Using Wearable Augmented Realityas a Clinical-Decision Support Tool for First Responders LTC Kenneth L. Wilson, MD Assistant Professor Division of Trauma and Surgical Critical Care Department of Surgery Atlanta, Georgia
OEF/OIF Mechanisms of Injury Peake, James B., NEJM, Jan 2005
344th US Military Major Service Admission Break out Represented as percentages 2010-2011 GSW IED Indirect Fire Fall Others
Levels of CareFront line Medics L-1 L-2 BAS Forward Surgical Team (FST) L-3 Combat Support Hospital (CSH) L-4 Field Hospital = Landstuhl L-5 US Medical Center
“Oh Lord, if I am called to the battlefield, giveme the courage to conserve our fighting forcesby providing medical care to all who are inneed…” Combat Medic Prayer
Tactical Combat Casualty Care• Care under fire • Casualty care rendered while under effective hostile fire • Attention to suppression of hostile fire • Stop any life threatening injuries with a tourniquet• Tactical Field Care • ABCs • Analgesia/Antibiotics • Prepare for Evac to higher level of care
Simulation Training Care under fire – Stop life-threatening bleeding – Move out of direct enemy fire Tactical Field Care CASEVAC – Package the patient for transport
Combat Medic Training• Ability to sustain trauma skills is problematic• 50% of a medics’ core skills can be lost within the first six months and continuing medical education does little to slow the process• Army combat medic may not work everyday in their occupational specialty
Semi-Annual Combat Medic Skills- Validation Test (SACMS-VT)• SACMS-VT is used by the Army to determine combat medic competency• Consists of 4 different scenarios• To pass the combat medic must achieve at least a score of 70%• Cannot miss any performance steps that are seen as critical
91W Participants in the SACMS-VT• Subjects were males (n = 53) in the rank of E4 (specialist) or below• Average age was 22 years• 4 had an associates degree and only 1 with a master’s degree• 94% had never been deployedMilitary Medicine, Vol. 172, August 2007
Evaluation of Combat Medic Skills Validation Test
Challenges• Training highly variable• Practice opportunities are limited• Many medics are deployed who have had little to no training in a far forward setting• Critical skills are highly perishable
Augmented RealityAugmented reality (AR) is a term for a livedirect or indirect view of a physical real-world environment whose elements areaugmented by virtual computer-generatedimagery.It superimposes graphics, audio and othersense enhancements from computerscreens onto real time environments.
Wearable Augmented Reality• Wearable computer• Voice-activated• Superimposed graphics not altered by movement• Head mounted vision allowing the warfighter to treat causalities and maintain situational awareness
Subjects• 1st and 2nd year medical school students to perform a needle decompression ( 34 participants) – Highly motivated – Negligible clinical experience• Needle decompression procedure using cadavers at Morehouse School of Medicine• All participated in a PowerPoint presentation to learn about how to perform a needle decompression procedure and to have an overview of a tension pneumothorax.• None of the students had experience with needle decompression procedures.
Pleural Cavity Anatomy 101Image: created by M. Jones. Biology 2404 Digestive Systems.http://science.tjc.edu/Course/BIOLOGY/2404/2404%20Digestive.htm
Tension Pneumothorax • Injury to visceral pleura • One way flap valve • Allows air into pleural space but prevents exitImage: www.healthcentral.com/.../1/19589_6077_5.jpg
Tension Pneumothorax: History, Diagnosis and Treatment
Vignette: A 19 year-old Army Ranger is violently thrownagainst a humvee after an IED attack. He has adistended abdomen with tenderness. His airway isintact, but he has severe right-sided chest pain and isunable to catch his breath. He is requiring emergentintervention for a tension pneumothorax.
Juxtopia® CAARS: Needle Decompression Procedure: Step #3 Step 3: Insert needle at a 90 1 degree angle as illustrated. 2 3 4 Juxtopia® CAARS OS
Continuous En Route Care Point of Injury to Definitive Care CASEVAC 1 Hour Intratheater EVACBAS 24 Hours IntertheaterLevel 1 EVAC Forward Surgical 48-72 Hours Teams Level 2 CSH, EMF, Theater Hospital Level 3 Surgical Capability CONUS/OCONUS MTF Level 4/5 35
Wearable Augmented Reality for First Response• Voice –request to visualize or hear status information from a variety of sources• View dynamically changing course of action logistics• Voice request assistance on complex clinical procedures• Voice request video conferences
Summary• Advanced situational interface• Facilitate better decision making maneuvers• Communicate with experts• Appropriate triage to higher and appropriate medical facilities