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Team Surgency
Supporting time-critical combat care during mass casualty response
Week 0:
Problem: Developing the capabilit...
Chris Sebastian
Software Engineering &
Product
Andrew DeClerck
Machine Learning &
Software Engineering
Negin Behzadian
Ana...
Who We Interviewed
58+
Experts
20
Users
12
Buyers
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
fo...
Develop capability for robotic
telesurgery that would allow
physicians to provide time-critical
treatments for injured pat...
“People are scared to move a
daVinci down a hallway, let alone
use it on the battlefield”
- Anonymous Stanford Hospital Tr...
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
fo...
Where can we add value?
Evacuation
Forward CarePOINT OF INJURY
Role 2
Role 3
Visit to 129th Rescue
Wing at Moffett Airfield
90%
before arrival to medical treatment facility
25%
of those fatalities were deemed survivable
Where can we add value?
Evacuation
Forward CarePOINT OF INJURY
Role 2
Role 3
“[Mass casualty triage] is not a
patient care problem, it’s a
management problem.”
- 129th Rescue Wing Pararescuer
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
fo...
Civilian Mass Casualty Training Simulation
“It’s a waste of time to try and
diagnose — it’s all about
prioritization.”
- Timothy Browder, MD; Stanford Trauma Surgery
Justin
Roberto
Davis
Clute
Nicolas
Lozano
MVP 1.0
A Potential Solution for Automating Pre-Evacuation Mass
Casualty Priorit...
UWB
Network
Zephyr Vitals Sensors
Leveraging FDA-approved physiological monitoring system, already deployed in several hig...
“The first time extensive triage
takes place is at the Battalion Aid
Station.”
- LtCol Hasseltine, former Commanding Offic...
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
fo...
Battalion Aid Station?
EXPECTANT
STAGING
AREA
BLACK
MEDEVAC:
Medical Officer
TRIAGE TREATMENT
INCOMING
CASUALTIES
MEDEVAC
...
Current Prioritization at Battalion Aid Stations
White Board
TrackingTriage Card
“There is a continuous stream of
communication at a BAS supporting triage,
treatment, and EVAC of casualties across
medica...
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
fo...
MVP 2.1: Triage Manager Interface
MVP 2.2: Physician Assistant Interface
Final MVP: Evaluating Product-Mission Fit at the BAS
TRIAGE TREATMENT
CAS. INFO
INPUT:
Secondary Triage
Officer
OUTPUT:
Ph...
Surgency: Mission Model Canvas
- UI/UX Design MVP
- Software Engineering
- Interface/integrate w/
Zephyr sensors
- Purchas...
Value Propositions and Beneficiaries
Automated Continuous
Monitoring
Improved Intra-BAS
Communication
Increased Situationa...
“I have dozens of anecdotes of
patients that have died or had poor
outcomes, because the number of
casualties overwhelmed ...
“...active monitoring would likely
have changed the outcome, for
the better, for many of those
patients.”
- LtCol DeLellis...
Mission Achievement:
Save lives deemed survivable, where they
are often lost
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
fo...
Development - Data Entry Application
Development - PA Interface
Development - PA Interface
Testing our Final MVP: 23rd Marine Regiment
“[The MVP] would effectively eliminate
the standard 15 minute interval
between vital re-measurements by
enabling continuou...
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
fo...
Internal Readiness Level
Prototype of low-
fidelity Minimum
Viable Product
Immediate Next Steps
Hacking for Defense
Spring 2017
Open Source GitHub
Where do we go from here?
- Secure funding sources for further development i.e. the
AAMTI Award
- Interface with Zephyr bi...
Acknowledgements:
- USAMMA: Amanda Love, Jay Wang, Nita Grimsley
- TATRC: Daniel Kral, James Beach, Nathan Fisher
- Mentor...
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mission model, mission model canvas, customer development, Hacking for Defense, lean startup, stanford, startup, steve blank, Pete Newell, Joe Felter, minimum viable product

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Surgency Hacking for Defense 2017

  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

mission model, mission model canvas, customer development, Hacking for Defense, lean startup, stanford, startup, steve blank, Pete Newell, Joe Felter, minimum viable product

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