support forces attached to the ground element.
c. Service Support - includes communications, medical, supply, maintenance, operations, etc.

13. CREstT (Ground Combat) (3)
SHOW SLIDE 13: CREstT (GROUND COMBAT) (3)
1. Combat Intensity is a baseline rate per 1000 per day that is modified through the application of adjustment factors. Region, Terrain, and Climate are applied to provide a greater accuracy.
2. Baseline rates are based on Peace Ops (Operation New Dawn), Light (OEF, 2010), Moderate (Vietnam 1968 & Korea 1951), Heavy (Second battle of Fallujah Nov 2004), and Intense (Battle of Hue).

14. CREstT Exercise Results
SHOW SLIDE 14: CREstT EXERCISE RESULTS
1. Look at the Average number of casualties per day.
2. Look at 75th Percentile for WIAs only.
3. Look at 95th percentile (worst case) for WIAs only.

15. Export CREstT Results to JMPT
SHOW SLIDE 15: EXPORT CREstT RESULTS TO JMPT
1. When Exporting Results from CREstT to JMPT, it’s best to use the ‘JMPT Table Patient Stream Generator’. Decide which risk levels (percentiles) need to be examined for the WIAs. Export at least one percentile to JMPT (select Results/Export Occurrences to JMPT).
2. ALWAYS export the ‘Average’ for Disease and Non-Battle Injury.
NOTE: A .psgt file will be exported that may then be imported into JMPT.
3. JMPT Replication Patient Stream Generator imports data for every replication in CREstT replications for a 180 day scenario will generate large amounts of data and may be too large for JMPT to process.

16. CREstT (Combined) SHOW SLIDE 16: CREST (COMBINED)
1. CREstT allows the user to combine two or more existing scenarios. The result is a combined patient stream that may be used as an input to EMRE.
2. COCOMS may combine all component scenarios into one large Joint scenario.