Medical simulations are typically developed as discrete solutions to narrow training problems, with little to no thought about interoperability.  Systemic limitations like intellectual property protection, contract limitations, and lack of formal requirements contribute to orphan simulations that are difficult to integrate into larger systems. Further, medical simulation training facilities have a large suite of legacy devices, which hinders interoperability with emerging and future training aids.  This issue is especially prevalent when creating exercises that integrate virtual environments, full body manikins, task trainers, virtual patients, and physiologies.   Melding live, virtual, and constructive (LVC) entities and gaming environments to improve soldier training is an Army modernization priority and a goal of the Synthetic Training Environment (STE) program.  Live and virtual medical concepts were developed and demonstrated by the S&T community in support of the STE.   These developments highlighted significant modularity and interoperability issues in integrating commercial and prototype devices.  With persistent resource challenges in the medical domain and a vision for a system of systems training capability, a development approach allowing the integration of disparate LVC projects is critical.  This paper will explore current standards, both formal (i.e. HLA, DIS, and MOSA) and informal such as Modular Healthcare Simulation and Education System (MoHSES) and Joint Emergency Trauma Simulation (JETS), that support modularity and interoperability.  It will also examine current programs (i.e. Modular Female and SPEARPOINTS) that have the potential to achieve this goal.  Additionally, a few examples of demonstrated modularity and interoperability will be closely examined and discussed including Combat Trauma Patient Simulation (CTPS), the Advanced Modular Manikin, Medical Extended Reality Research (MxRR), and Multi Modal Medical Training System (M3TS).  Finally, common obstacles and misperceptions (i.e. limited market and degraded profits) will be explored.

Keywords
COMBAT CASUALTY CARE;INTEROPERABILITY;MEDICAL MODELING AND SIMULATION;OPEN STANDARDS

Additional Keywords
STE