Executive SummaryAn unprecedented opportunity exists to introduce real-time physiological and environmental monitoring technology into future US Army dismounted forces for use in both training and combat situations. The motivation is to enhance the survivability of the individual warfighter and to provide increased situational awareness to both combat medics and commanders during the course of a mission or field operation.To seize this opportunity, the monitoring technology must be reliable, must be unobtrusive, and compelling in terms of value to both the lowest-echelon warfighters and their command chain. Realizing these objectives will require adapting and extending ambulatory medical monitoring technology well beyond the capabilities of current commercial devices and systems, and will place the US Army in a unique position, with the ability to continuously monitor a variety of physiological and metabolic parameters over extended periods of time and over a range of environments and activities.The goal of integrating physiological sensors and supporting communication, processing, and power on the soldier in a manner that is affordable, reliable, light and simple is extremely challenging. One need only examine the state of the art in ambulatory medical monitoring to realize that existing approaches are deficient in a number of aspects:1. Cost -Commercial real-time ambulatory medical monitoring systems (e.g., hospital or home wireless monitoring of respiration, ECG, SpO 2 ) cost in excess of $25K per system 2. Size, weight, and power -Excluding the sensors, the mobile components (comm link and data archiving unit) of the smallest commercial system weigh 400 g, with a volume of 230 cm 3 , a wireless connection range of less than 50 m, continuous data archival capability of 24 hours, and non-real-time post-processing and analysis 3. Intrusiveness -Commercial systems require placement of adhesive electrodes 4. Immunity to motion artifacts -Motion introduces noise in the sensors and commercial systems have limited or no real-time processing to correct or suppress artifacts 5. Scalability to multiple users -Commercial systems are not designed to operate with multiple wearers in close proximity, so RF interference may occur and disrupt reporting of information when wearers come into close proximity 6. Scalability in range of operation -Commercial systems operate in unlicensed ISM bands or designated medical bands with maximum ranges of 50-150 m between wearer and wired base station 7. Covertness -Commercial systems employ unlicensed RF transceivers to implement wireless links. These transceivers are easily detectable at standoff ranges and therefore represent a serious vulnerability in a combat situation, since the RF signal could be used to detect, locate, and track the movements of individual combatantsWhile the technology challenges associated with implementing a robust physiological and environmental monitoring system on the soldier are daunting, the biggest challenges will be gaining user acceptance of the system...

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