Walker Curve (Dip)

The Walker Dip refers to the cycle of the improvement of care for the battle injured soldier over the course of a conflict, followed by the decline in the skills needed to provide this care during peacetime, and the requisite need to relearn those skills during the next conflict. When reviewing the wars of the last two centuries, three themes emerge. Firstly, post-war military cuts fall disproportionately on medical services, leaving a mismatch between the size of forces that can be deployed and the ability to care for them when injured. Secondly, insufficient medical representation in military operational planning results in the neglect of medical logistics; and finally, technical and procedural lessons are not adequately captured and incorporated into training and doctrine. 

Analysis of combat casualty care data from 2001 to 2017 for the conflict in Afghanistan showed decreased case fatality rate from 20 percent to 8.6 percent. Recurrent historical cycles demonstrate case fatality rates at the beginning of a conflict often exceed case fatality rates at the end of the previous conflict. Survivability rates then improve through the course of each conflict. This cycle, known as “the Walker Dip”.

To address the Walker Dip, the U.S. military developed the Department of Defense Instruction (DODI) 1322.24 requiring every U.S. Service Member to train on Tactical Combat Casualty Care (TCCC) every three years and / or six months prior to deployment.  Emergency Management Systems (EMS) have adopted TCCC as Tactical Emergency Casualty Care (TECC) to counter the increased violence seen on calls, specifically Active Shooter incidents.  The Stop-The-Bleed (STB) program also compliments the efforts to mitigate Active Shooter trauma in schools.

Will the Walker Curve (Dip) ever receive the attention required to flatten the curve? Can Augmented Reality training solutions allow a consistent level of training on and off duty?