Telemedicine-Guided Two-Incision Lower Leg Fasciotomy Performed by Combat Medics During Tactical Combat Casualty Care:A Feasibility Study

IntroductionDuring tactical combat casualty care, life- and limb-saving procedures might also be performed by combat medics. This study assesses whether it is feasible to use a head-mounted display (HMD) to provide telemedicine (TM) support from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy.Materials and MethodsNine combat medics were randomized into groups to perform a two-incision lower leg fasciotomy. One group used the Vuzix M400 and the second group used the RealWear HMT-1Z1. A third, control, group received no guidance. In the Vuzix M400 group and RealWear HMT-1Z1 group, a senior surgeon examined the results after the two-incision lower leg fasciotomy was finished to assess the release of compartments, possible collateral damage, and performance of the combat medics. In the control group, these results were examined by a surgical resident with expertise in two-incision lower leg fasciotomies. The resident’s operative performance questionnaire was used to score the performance of the combat medics. The telehealth usability questionnaire was used to evaluate the usability of the HMDs as perceived by the combat medics.ResultsCombat medics using an HMD were considered competent in performing a two-incision lower leg fasciotomy (Vuzix: median 3 [range 0], RealWear: median 3 [range 1]). These combat medics had a significantly better score in their ability to adapt to anatomical variances compared to the control group (Vuzix: median 3 [range 0], RealWear: median 3 [range 0], control: median 1 [range 0]; P = .018). Combat medics using an HMD were faster than combat medics in the control group (Vuzix: mean 14:14 [SD 3:41], RealWear: mean 15:42 [SD 1:58], control: mean 17:45 [SD 2:02]; P = .340). The overall satisfaction with both HMDs was 5 out of 7 (Vuzix: median 5 [range 0], RealWear: median 5 [range 1]; P = .317).ConclusionsThis study shows that it is feasible to use an HMD to provide TM support performance from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. The results of this study suggest that TM support might be useful for combat medics during tactical combat casualty care when performing life- and limb-saving procedures

Telemedicine Improves Performance of a Two-Incision Lower Leg Fasciotomy by Combat Medics:A Randomized Controlled Trial

Introduction:The primary aim of this randomized controlled trial was to assess if a head-mounted display (HMD) providing telemedicine support improves performance of a two-incision lower leg fasciotomy by a NATO special operations combat medic (combat medic).Materials and Methods:Thirty-six combat medics were randomized into two groups: One group performed a two-incision lower leg fasciotomy with the assistance of an HMD, while the control group completed the procedure without guidance. A Mann-Whitney U test was used to determine the possible differences in release of compartments and performance scores, as assessed by a supervising medical specialist. A Fisher's exact test was used to compare the proportions of collateral damage between groups. An independent-samples t-test was used to interpret total procedure times. The usability and technical factors involving HMD utilization were also assessed.Results:Combat medics in the HMD group released the anterior compartment (P <= .001) and deep posterior compartment (P = .008) significantly better. There was significantly more iatrogenic muscle (P <= .001) and venous damage (P <= .001) in the control group. The overall performance of combat medics in the HMD group was significantly better than that of the control group (P < .001). Combat medics in the control group were significantly faster (P = .012). The combat medics were very satisfied with the HMD. The HMD showed no major technical errors.Conclusions:This randomized controlled trial shows that a HMD providing telemedicine support leads to significantly better performance of a two-incision lower leg fasciotomy by a combat medic with less iatrogenic muscle and venous damage

Telemedicine Improves Performance of a Two-Incision Lower Leg Fasciotomy by Combat Medics:A Randomized Controlled Trial

Introduction:The primary aim of this randomized controlled trial was to assess if a head-mounted display (HMD) providing telemedicine support improves performance of a two-incision lower leg fasciotomy by a NATO special operations combat medic (combat medic).Materials and Methods:Thirty-six combat medics were randomized into two groups: One group performed a two-incision lower leg fasciotomy with the assistance of an HMD, while the control group completed the procedure without guidance. A Mann-Whitney U test was used to determine the possible differences in release of compartments and performance scores, as assessed by a supervising medical specialist. A Fisher's exact test was used to compare the proportions of collateral damage between groups. An independent-samples t-test was used to interpret total procedure times. The usability and technical factors involving HMD utilization were also assessed.Results:Combat medics in the HMD group released the anterior compartment (P <= .001) and deep posterior compartment (P = .008) significantly better. There was significantly more iatrogenic muscle (P <= .001) and venous damage (P <= .001) in the control group. The overall performance of combat medics in the HMD group was significantly better than that of the control group (P < .001). Combat medics in the control group were significantly faster (P = .012). The combat medics were very satisfied with the HMD. The HMD showed no major technical errors.Conclusions:This randomized controlled trial shows that a HMD providing telemedicine support leads to significantly better performance of a two-incision lower leg fasciotomy by a combat medic with less iatrogenic muscle and venous damage

SUPPORTING MISSION PLANNING WITH A PERSISTENT AUGMENTED ENVIRONMENT

Includes supplementary materialIncludes Supplementary MaterialThe Department of the Navy relies on current naval practices such as briefs, chat, and voice reports to provide an overall operational assessment of the fleet. That includes the cyber domain, or battlespace, depicting a single snapshot of a ship’s network equipment and service statuses. However, the information can be outdated and inaccurate, creating confusion among decision-makers in understanding the service and availability of equipment in the cyber domain. We examine the ability of a persistent augmented environment (PAE) and 3D visualization to support communications and cyber network operations, reporting, and resource management decision-making. We designed and developed a PAE prototype and tested the usability of its interface. Our study examined users’ comprehension of 3D visualization of the naval cyber battlespace onboard multiple ships and evaluated the PAE’s ability to assist in effective mission planning at the tactical level. The results are highly encouraging: the participants were able to complete their tasks successfully. They found the interface easy to understand and operate, and the prototype was characterized as a valuable alternative to their current practices. Our research provides close insights into the feasibility and effectiveness of the novel form of data representation and its capability to support faster and improved situational awareness and decision-making in a complex operational technology (OT) environment between diverse communities.Lieutenant, United States NavyLieutenant, United States NavyApproved for public release. Distribution is unlimited

Medical Command and Control in Sea-Based Operations

During World War II it took the Navy and Marine Corps years to confirm and refine their prewar doctrine for amphibious attack. The labor began with the first U.S. landings at Guadalcanal in August 1942; the resulting doc- trine, organization, tactics, and techniques were subsequently used by the Army in Europe. Early operations in both theaters highlighted the enormous difficul- ties associated with essential medical elements, and it was not until late 1944, perhaps 1945, that these problems were adequately solved

The Role 3 Multinational Medical Unit at Kandahar Airfield 2005–2010

In late 2005, Canadian Forces Health Services (CFHS) was tasked with the command of the NATO Role 3 Multinational Medical Unit (R3MMU) on Kandahar Airfield in southern Afghanistan. Preparations drew on past experience and planning. Eight complete hospital contingents were trained and deployed in rotation. Near-reality simulation training was undertaken with the combat brigade, including complete deployment of the field hospital in the exercise area. Standard operating procedures (SOP) were developed and applied by each rotation so successfully that they were adopted by the new command in late 2009. The Canadian period at R3MMU had the highest survival rate ever recorded for victims of war. Lessons learned are being applied among victims of the conflict and trauma. The experience of the R3MMU was used to successfully deploy a hospital as part of the earthquake relief effort in Haiti in 2010. The training protocols and SOP are being applied to disaster preparedness in Canadian civilian hospitals

Has the Red Cross–Adorned Hospital Ship Become Obsolete?

Those responsible for casualty management in littoral conflicts must weigh multiple variables such as: the enemy’s war-fighting strategies and tactics; the types of weapons systems used by the enemy; the complexity of the kinds of wounds and diseases commonly encountered during armed conflict; and the availability of resources to effectively treat those conditions

A Study Of Army Medical Treatment Methodology & Medical Simulation Related Products: Final Technical Report

Report detailing the research undertaken between phases 1 and 2 of the Combat Trauma Patient Simulator (CTPS) program, a long term research effort in which a dual purpose training and test and evaluation system that realistically simulates emergency medical treatment situations is being developed and prototyped

Medical planning for military operations other then [i.e. than] war: Is a paradigm shift required?

Military operations other than war are increasing in frequency and, as one might surmise present unique challenges to the operational commander and the medical planner. Over time and by necessity the U.S. military has developed a logistical support system with unprecedented capability. This logistical system includes a medical system that is increasingly called upon to provide care to people outside the normal scope. Increased participation means Navy assets will be tasked to provide care to U.S. troops, U.N. troops, multinational troops, NGO personnel, and the civilians that precipitated the need for intervention in the first place. The current planning paradigm is rightfully focused on combat support. This thesis will investigate the necessity of breaking away from that paradigm when planning MOOTW.http://archive.org/details/medicalplanningf109459791Lieutenant, United States NavyApproved for public release; distribution is unlimited