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Activity title

Solutions for Combat Casualty Care

Activity Reference

HFM-317

Panel

Human Factors and Medicine

Security Classification

PUBLIC RELEASE

Status

Planning

Activity type

LTSS

Start date

2019

End date

2023

Keywords

Autonomous Care and Evacuation, Blood on demand, Casualty status monitoring, Combat casualty care, Combat trauma therapies, Craniomaxillofacial injury, Damage control resuscitation, Extremity trauma, Neuroprotection, Neurotrauma, Pain control on battlefield, Prolonged field care, Regenerative medicine, Traumatic brain injury

Background

Warfare conducted as part of low-level counter-insurgency and counter-terrorism operations over the past two decades has enabled military medicine to achieve the highest rate of survival from combat-related injuries. A significant factor in this success has been the military’s ability to provide lifesaving care within a short time frame after injury known as the “Golden hour”. In contrast, military operations today, and those projected to occur in the future against peer or near-peer forces will greatly limit access to casualties, casualty evacuation, and the sustainability of medical capabilities. Moreover, global access to technology and scientific talent by adversaries now and in the future will challenge NATO superiority. In aggregate it can be anticipated that complexities associated with the future battle space will significantly challenge the military’s “Golden Hour” paradigm and thus the its ability to maintain a sub-10% case fatality rate. Responding to this challenge and taking measures to maintain high rates of survival and recovery among injured Warfighters requires an innovative, long-term scientific study of casualty care; a study that will anticipate requirements that need to be met with new knowledge and materiel products to prevent strategic surprise and sustain/build medical capability and force lethality.

Objectives

Improving capabilities to accurately assess combat injuries to inform return to duty, resource allocation, and evacuation priorities during prolonged care scenarios Providing safe and effective pain management for all phases of care (point of injury, en-route and facility-based) for combat casualties without physiologic or cognitive impairment Enabling treatments for neuromusculoskeletal, sensory systems, and minor injuries to be diagnosed and treated rapidly to accelerate return to duty and augment lethality of the force Optimizing ongoing life-saving resuscitation, particularly in resource limited settings Developing advanced treatment options to deliver critical care closer to the point of injury/point of need Providing capabilities to manage organ dysfunction and failure, and injury sequelae at point of injury/ point of need Enabling damage control surgery or equivalent at the point of need when casualty evacuation is delayed or unavailable Developing solutions to immediately stabilize composite tissue injuries and preserve injured tissue Providing prolonged patient management capabilities after initial survival Providing palliative care to all casualties with non-survivable injuries Increasing manned and unmanned capabilities to provide en route critical care, leveraging current and future ground, air and naval evacuation platforms Identification of concussion at or near the point on injury and return to duty indicators Early diagnosis of moderate and severe TBI at or near the point of injury Provide effective, logistically supportable, therapeutic capabilities to treat TBI and prevent the progression of injury

Topics

Combat Casualty Care as a System To minimize mortality and morbidity in future NATO operations, S&T capabilities related to the combat casualty care system must be optimized. Major topic areas that must be investigated to achieve the combat casualty care objectives include: . Medical force structure requirements (e.g., number of personnel, provider level and applicable training) . Field hospital configuration/capabilities . Joint doctrine and policy related to medical planning . Manned and unmanned patient evacuation coordination capabilities . Logistical support systems for medical care in future operational environments Prolonged Field Care Multiple scientific topic areas to address combat casualty care objectives specific to prolonged field care are required to address S&T objectives. Specific topics include: . Disruptive resuscitation fluids and adjuncts . Automation of central arterial and venous access as well as peripheral venous access to disruptively facilitate resuscitation of large casualty numbers in austere environments and to enable use of advanced endovascular (i.e. inside the blood vessel) technologies . Optimization of freeze dried plasma, platelet preservation technologies, oxygen carriers, and whole blood for use in the far forward environment with minimal logistical footprint . Extracorporeal life support capabilities - miniaturized, ruggedized and optimized for use near the point of injury, with integrated physiologic monitoring capability (advanced biosensors) . Advanced treatments for non-compressible torso hemorrhage .Technologies to maintain distal perfusion following tourniquet placement, vascular injury, or endovascular balloon occlusion of the aorta . Advanced wound dressings to facilitate hemostasis, wound healing and prevent infection . Innovative toolsets to diagnose and treat abdominal hemorrhage and contamination, temporally bridging to damage control surgery . Rapid sterilization of surgical instruments . Novel technologies for non-surgical debridement and regenerative coverage . Advanced burn resuscitation and regenerative burn wound dressings . Therapeutics to prevent and treat ischemia reperfusion injury . Field deployable capability to prevent, diagnose, and treat sepsis . Improved compartment syndrome diagnostics . Field deployable capability to monitor toxins, electrolytes, and nutrition . Thermoregulation technologies for austere environments, particularly extremes of cold and heat Casualty Sensing, Monitoring, and Predictive Analytics Capability to provide combat casualty care in future operational environments will be enabled by advanced sensing, monitoring, and predictive analytic technologies. Scientific topic areas include: . Offset/Remote vital sign monitoring capability . Advanced ultra-low footprint wearable biosensor technologies for triage and homeostatic maintenance . Development of in-line monitoring capabilities, integrated with treatment devices . Development and validation of predictive algorithms for physiologic decompensation in the context of hemorrhagic shock, organ failure, sepsis, and CBRN exposure . Rapid detection of mild TBI in the acute and post-acute periods . Identification of non-penetrating moderate to severe TBI requiring rapid intervention

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