The use of military forces in urban operations has increased considerably over the past years. As illustrated by the current conflict in Iraq, the Army finds itself fighting its toughest battles in urban areas facing unconventional forces. Soldiers face many threats in hostile fire environments, whether conducting large-scale mechanized warfare, low-intensity conflicts, or operations other than war. Through 1970, there has been no demonstrable reduction in battlefield mortality rate as a percentage of all casualties since data was kept since before the Civil War. For that period of time, nearly all the reduction in overall mortality rate occurred through reduced mortality in Hospital Chain. As of 1970, about 90 percent of all combat deaths occur before a casualty reaches a definitive care facility. Tactical Combat Casualty Care (TCCC), also known as TC3, is the pre-hospital care rendered to a casualty in a combat environment. The application of TCCC principles during a tactical combat environment has proven highly effective and is a major reason why combat deaths in latest conflicts (Operation Iraqi Freedom and Operation Enduring Freedom) are lower than in any other conflict in the history of the United States. The Army continues to emphasize reducing battlefield mortality rate. Current tools and methods used for initial skills and sustainment training of combat medics throughout the Army are insufficient. New technologies are needed to provide medics with greater opportunities to develop and test their decision making and technical medical skills in multiple, COE-relevant, training scenarios. In order to address some of these requirements, the U.S. Army Research Development and Engineering Command, Simulation and Training Technology Center (RDECOM-STTC) is developing the 68W - Tactical Combat Casualty Care Simulation (TC3 Sim) for the US Army Medical Department (AMEDD) Center & School at Fort Sam Houston. The Army is considering the use of the TC3 Sim game as a tool to improve the training of individual Soldiers as well as improve the readiness of combat medics. It is the intent of this research to evaluate the effectiveness of instructional games in general and the use of the TC3 game in particular for teaching the concepts of tactical combat casualty care. Experiments were conducted to evaluate the training effectiveness of this tool in supporting the 68W10 Healthcare Specialist Course program of instruction (POI). The goal of this research is to address important questions such as: Is this game an effective tool to train Soldiers the aspects of TC3? Can knowledge gain through the use of the simulation be transferred into task related situations? How can this tool be incorporated in the current POI in order to increase training effectiveness?

The U.S. Army Training and Doctrine Command*s Army Learning Concept 2015 and Army Training Concept 2025 are documents that discuss the need for an adaptive soldier learning model with a flexible training delivery methodology. The U.S. Army has been investing in serious gaming technology for the past two decades as a cost effective means to teach tactics and strategy. Today, the U.S. Army is seeking to expand its application of virtual environment training to areas such as cultural awareness and human network analysis for the infantry soldier. These new expanded applications will require a higher level of non-determinant behavior inside the virtual environment. To meet more of the training needs of the war fighter, the U.S. Army is looking beyond first person perspective games to the cooperative and social gaming experience offered by the MMOG (Massively Multiplayer Online Game) and the VWT (Virtual World Technology). Altogether, these classes of games have the potential to teach leadership skills, social acclimation skills, cultural awareness and practice skills, and critical thinking skills for problem solving in a cost effective manner. Unfortunately, even today there is a paucity of scientific research to support whether this potential may be realized or not. A literature review was performed which covers current concepts in the usage of virtual environments for military individual and team training in the U.S. Army infantry soldier domains. There are many variables involved with the lifecycle of the virtual training activity including the acquisition, information assurance and cyber security, deployment, proper employment, content development and maintenance, and retirement. This discussion goes beyond the traditional topics of graphics and game engine technology and delves deeper into concepts of the importance of proper usage of the environments by the trainees. This dissertation is composed of three studies with two subject pools: experienced soldiers and novice soldiers. The participants in the studies were randomly assigned to one of two training conditions. The training conditions were either a traditional slide-show in a classroom or a virtual environment based training system. The participants were then provided with training for a room clearing tasks in each of the conditions. The independent variables are training condition and soldier condition. The dependent variables are individual performance, team performance, stress questionnaire scores, and workload questionnaire scores. A number of relationships are explored in this dissertation. The first objective of these studies is to attempt to identify any effect the training conditions have on either individual performance or team performance. Lastly, these studies attempt to identify if there is any difference the training conditions have on novice versus experienced subjects* performance during a live assessment.