Augmented Reality and Telestrated Surgical Support for Point of Injury Combat Casualty Care: A Feasibility Study
Providing surgical care in remote environments presents a significant challenge. Telepresence and telesurgery have the potential to bridge the gap between definitive care and nonsurgical critical care for prolonged field care scenarios. This feasibility study investigated several key questions regarding the suitability of these technologies for this application. First, what are the technology requirements and minimum specifications for telestration capabilities between a surgical specialist at a Medical Treatment Facility and a remote non-surgeon in a far-forward environment using existing telecommunication systems within the US Army? Second, what training requirements are needed to prepare surgeons and non-surgeons to control lower extremity junctional hemorrhage, and to use associated telestration hardware, software and communications systems? Third, what is the transferability of this training paradigm and technology suite to a wider range of medical care and clinical procedural skills to anticipated future military medical care needs and environments? Our initial feasibility study indicates that telementoring and telestration using augmented reality (AR) systems appears well suited to providing surgical support and training across dispersed groups of medical providers. Forward surgical support using AR and telestration technologies are viable for point of injury surgical support and may be essential to filling this “missing middle” in the Combat Casualty Care continuum. We anticipate that the life and limb saving capabilities supported by this approach will be necessary in future Multi-Domain Battlefield Concept and in cases of remote and dispersed operations.
KeywordsAugmented reality Telestration Telementoring Modeling Simulation Combat casualty care
Since the demonstration described in this report, the Army Medical Department’s Advanced Medical Technology Initiative Program has funded a research study for further investigation and development.
The views expressed herein are those of the authors and do not necessarily reflect the official policy of the Department of Defense, Department of the Army, U.S. Army Medical Department or the U.S. Government.
Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favoring by the U.S. Government.
- 5.Gordon, J., Matusmura, J.: The Army’s role in overcoming anti-access and area denial challenges. No. W74V8H-06-C-001. RAND Arroyo Center, Santa Monica (2013)Google Scholar
- 6.DeSoucy, E., Shackelford, S., DuBose, J.J., et al.: Review of 54 cases of prolonged field care. J. Spec. Oper. Med. 17, 121–129 (2017)Google Scholar
- 12.Budrionis, A., Bellika, J.G.: Telestration in mobile telementoring. In: eTELEMED 2013 The Fifth International Conference on eHealth, Telemedicine and Social Medicine, pp. 307–309 (2013)Google Scholar
- 13.European Commission. Guidelines on the qualification and classification of stand alone software used in healthcare within the regulatory framework of medical devices. http://ec.europa.eu/health/medicaldevices/files/meddev/2_1_6_ol_en.pdf
- 14.Augestad, K.M., Bellika, J.G., Budrionis, A., et al.: Surgical telementoring in knowledge translation—clinical outcomes and educational benefits: a comprehensive review. Surg. Innov. 20–3, 273–281 (2012)Google Scholar
- 17.American College of Surgeons Committee on Trauma. ASSET (Advanced Surgical Skills for Exposure in Trauma) Exposure Techniques When Time Matters. American College of Surgeons, Chicago (IL) (2010)Google Scholar