Military medicine
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For behind armor blunt trauma (BABT), recent prominent BABT standards for chest plate define a maximum deformation distance of 44 mm in clay. It was developed for soft body armor applications with limited animal, gelatin, and clay tests. The legacy criterion does not account for differing regional thoracoabdominal tolerances to behind armor-induced injury. This study examines the rationale and approaches used in the legacy BABT clay criterion and presents a novel paradigm to develop thoracoabdominal regional injury risk curves. ⋯ While the original authors stressed limitations and the importance of additional tests for refining the 44 mm recommendation, they were not pursued. As live swine tests are effective in developing injury criteria and the responses of different areas of the thoracoabdominal regions are different because of anatomy, structure, and function, a new set of swine and human cadaver tests are necessary to develop scaling relationships. Live swine tests are needed to develop incapacitation/lethal injury risk functions; using scaling relationships, human injury criteria can be developed.
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Increased complexity in robotic-assisted surgical system interfaces introduces problems with human-robot collaboration that result in excessive mental workload (MWL), adversely impacting a surgeon's task performance and increasing error probability. Real-time monitoring of the operator's MWL will aid in identifying when and how interventions can be best provided to moderate MWL. In this study, an MWL-based adaptive automation system is constructed and evaluated for its effectiveness during robotic-assisted surgery. ⋯ The proposed MWL monitoring system successfully diminished the perceived workload of participants and increased their task performance under high-stress conditions via interventions by a semi-autonomous suction tool. The preliminary results from the comparative study show the potential impact of automated adaptive aiding systems in enhancing surgical task performance via cognitive workload-triggered interventions in robotic-assisted surgery.
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Expected future delays in evacuation during near-peer conflicts in remote locales are expected to require extended care including prolonged field care over hours to days. Such delays can increase potential complications, such as insufficient blood flow (shock), bloodstream infection (sepsis), internal bleeding (hemorrhage), and require more complex treatment beyond stabilization. The Trauma Triage Treatment and Training Decision Support (4TDS) system is a real-time decision support system to monitor casualty health and identify such complications. The 4TDS software prototype operates on an Android smart phone or tablet configured for use in the DoD Nett Warrior program. It includes machine learning models to evaluate trends in six vital signs streamed from a sensor placed on a casualty to identify shock probability, internal hemorrhage risk, and need for a massive transfusion. ⋯ Participatory design ensured 4TDS and machine learning models reflect medic and clinician mental models and work processes and built support among potential users should the system transition to operational use. Validation results can support 4TDS readiness for FDA 510k clearance as a Class II medical device.
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Preventable patient harm has persisted in health care despite recent advances to reduce errors. There is increasing recognition that non-technical skills, including communication and relationships, greatly impact interprofessional team performance and health care quality. Team familiarity and size are critical structural components that potentially influence information flow, communication, and efficiency. ⋯ For military surgical teams, greater familiarity and smaller team sizes were associated with small improvements in communication effectiveness. Military leaders can likely enhance team communication by engaging in a thoughtful and concerted program to foster cohesion by building familiarity and optimizing team size to meet task and cognitive demands. We suggest leaders develop bundled approaches to improve communication by integrating team familiarity and team size optimization into current evidence-based initiatives to enhance performance.
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To assist in addressing medical readiness challenges, the DOD has established various Centers of Excellence to focus efforts to protect, treat, train, and educate service members concerning risks and potential injuries. Using the hearing health domain as a pilot, this effort used DOD methods to evaluate all facets of successful health behavior change (HBC) practices within a military environment and developed a framework and pathway for HBC. ⋯ Use of the "Guidebook for Design, Conduct and Assessment of Health Behavior Change Campaign Within the DOD" and DOTMLPF-P analysis will move Defense Health Agency toward more disciplined use of the JCIDS. The HBC framework allowed the Hearing Center of Excellence to lead the hearing health community to create a capability-based assessment for hearing HBC.