PALO ALTO, Calif. -- At Stanford University in California, a group of college students huddle around a table to brainstorm potential solutions to some of the Department of Defense's most complicated problems. These students do not work for DOD -- and, for this project, that's a good thing. If the government is the box, their goal is to think outside of it.The project is called Hacking for Defense (H4D) and started as a pilot 10-week class at Stanford University in 2016. Steve Blank, creator of the Lean Startup movement, and retired Army colonels Peter Newell and Joe Felter developed the concept for H4D. According to Blank, their primary goal was to teach students entrepreneurship while they engaged in national public service."We combined the Lean Startup methodology -- used by the National Science Foundation to commercialize science -- with the rapid problem sourcing and solution methodology Pete developed on the battlefields in Afghanistan and Iraq when he ran the U.S. Army's Rapid Equipping Force," explained Blank in a commentary he wrote July 19.A year after its launch, H4D has spread to nine universities nationwide, including Stanford University, Georgetown University, University of Pittsburgh, Boise State, University of California San Diego, James Madison University, University of Southern Mississippi, University of Southern California and Columbia University.Besides helping the next generation of great thinkers, H4D is growing government expertise. Blank explained that H4D also introduces project "sponsors" from inside the DOD and intelligence community to a methodology that can help them understand and better respond to rapidly evolving asymmetric threats."We believed if we could get teams to rapidly discover the real problems in the field using Lean methods, and only then articulate the requirements to solve them, then defense acquisition programs could operate at speed and urgency and deliver timely and needed solutions," added Blank.One such recent sponsor was Maj. Amanda Love, a nurse consultant at the U.S. Army Medical Materiel Agency and member of the defense acquisition community. At USAMMA, Love is a project manager who works with a team responsible for the full lifecycle of U.S. Food and Drug Administration-approved patient care devices."Lifecycle management of complex medical materiel, such as patient care devices, is not a simple process. Every part of the process is interconnected, from development of new products to full procurement, fielding and sustainment," said Love. "Every new technology we develop and field must be well-planned and supported at multiple levels."Love originally got involved with H4D because of Maj. Steven Hong, an Army clinician colleague, who is currently assigned at Stanford University Hospitals as a Head and Neck Surgical Oncology and Reconstructive surgery fellow and consulting assistant professor. Hong encouraged her to participate in H4D because he thought it would be a win-win."There was an H4D team that needed a military sponsor," said Love. "For me, it was a chance to get some fresh eyes on our work at USAMMA."Love's H4D team, which was one of eight teams participating in this session of H4D at Stanford University, included two software engineers, one programmer and one medical student, Additionally, Love brought in USAMMA colleague Jay Wang, who is a product manager for Transport Telemedicine Systems. Together, they asked the team to address bottlenecks in casualty care triage using novel technology -- specifically, wearable sensors. "When the team started to develop their concepts for using wearable devices, it was a sort of 'wow' moment for me. As a clinician, I am familiar with using wearable sensors to monitor vital signs. But this is something we currently do in a hospital setting -- not at the point of injury," said Love. Wang agreed in the value in wearable sensors as a tool to automatically gather patient care data on the battlefield."Wearable sensors that autonomously gather patient care data and transmit it to a field hospital's medical team provide essential situational awareness that can speed up health care delivery. The goal is to keep the medic or flight paramedic focused for performing life-saving tasks, unencumbered from any requirements for additional documentation," Wang explained.Love's team, who went by the name "Team Surgency," interviewed more than 90 people, including trauma doctors, military medics, combatant commandeers and Special Forces personnel. Additionally, the team reached out to academia partners and industry experts. They also visited military installations to learn more about casualty triage and the kinds of data that would be meaningful for triage on the battlefield."We learned … most casualty fatalities occur before arrival at a medical treatment facility and 25 percent of these fatalities are deemed potentially survivable," explained H4D team member Abbey Cutchin, talking about why data is a valuable tool in combat casualty care triage, where every minute counts.In the final week of the class, Team Surgency, along with the other seven teams, gave presentations that provided an overview of their sponsor's problem and the team's proposed solutions. Other teams presented novel ideas for solving a wide variety of problems, from monitoring traumatic brain injury in veterans to tracking drug trafficking to knowledge management within the defense intelligence community.For many, the H4D presentations did not represent the end of their quest for real-world solutions. Blank said that more than half the student teams, including Team Surgency, have decided to continue working on national security projects after this class."The H4D team definitely added value to our current advanced development efforts at USAMMA," said Love. "Additionally, these students now have a much better understanding of the Military Health System. I believe the project may have also sparked an interest for some students who may not have ever thought about working in or for the military. Now they see that we do a lot of really interesting and meaningful work -- and they can be a part of our mission, which is to save lives."USAMMA is a subordinate agency of the U.S. Army Medical Research and Materiel Command, which is the Army's main medical materiel developer. USAMMA's mission is to develop, tailor, deliver, and sustain medical materiel capabilities and data in order to build and enable health readiness.