Trauma Triage Treatment and Training Decision Support (4TDS)
June 10 2022 - 10:23AM
ML-supported decision support for austere battlefield
settings
Saving lives on the battlefield through Tactical Combat Casualty
Care (TCCC) and Prolonged Field Care (PFC) relies on accurate,
rapid diagnosis and treatment to prevent the effects of trauma that
can lead to morbidity and mortality if not detected.
To meet that need, Applied Research Associates, Inc. (ARA), the
Mayo Clinic, and Ambient Clinical Analytics developed the Trauma
Triage Treatment and Training Decision Support (4TDS) system. 4TDS
uses the VitalTag monitor (Pacific Northwest National Laboratory in
Richland, WA) placed on a casualty at point of injury (PoI) to
stream six vital signs to the phone: heart rate, respiration
rate, peripheral oxygen saturation (SpO2), and diastolic and
systolic blood pressure. Two artificial intelligence (AI) models
analyze the vital signs. One indicates the current risk of internal
hemorrhage and probability of the need for a massive transfusion
(more than one unit of red blood cells) while the other indicates
the probability of shock.
Participatory design ensures solutions align with
TCCC/PFC
Early engagement with experienced military medics and clinicians
from all services ensured 4TDS reflects their mental models and
work processes. It also built support among potential users should
the system transition to operational use. Two series of usability
assessments with nearly 100 Army, Navy and Air Force medics,
nurses, doctors, and physician’s assistants at Joint Base San
Antonio, TX discovered opportunities for improvement and confirmed
alignment with TCCC/PFC needs. Scripted scenarios led participants
through casualty care decisions to verify whether 4TDS improved
their performance, and reviewed refresher training on life-critical
skills such as restoring a compromised airway.
Strong military healthcare/industry/academic
team
Two agencies funded 4TDS through MTEC’s Multi-Topic Request for
Project Proposals: the U.S. Army Medical Research and Development
Command (USAMRDC) and U.S. Army Medical Materiel Development
Activity (USAMMDA). Co-PIs-Christopher Nemeth, PhD (ARA) and Dr.
Vitaly Herasevich (Mayo Clinic) led the project. Dr. Nemeth led
4TDS design and testing with ARA team members Mr. Greg Rule, Ms.
Natalie Keeney, and Mr. Steven Antrim. Dr. Herasevich led shock
prediction model development and testing with support from ARA’s
Adam Amos-Binks, PhD. Dr. Jaques Reifman of the Biotechnology
High-performance computing Software Applications Institute (BHSAI)
supported the addition of the hemorrhage risk models. CAPT Eric
Elster, MD and Dr. Matthew D’Angelo of the Uniformed Services
University of Health Sciences (USUHS) and Mr. Bret Smith (Tactical
Combat Medicine Course, JBSA) provided guidance from deployed
TCCC/PFC experience.
ARA is working closely with the military medical community to
complete FDA approvals and to field 4TDS and VitalTag to medics of
all military services.
About ARA
Applied Research Associates, Inc. (ARA) was founded in 1979, in
Albuquerque, New Mexico, to offer science and engineering research
to solve problems of national importance. ARA delivers leading-edge
products and solutions for national defense, energy, homeland
security, aerospace, healthcare, transportation, and manufacturing.
With over 1,500 employee-owners at locations in the U.S. and
Canada, ARA offers a broad range of technical expertise in defense
technologies, civil engineering, computer software and simulation,
systems analysis, biomedical engineering, environmental
technologies, and blast testing and measurement.
- Trauma Triage Treatment and Training Decision Support
(4TDS)
Greg Rule
Applied Research Associates, Inc.
grule@ara.com
