Treating Fallen Troops: Two New Battlefield Devices
SAN ANTONIO, Tex. (Ivanhoe Newswire) - With life-saving equipment strapped to their backs, they rush in to help fallen comrades on the frontlines, but one of the items combat medics carry is something that's stayed pretty much the same for centuries. Now, two new devices could help treat troops on the battlefield.
Combat medics are in training learn how to save lives. A simple tool helps them do just that.
"About 3,000 U.S. military casualties have been saved with the tourniquet since the beginning of the war," John Kragh, MD, ISR Tourniquet Specialist at the U.S. Army Institute of Surgical Research, told Ivanhoe.
While the materials have improved, "Tourniquets haven't changed in 2000 years," Jose Salinas, PhD, Manager for the Comprehensive Intensive Care Research at the U.S. Army Institute of Surgical Research, told Ivanhoe.
Jose Salinas and John Kragh of the Army's Institute for Surgical Research want to change that.
"We call it the intelligent tourniquet," Dr. Salinas said.
The intelligent tourniquet has a pump and sensor system that can be controlled wirelessly.
"And I can go ahead and activate it by clicking this button. It can determine how much pressure it needs based on the limb to stop blood flow. It will always maintain accurate pressure." Dr. Salinas said.
It could be carried by medics or even built into uniforms. The wireless vital sign monitor weighs just one pound.
"It's extremely portable," Dr. Salinas explained.
It keeps track of basic vitals like heart rate and blood pressure. Wirelessly connect it to a laptop, tablet, or smartphone and you get more detailed readings.
"With this system you bring the power of a full vital signs monitor to the frontlines," Dr. Salinas concluded.
These two new technologies could save troops' lives.
The wireless vital sign monitor is FDA cleared and is even available for civilian EMS use, but the device is not yet on the battlefield. Salinas hopes to have the system available for deployment within the next two years. The intelligent tourniquet is still in the early prototype stage.
BACKGROUND: Research at the U.S. Army Institute of Surgical Research (ISR) on extremity injuries in 2004, has led to improving tourniquet devices to all U.S. troops deployed to combat by the Department of Defense in 2005. This resulted in a reduction in battlefield deaths from limb exsanguinations. Research has shown that soldiers who were wounded, incapacitated, and were in a location where a field medic could not reach them died. A tourniquet is used to control bleeding by constricting the limb above the wound. It should only be used if the bleeding is life-threatening. Today, the same tourniquets that save lives in the battlefield are used by paramedics to save lives of people with life-threatening, non-combat injuries.. For example, a paramedic team from the Emergency Medical Service in Schertz, Texas, used the Combat Application Tourniquet (CAT) on a motorist whose leg was amputated by another driver when he was changing a flat tire on the side of the road. (Source: www.combattourniquet.com)
INTELLIGENT TOURNIQUET (iTK): The iTK was first developed through a partnership between the ISR and Athena GTX. Scientists developed it because they wanted to integrate the tourniquet concept with computer technology. It is an air bladder, sensor suite, and wireless computer control system that is all compacted into the existing tourniquet to provide automated control of tourniquet activation based on patient sensor data or at the direction of a nearby medic through a wireless connection to the intelligent tourniquet. It is still in the prototype stages, but researchers are hoping to be able to have a system that they can test on patients in a few years. The iTK is fitted with a computer the size of a pack of cards. It can be activated or deactivated at the point of injury by the wounded warrior or remotely from a different location. The computer can also monitor the patient's vital signs and interventions. For example, if the unit notices the blood pressure of the patient is starting to stabilize itself, then the computer system would tell the control units to loosen the tourniquet and profuse the limb if it needs to be. Researchers want to eventually fit battle uniforms with the iTK along with sensors that would detect a blast going off around the warrior and automatically deploy. If it activates and is not needed, then the warrior could push a button on the computer to deactivate it. (Source:www.usaisr.amedd.army.mil)
WIRELESS VITAL SIGNS MONITOR: The FDA approved the Wireless Vital Signs Monitor (WVSM), which was designed by a partnership between the U.S. Office of Naval Research and Athena GTX. It is a small device that measures and records a patient's electrocardiogram, pulse oximeter, heart rate, and non-invasive systolic, diastolic, and mean blood pressures. The information can be transmitted to a medic's laptop, electronic tablet, or smartphone where it calculates even more patient information; such as, trends, pulse pressure, and complexity indices. This device has ISR technology to provide users with information on the patient's condition, not just from actually seeing the patient. The WVSM is strapped on to a patient's arm or leg and it captures all vital signs from the point of injury. It is capable of transmitting and downloading information to a hospital's emergency department monitoring system. The WVSM tells the medic when a patient's condition is getting worse even though there may not be any physical signs. The current WVSM uses electronic waves to connect the pulse oximeter that attaches to a patient's finger and the electrodes that are placed on the chest. They could get cut or damaged during treatment. Researchers are hoping that the new version in clinical trials will eliminate these wires. (Source: www.usaisr.amedd.army.mil)
Jose Salinas, PhD, Task Area Manager for Comprehensive Intensive Care Research of the U.S. Army Institute of Surgical Research and the U.S. Army Medical Research and Material Command, talks about new technology for military med techs.
Can you tell us about the tourniquet overall. How long has it been around?
Jose Salinas, PhD: The tourniquet has been around for thousands of years; even the Roman soldiers used tourniquets. Unfortunately, the design has not changed in the last 2,000 years. Literally, it is a piece of cloth with a cravat that is used to tighten around an extremity to stop bleeding when a patient or a solider gets injured in the battlefield. We do have tourniquets now that are modern versions of the old Roman tourniquets, but the concept is still the same. We use high-tech materials. We use high-tech plastics, but overall mechanics have not changed; a strap with a cravat that is tightened manually by a user. We have taken that concept and explored the use of other types of technology to improve this 2,000 year old design. Specifically, we want to use wireless and computer technology to be able to create a tourniquet system that provides a lot more capability than existing designs.
It is called the Intelligent Tourniquet?
Jose Salinas, PhD: Yes. We call it the Intelligent Tourniquet or iTK for short because it brings the power of computer technology and microelectronics to tourniquet design. Specifically, we have a system where we have taken a sensor with a micro pump and created a wireless control unit that can be carried by medics or soldiers, in addition to letting us control the performance of the tourniquet remotely so we can program profiles. The current tourniquet prototype has sensors on it that will always maintain adequate pressures automatically. In the near future, it will be able to determine whether the patient has reduced blood flow or not, and be able to have a much better performance than a standard manually controlled tourniquet.
What are some of the different ways it could be used?
Jose Salinas, PhD: There are several ways to use this concept. Right now, it is still in the prototype stages, but we have explored taking the system, building it into a soldier's uniform, and tying it out in blast over pressure sensors. For example, if a solider walks into a situation when there is an IED, the sensors on his body will detect the explosion going off and automatically deploy those tourniquets. We have also explored tying it into a vehicle's safety systems. So, if a solider is inside of a vehicle and it has an accident or runs over a mine, as soon as the vehicle safety systems get activated, the tourniquet on the soldiers will also get deployed automatically. There are a lot of areas where this technology can be used to improve current tourniquet designs and approaches.
How long have you been working on it and how long do you think it will be until we will see it?
Jose Salinas, PhD: We have been working on the overall concept of new tourniquet designs for the last 5 or 6 years. We have been working on the idea of building information technology and intelligent tourniquet technology into them for approximately 1 year. It is still in the preliminary stages. This is mainly a proof of concept. We want to be able to show that this can be done and that it is reliable enough to eventually be on the battlefield. We hope that within the next 5 years or so, we might be able to have something that is worth testing on the soldiers.
How does to keep the correct pressure?
Jose Salinas, PhD: That is an interesting concept. The system is composed of a wireless controller, a pump, and a set of sensors that detect how much pressure the tourniquet is exerting on the extremity. So, as the tourniquet starts inflating based on the command from the wireless controller, or from another source, it can determine how much pressure it needs based on the limb to stop blood flow. For example, normally it takes about 300 mmHg to stop blood flow through a normal artery. This system, based on the pressure sensors, knows how tight the tourniquet is and if it is exerting the correct pressure. Based on that, it is programmed to maintain that pressure automatically. For example, if the patient's blood pressure drops from an injury, it will increase pressure on the tourniquet to always maintain the correct pressure and prevent blood flow through that extremity. In this prototype control unit each limb has a tourniquet associated with it that can be activated by clicking a button on the display. So, by activating the tourniquet, the wireless controller within the tourniquet system can activate the tourniquet itself. As it inflates, it is measuring the pressure that that tourniquet is exceeding on the arm and it will maintain that pressure as needed while the tourniquet is used.
Can you tell us more about how this new system differs from the old version of a tourniquet?
Jose Salinas, PhD: In today's day and age tourniquets are widely used in the battlefield, but even with tourniquet use, bleeding and death from extremity exsanguination is still a serious issue in the current environment. We asked ourselves, can we use information technology to try to improve on the current tourniquet system? Because tourniquets have not changed in 2,000 years, it is still a strap with a cravat that you tighten. Now, we have the high-tech materials, but it is still the same concept. We are using newer approaches to try to improve the system. We are building a pump system that can be controlled remotely so that we can go ahead and active the tourniquet as needed. You can activate it through physiologic science. For example, if you have a sensor that detects a blast going off around you, you can use that information to automatically active the tourniquet. The medics can carry control systems so they can put a tourniquet on a patient and activate it as needed. If a patient has a tourniquet on him and he is in a location where he cannot be extricated, he can go ahead and activate it remotely. We have had several cases of patients, exsanguinating because the medics cannot physically get to the patient and put a tourniquet on them. So, that is why we have been looking at how we can build the next generation tourniquet by using computer technology, coupled with advanced sensors.
Can you tell us about the vital signs monitor?
Jose Salinas, PhD: The Wireless Vital Signs Monitor (WVSM) is a monitor that was developed with our partner Athena GTX, Inc. The concept is to build a monitor that can be taken by medics to the front lines and is able to monitor the standard vital signs of a patient, either locally or remotely. The system takes technology that is available now and it weighs about 10 pounds and puts it into a package that weighs only 1 pound. It is extremely portable and it basically allows a medic in the field to monitor multiple patients simultaneously.
The system provides users access to very advanced algorithms for tracking a patient's injury status and progression while wearing the main sensor package. However, some of the more advanced algorithms that we have developed cannot be performed in the soldier worn unit. This form factor was done with very low power, very low computing capability. It mainly just reads data off of the body and does some very basic analyses, but as the data is transferred to a receiving station more advanced algorithms can be executed and tested. For example, shock index is one of these new vital signs that we have been investigating to give us more information than your standard vital signs.
Currently, if you get put in an ambulance in San Antonio with a standard vital signs monitor, that system will give you the blood pressure, your heart rate, your SpO2, and that is about it. We have the capability to give you more than that. A shock index, which is the difference between your heart rate and your systolic blood pressure, by combining those two together we can actually get more information. Your pulse pressure, which is your differences between your systolic and diastolic pressures, will also give you more information. We have some of these very complex vital signs that we also use like heart rate complexity (HRC) and heart rate variability (HRV). Heart rate complexity measures the regularity of your heart beat. Now, this is kind of contra-intuitive; you think of your heart rate as regular and does not change. Actually, that is not true. The healthier you are the more irregular your heart beat is. The sicker you are the more regular your heart beat becomes. We can detect, measure, and analyze these changes to determine your injury status and severity.
Is this in the field yet?
Jose Salinas, PhD: This is not in the field. The device received FDA clearance 2 years ago and we are working through the process to eventually get it out in the field and used by medics.
How could this benefit medics and their patients?
Jose Salinas, PhD: It benefits medics in many, many ways. First of all, right now the way medics monitor their patients in the field is very rudimentary. There is very little technology to diagnose patient status. What is available to them is a single finger pulse oximeter, which is a device they put on their finger and it gives them the blood oxygen level. That is the limit of the current technology. With this system, you bring the power of a full vital signs monitor to the front line. So, not just the pulse, but you can measure heart rate, blood pressure, and all that data can be transmitted to a receiving station where we can do advanced vital signs monitoring algorithms to help the medic do a better diagnosis and treat the patient better.
If the patient looks fine and is talking to them, but might have something internally that the medic cannot see; this will alert them?
Jose Salinas, PhD: One of the issues that we find, especially with inexperienced medics and clinicians, is that if a patient is talking at you, a lot of the clinicians assume that that patient is doing okay. However, that is not necessarily the case. There are a lot of reports on patients that are actively engaging the provider. The provider assumes that the patient is doing okay and they walk away to treat what they think is a more serious patient; in the meantime the first patient dies because of decompensated shock that was not detected by the medic. So, we hope that by providing the medic with a lot more information than he currently has, coupled with advanced decision support technologies, we could actually give enough information to the medic to be able to detect those patients that may not have outward signs of their injury.
The system can provide a full history to the physician, so he can know exactly what the pressures are. He knows exactly what the interventions were. He does not need a report from the medic. Then, we have the trends so we can analyze the historical data and tell you whether it is stable, going up, or going down. Then there is the standard vital sign. This is the numeric data that comes out of the monitor with a couple of fractions. We have your shock index, which basically does a measurement of the systolic blood pressure compared to your heart rate. Then we have this thing called the LSI. LSI stands for "life-saving intervention." The system is running a neural network in the background and this neural network is basically an artificial intelligence algorithm that is looking at all the data that the monitor is generating and telling you whether that patient needs an intervention right now or not. So, we talked about those patients that may look good that are talking to you, but internally they might have something going on. The system will then say you better look at this patient. He needs an intervention and it basically gives you better situational awareness.
When will this hit the battle field?
Jose Salinas, PhD: Unfortunately, the process for fielding equipment to the front lines tends to be fairly long and cumbersome. We hope within the next couple of years we will see some of these units actively being used in the front lines.
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