ken wilson's hit leadership summit presentation
TRANSCRIPT
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Using Wearable Augmented Reality as 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
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OEF/OIF Mechanisms of Injury
Peake, James B., NEJM, Jan 2005
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344th US Military Major Service Admission Break out
GSW IED Indirect Fire Fall Others
Represented as percentages 2010-2011
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IEDs
Oil Can Tank Buster
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IEDs
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Preventable Forms of Combat Deaths
60% Hemorrhage from extremity wounds 33% Tension pneumothorax 6% Airway obstruction
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Explosive Delivery
Vehicle-borne improvised explosive device (VBIED)
Improvised explosive device (IED)
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Levels of Care Front line
Forward Surgical Team (FST)
L-1
L-2
L-3
L-4 L-5
Combat Support Hospital (CSH)
Field Hospital = Landstuhl
US Medical Center
BAS
Medics
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“Oh Lord, if I am called to the battlefield, give me the courage to conserve our fighting forces by providing medical care to all who are in need…” Combat Medic Prayer
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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
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Immediate
• Life-threatening wounds • Require quick intervention • “2 Minutes” • High likelihood of initial survival with
minimal resource use • Injuries
– Airway, tension PTX, hemorrhage – Limb ischemia, incomplete amputations,
circumferential burns
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Simulation Training
Care under fire – Stop life-threatening
bleeding – Move out of direct
enemy fire
Tactical Field Care CASEVAC
– Package the patient for transport
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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
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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
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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 deployed
Military Medicine, Vol. 172, August 2007
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Evaluation of Combat Medic Skills Validation Test
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SACMS-VT Test Score
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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
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Augmented Reality
Augmented reality (AR) is a term for a live direct or indirect view of a physical real-world environment whose elements are augmented by virtual computer-generated imagery.
It superimposes graphics, audio and other sense enhancements from computer screens onto real time environments.
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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
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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.
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Pleural Cavity Anatomy 101
Image: created by M. Jones. Biology 2404 Digestive Systems. http://science.tjc.edu/Course/BIOLOGY/2404/2404%20Digestive.htm
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Surface Anatomy
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Needle Decompression
Image: www.medical-supplies-equipment-company.com/fi
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Tension Pneumothorax
• Injury to visceral pleura • One way flap valve • Allows air into pleural space but prevents
exit
Image: www.healthcentral.com/.../1/19589_6077_5.jpg
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Tension Pneumothorax: History, Diagnosis and Treatment
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Vignette: A 19 year-old Army Ranger is violently thrown against a humvee after an IED attack. He has a distended abdomen with tenderness. His airway is intact, but he has severe right-sided chest pain and is unable to catch his breath. He is requiring emergent intervention for a tension pneumothorax.
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Juxtopia® CAARS OS
Step 3: Insert needle at a 90
degree angle as illustrated.
Juxtopia® CAARS: Needle Decompression Procedure: Step #3
1
2
3
4
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Mean Scores
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Evacuation
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35
Continuous En Route Care
BAS Level 1
Point of Injury to Definitive Care
Surgical Capability
CASEVAC 1 Hour
Intratheater EVAC 24 Hours
Intertheater EVAC 48-72 Hours Forward Surgical
Teams Level 2
CSH, EMF, Theater Hospital Level 3
CONUS/OCONUS MTF Level 4/5
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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
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Summary
• Advanced situational interface • Facilitate better decision making
maneuvers • Communicate with experts • Appropriate triage to higher and
appropriate medical facilities
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