Team Surgency

1. Team Surgency
Supporting time-critical combat care during mass casualty response
Week 0:
Problem: Developing the capability
for forward deployment of robotic
telesurgery in order to reduce the
‘Golden Hour’ critical time window
with early surgical intervention
Solution: Solve signal latency for
robotic telesurgery
Week 10:
Problem: Addressing triage and
treatment bottlenecks during mass
casualty situations at a Role 1
Battalion Aid Station
Solution: improve situational
awareness and intra-BAS
communication
90+
Interviews

2. Chris Sebastian
Software Engineering &
Product
Andrew DeClerck
Machine Learning &
Software Engineering
Negin Behzadian
Analog Circuit Design &
Signals
Abbey Cutchin
Tissue Engineering &
Orthopedic Surgery
Mentors and Sponsors
Rafi Holtzman
Dr. Steve Hong
Amanda Love, USAMMA
The Team

3. Who We Interviewed
58+
Experts
20
Users
12
Buyers

4. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

5. Develop capability for robotic
telesurgery that would allow
physicians to provide time-critical
treatments for injured patients from
remote geographic distances.
The Original Challenge

6. “People are scared to move a daVinci
down a hallway, let alone use it on
the battlefield”
- Anonymous Stanford Hospital Trauma Surgeon

7. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

8. Where can we add value?
Evacuation
Forward CarePOINT OF INJURY
Role 2
Role 3

9. Visit to 129th Rescue
Wing at Moffett Airfield

10. 90%
before arrival to medical treatment facility

11. 25%
of those fatalities were deemed survivable

12. Where can we add value?
Evacuation
Forward CarePOINT OF INJURY
Role 2
Role 3

13. “[Mass casualty triage] is not a
patient care problem, it’s a
management problem.”
- 129th Rescue Wing Pararescuer

14. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

15. Civilian Mass Casualty Training Simulation

16. “It’s a waste of time to try and
diagnose — it’s all about
prioritization.”
- Timothy Browder, MD; Stanford Trauma Surgery

17. Justin
Roberto
Davis
Clute
Nicolas
Lozano
MVP 1.0
A Potential Solution for Automating Pre-Evacuation Mass
Casualty Prioritization

18. UWB
Network
Zephyr Vitals Sensors
Leveraging FDA-approved physiological monitoring system, already deployed in several high-stress
operational environments

19. “The first time extensive triage takes
place is at the Battalion Aid Station.”
- LtCol Hasseltine, former Commanding Officer, 2d Battalion,
7th Marines,1st Marine Divison

20. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

21. Battalion Aid Station?
EXPECTANT
STAGING
AREA
BLACK
MEDEVAC:
Medical Officer
TRIAGE TREATMENT
INCOMING
CASUALTIES
MEDEVAC
To Role II/III

22. Current Prioritization at Battalion Aid Stations
White Board
TrackingTriage Card

23. “There is a continuous stream of
communication at a BAS supporting triage,
treatment, and EVAC of casualties across
medical and tactical personnel. This chain
could easily break down in the chaos of a
mass cal.”
- MAJ Michael Holloway, former BAS Physician Assistant

24. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

25. MVP 2.1: Triage Manager Interface

26. MVP 2.2: Physician Assistant Interface

27. Final MVP: Evaluating Product-Mission Fit at the BAS
TRIAGE TREATMENT
CAS. INFO
INPUT:
Secondary Triage
Officer
OUTPUT:
Physician
Assistant
EXPECTANT
STAGING AREA
BLACK
SENSOR
INPUT:
Field Medics
MEDEVAC:
Medical Officer

28. Surgency: Mission Model Canvas
- UI/UX Design MVP
- Software Engineering
- Interface/integrate w/
Zephyr sensors
- Purchase/support
Zephyr supply
- Gain buy-in from JTS
and incorporate in
standard practice
- Continued sponsorship by
military beneficiary
- Industry (wearable
sensors, H2Care, Zephyr
Technologies)
- Course faculty and staff,
military liaisons, DIUx,
SOFWERX, In-Q-Tel
- Problem Sponsors:
USAMMA
- DoD organization with
interest in medical device
research (USAMRMC,
TATRC, DARPA)
- Joint Trauma Registry
-Primary: Physician
Assistants at Role 1 BAS
- Secondary: other BAS
medical officers (i.e., triage
medics), and potentially
tactical officers
- Tertiary:
Care providers at higher
echelons of care
- Increase situational
awareness: Constant vital
monitoring provides PA with
greater awareness of patient
status.
- Improve efficiency of
communication among BAS
roles: Augmenting PA access
to communication flow from
medical officer -> PA -> Platoon
Sgt for quicker, more informed
decisions
- Improve efficiency of
MEDEVACs from BAS: More
accurate prioritization during
MEDEVAC requests prevents
unnecessary allocation of
MEDEVACs and crew
-Medical force multiplier: With
more efficient allocation of
MEDEVACs, allow for increased
access to shared resources between
different teams.
- Improved medic-supported triage of combat injuries at POI in
mass casualty situations
- Widespread adoption & trust from DoD medical team and DoD
command
- Lives saved / Improved Quality of Care / Time to MEDEVAC /
MEDEVACS sent vs patients transported
- Test case in mass
casualty situation with
advanced medical first
responders (18D trained)
- Test case in mass
casualty situation with
standard combat medics
Fixed:
- Software design & engineering
- Robotics/Surgery Suite Costs
Variable:
- Customer acquisition/sales
- USAMMA procurement
/sustainment resources
- Medical Advisors
- Testing facilities
- AI/ML advisors
- Need demand signal from
BAS medical officers
responsible for triage,
treatment, and EVAC
decisions
- Need execution and active
use by medics and first
responders at BAS
-Need implementation
direction from DoD
leadership
Beneficiaries
Mission AchievementMission Budget/Costs
Buy-In/Support
Deployment
Value PropositionKey Activities
Key Resources
Key Partners

29. Value Propositions and Beneficiaries
Automated Continuous
Monitoring
Improved Intra-BAS
Communication
Increased Situational
Awareness @BAS
Medical personnel at
a BAS
Care providers at higher
echelons of care
Increased Situational
Awareness/Preparation at higher
Roles of Care
Tactical personnel at
a BAS

30. “I have dozens of anecdotes of patients
that have died or had poor outcomes,
because the number of casualties
overwhelmed capability to monitor
or treat...”
- LtCol DeLellis, Deputy Surgeon at the United States Army
Special Operations Command

31. “...active monitoring would likely have
changed the outcome, for the
better, for many of those patients.”
- LtCol DeLellis, Deputy Surgeon at the United States Army
Special Operations Command

32. Mission Achievement:
Save lives deemed survivable, where they
are often lost

33. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

34. Development - Data Entry Application

35. Development - PA Interface

36. Development - PA Interface

37. Testing our Final MVP: 23rd Marine Regiment

38. “[The MVP] would effectively eliminate
the standard 15 minute interval between
vital re-measurements by enabling
continuous vitals monitoring.”
- 23rd Marine Regiment Corpsman

39. 0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey

40. Internal Readiness Level
Prototype of low-
fidelity Minimum Viable
Product

41. Immediate Next Steps
Hacking for Defense
Spring 2017
Open Source GitHub

42. Where do we go from here?
- Secure funding sources for further development i.e. the AAMTI
Award
- Interface with Zephyr biopatch sensors
- Work with USAMMA to develop formal requirement upon MVP
screening
- Explore field testing with a unit in a frequent deployment cycle
i.e. the 101st Airborne

43. Acknowledgements:
- USAMMA: Amanda Love, Jay Wang, Nita Grimsley
- TATRC: Daniel Kral, James Beach, Nathan Fisher
- Mentors: Steven Hong, David Zinn, George Hasseltine, Seth Krummrich,
Rafi Holtzman, Tammer Barkouki
- MVP Feedback: Stephen DeLellis, Jeffrey Oliver, Michael Holloway, Erwin
Villeros