In this episode of “Between the Simulators”, Jake Rahman sits down with Lou Oberndorf from Operative Experience Inc. (OEI) for an in-depth conversation on the future of combat medical training. They discuss how TCCC (Tactical Combat Casualty Care) is becoming the global standard protocol, the growing worldwide demand for combat trauma training driven by ongoing conflicts, and OEI’s new TCCS Tier 3 Pro simulator a high-fidelity, autonomous, and affordable system built to match official military requirements, available on a common platform for both male and female casualties. The conversation also covers NATO’s role in aligning training standards across member nations, the challenges and opportunities of AI and VR in medical simulation, and OEI’s next major focus: Prolonged Casualty Care (PCC) training medics to manage critically injured patients in austere environments for extended periods, across the full range of battlefield scenarios.
A conversation with Lou Oberndorf, Operative Experience Inc. — hosted by Jake Rahman on “Between the Simulators”
The World Has Changed — And So Has the Demand for Combat Medical Training
There was a time when TCCC (Tactical Combat Casualty Care) felt like a niche protocol, championed by a handful of forward-thinking organizations and largely confined to the US military ecosystem. That time has passed.
In a candid conversation on Between the Simulators, Lou Oberndorf, co-founder of Operative Experience Inc. (OEI), made it clear: combat trauma training is no longer a US-centric concern. It has become a global imperative. “The more things change, the more they stay the same,” Oberndorf reflected. “TCCC has become the dominant protocol worldwide. The awareness is there now it’s just a question of executing.”
Driven by ongoing conflicts in Ukraine and the Middle East, and the broader geopolitical shifts reshaping defence budgets across NATO and beyond, countries that previously observed from a distance are now actively planning, budgeting, and reaching out for solutions. OEI finds itself at the center of that demand.
NATO as a Training Force Multiplier
One of the underappreciated drivers of TCCC adoption is NATO itself. Host Jake Rahman, who attended the NATO Special Operations Combat Medics event in Paris, described witnessing something remarkable: soldiers from different armies, different countries, different ranks — all sitting together, sharing knowledge and aligning on medical protocols.
“NATO is really the bridging of all these different organizations,” Rahman noted. “Long may it continue.”
Oberndorf, a veteran who served with the US Air Force in Germany during the 1970s, echoed the sentiment. NATO standards, he explained, have long been aligned with US standards, creating a natural pathway for TCCC to proliferate across member nations. Add to that CENTCOM’s reach in the Middle East and South Asia, and the picture becomes clear: TCCC didn’t just go global by accident. It was carried there by alliances, shared training events, and the hard lessons of two decades of conflict.
Introducing the TCCS Tier 3 Pro: Affordable Fidelity at Scale
At the heart of OEI’s 2024–2025 product push is the Tier 3 Pro simulator a high-fidelity, autonomous training mannequin built specifically to meet official military requirements, at a price point designed for wide adoption. The Tier 3 Pro addresses a long-standing gap in the market: most high-fidelity simulators were either too expensive for widespread deployment or too limited in capability to satisfy military specifications. The Tier 3 Pro changes that equation.
Key features include:
- Autonomous operation — no dedicated technician required to run scenarios
- Military-specification fidelity — built to meet DOD and allied nation requirements
- Common platform for male and female casualties — a single system that covers both, a growing priority as awareness of the need to train for treating female soldiers increases globally
That last point surprised even Oberndorf. “We’re finding, in cultures I never expected, that training medics to treat a female soldier is absolutely at the forefront of awareness globally,” he said. “We have that package common technology, both male and female on the Tier 3.”
The Next Frontier: Prolonged Casualty Care (PCC)
If the Tier 3 Pro represents OEI’s answer to the current moment, Prolonged Casualty Care (PCC) is where the company is pointing its compass for the future.
PCC refers to the management of critically injured patients in austere environments not for thirty minutes, but for hours or days, until evacuation becomes possible. It is, as Rahman described it, “everything you might do in an intensive care unit, but while you’re on the move, while people are shooting at you, while you’re in vehicles.”
The shift from traditional TCCC scenarios stabilise, extract, transfer to prolonged care reflects the realities of modern warfare. Drone warfare, contested airspace, and complex operational environments mean that wounded soldiers may need to be held and maintained for 72 hours or more before they can reach definitive care.
OEI’s vision for PCC is not to build a separate platform for every scenario, but to create a seamless continuum of capability across their existing simulator portfolio. “I want a seamless technology and a seamless platform that could cover the entire range of prolonged casualty care,” Oberndorf said. “Without having to go from one platform to another platform to another platform.”
AI, VR, and the Honest Limits of Technology
No conversation about simulation in 2026 is complete without addressing artificial intelligence and virtual reality. Oberndorf was measured but clear in his assessment.
The challenge with AI in medical simulation is not the technology itself it’s the variability of clinical knowledge. Talk to one subject matter expert, he noted, and you get one set of answers. Talk to another, and you get a different set. The lack of standardised input creates unstable ground for AI to build on.
“If you don’t have a solid technology foundation,” he warned, “what happens is you find yourself jumping all around every time a new procedure comes out.”
TCCC, with its defined protocols and relatively stable knowledge base, is better positioned than most medical domains to benefit from AI augmentation. But the hard work of translating expert knowledge into reliable simulation capability remains deeply human.
Where to See OEI Next
The Tier 3 Pro simulator will be on display at SESAM in Lyon, where OEI has been selected to participate in a live mass casualty event demonstration. From there, expect to see the Tier 3 in both male and female configurations at IMSH, SESAM, SOMA, and major military simulation conferences throughout the year.
For a company that has spent years building toward this moment, the global stage is finally set.
For more info: https://operativeexperience.com/
“Between the Simulators” is a podcast hosted by Jake Rahman exploring the world of medical simulation, training technology, and combat medicine. Operative Experience Inc. (OEI) develops high-fidelity trauma simulators for military and emergency medical training.
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