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Birch E, Couperus K, Gorbatkin C, Kirkpatrick AW, Wachs J, Candelore R, Jiang N, Tran O, Beck J, Couperus C, McKee J, Curlett T, DeVane D, Colombo C. Trauma THOMPSON: Clinical Decision Support for the Frontline Medic. Mil Med 2023; 188:208-214. [PMID: 37948255 DOI: 10.1093/milmed/usad087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/10/2023] [Accepted: 03/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION U.S. Military healthcare providers increasingly perform prolonged casualty care because of operations in settings with prolonged evacuation times. Varied training and experience mean that this care may fall to providers unfamiliar with providing critical care. Telemedicine tools with audiovisual capabilities, artificial intelligence (AI), and augmented reality (AR) can enhance inexperienced personnel's competence and confidence when providing prolonged casualty care. Furthermore, implementing offline functionality provides assistance options in communications-limited settings. The intent of the Trauma TeleHelper for Operational Medical Procedure Support and Offline Network (THOMPSON) is to develop (1) a voice-controlled mobile application with video references for procedural guidance, (2) audio narration of each video using procedure mentoring scripts, and (3) an AI-guided intervention system using AR overlay and voice command to create immersive video modeling. These capabilities will be available offline and in downloadable format. MATERIALS AND METHODS The Trauma THOMPSON platform is in development. Focus groups of subject matter experts will identify appropriate procedures and best practices. Procedural video recordings will be collected to develop reference materials for the Trauma THOMPSON mobile application and to train a machine learning algorithm on action recognition and anticipation. Finally, an efficacy evaluation of the application will be conducted in a simulated environment. RESULTS Preliminary video collection has been initiated for tube thoracostomy, needle decompression, cricothyrotomy, intraosseous access, and tourniquet application. Initial results from the machine learning algorithm show action recognition and anticipation accuracies of 20.1% and 11.4%, respectively, in unscripted datasets "in the wild," notably on a limited dataset. This system performs over 100 times better than a random prediction. CONCLUSIONS Developing a platform to provide real-time, offline support will deliver the benefits of synchronous expert advice within communications-limited and remote environments. Trauma THOMPSON has the potential to fill an important gap for clinical decision support tools in these settings.
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Affiliation(s)
- Eleanor Birch
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - Kyle Couperus
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
| | - Chad Gorbatkin
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - Andrew W Kirkpatrick
- TeleMentored Ultrasound Supported Medical Interventions Research Group, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Juan Wachs
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Ross Candelore
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
- Department of Emergency Medicine, William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
| | - Nina Jiang
- School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Oanh Tran
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
| | - Jonah Beck
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
| | - Cody Couperus
- Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Jessica McKee
- TeleMentored Ultrasound Supported Medical Interventions Research Group, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Timothy Curlett
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
| | - DeAnna DeVane
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
| | - Christopher Colombo
- Department of Emergency Medicine, Madigan Army Medical Center, JBLM, WA 98431, USA
- The Geneva Foundation, Tacoma, WA 98402, USA
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Knisely BM, Gaudaen JC, Smith AV, Perta JM, Pamplin JC, Quinn MT, Schmidt PM. Evaluating Medic Performance in Combat Casualty Care Simulation and Training: A Scoping Review of Prospective Research. Mil Med 2023; 188:e1664-e1672. [PMID: 35986604 DOI: 10.1093/milmed/usac250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/29/2022] [Accepted: 08/04/2022] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Combat medics are required to perform highly technical medical procedures in austere environments with minimal error. Effective means to quantify medic performance in field and simulated environments are critical to optimize medic training procedures as well as to evaluate the influence of medical equipment and other supportive technologies on medic performance. Human performance evaluation in combat casualty care presents many unique challenges due to the unique environment (battlefields) and population (medics) that must be represented. Recent advances in simulation and measurement technology have presented opportunities to improve simulation fidelity and measurement quality; however, it is currently unclear to what extent these advances have been adopted in this domain. METHODOLOGY In this work, a scoping review of recent (2011-2021) prospective research on Army medic (68 W and Special Operations) performance is presented. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines served as the framework for the review. The goal of this work was to summarize recent trends and practices and to illuminate opportunities for future work. Two human factors experts performed an exhaustive review of relevant, peer-reviewed literature and systematically identified articles for inclusion in the final analysis. The articles were examined in detail, and data elements of interest were extracted. RESULTS Forty-eight articles were identified based on the defined inclusion criteria. Thirty three of the articles focused on technological evaluation, 25 focused on medic training procedures, and 5 focused on evaluating medical techniques. Study contributions were predominantly related to medic training materials/procedures and simulator technology. Supportive medical technologies, including telemedical systems, hemorrhage control devices, and ultrasound devices, also received significant attention. Timing was the most common metric used to quantify medic performance, followed by skill pass/fail ratings. There was a notable lack of neurophysiological data used to examine medic physical/cognitive workload during procedures, a growing practice in many other related domains. The most commonly simulated procedures were hemorrhage control, airway management, and thoracostomy. Notable limitations cited across articles were insufficient simulation fidelity, inadequate sample size or sample representativeness, and poor study design. CONCLUSIONS This work provided a summary of recent peer-reviewed research related to medic simulation and training, and performance evaluation. This article should be used to contextualize existing research and inspire new research questions. Expanding and advancing research on medic simulation and training will help to ensure optimal casualty care at the front lines.
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Affiliation(s)
- Benjamin M Knisely
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - James C Gaudaen
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Andrew V Smith
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Julie M Perta
- MedStar Montgomery Medical Center, Olney, MD 20832, USA
| | - Jeremy C Pamplin
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
- Uniformed Services University, Bethesda, MD 20814, USA
| | - Matthew T Quinn
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
| | - Patricia M Schmidt
- Telemedicine and Advanced Technology Research Center, United States Army Medical Research and Development Command, Fort Detrick, MD 21702, USA
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Simmons MA, Otero-Luna A, Redmond B, Fahey J, Beach C, Bruno C, Johnston L. Neonatal Cardiac Emergencies: A Multidisciplinary Simulation Curriculum for Neonatology and Pediatric Cardiology Fellows. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11045. [PMID: 33365389 PMCID: PMC7751327 DOI: 10.15766/mep_2374-8265.11045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/06/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Although care for neonates with cardiac disease is frequently provided by neonatologists and pediatric cardiologists, training in the multidisciplinary management of neonatal cardiac emergencies is not often included in fellowship training. We created a multidisciplinary simulation curriculum to address the skills needed for neonatal cardiac care. METHODS Neonatology and pediatric cardiology fellows participated in 1-hour simulations on 3 different days. They managed a neonate with: (1) cyanosis, (2) cardiogenic shock, and (3) an unstable arrhythmia. Using both remote consultation and bedside evaluation, the participants diagnosed and jointly established a management plan for the infant. During the debrief, facilitators reviewed the clinical decisions and multidisciplinary management skills of the participants. Participants completed pre- and postparticipation surveys to evaluate the curriculum's effect on their confidence in the management of neonatal cardiac disease. RESULTS Thirty-three paired survey responses from 20 participants (11 neonatology and 9 pediatric cardiology) reported a mean overall satisfaction score of 4.6 (SD = 0.7) based on a 5-point Likert scale. Postparticipation confidence scores improved significantly in: (1) the recognition of the signs of congenital heart disease (pre = 4.1, post = 4.5, p = .01), (2) differentiation of cardiac cyanosis from noncardiac cyanosis (pre = 3.9, post = 4.2, p = .05), and (3) confidence in discussing cardiac concerns with consultants (pre = 3.3, post = 4.1, p = .02). DISCUSSION This multidisciplinary simulation improved fellows' confidence in the management of neonates with cardiac disease and provided an opportunity to practice team work, remote consultation, and cross-disciplinary communication.
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Affiliation(s)
- M. Abigail Simmons
- Fellow, Department of Pediatrics, Section of Cardiology, Yale University School of Medicine
| | - Andrea Otero-Luna
- Fellow, Department of Pediatrics, Section of Cardiology, Yale University School of Medicine
| | - Brooke Redmond
- Fellow, Department of Pediatrics, Section of Neonatal and Perinatal Medicine, Yale University School of Medicine
| | - John Fahey
- Professor, Department of Pediatrics, Section of Cardiology, Yale University School of Medicine
| | - Cheyenne Beach
- Assistant Professor, Department of Pediatrics, Section of Cardiology, Yale University School of Medicine
| | - Christie Bruno
- Associate Professor, Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Yale University School of Medicine
| | - Lindsay Johnston
- Associate Professor, Department of Pediatrics, Section of Neonatal-Perinatal Medicine, Yale University School of Medicine
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Kim Y, Groombridge C, Romero L, Clare S, Fitzgerald MC. Decision Support Capabilities of Telemedicine in Emergency Prehospital Care: Systematic Review. J Med Internet Res 2020; 22:e18959. [PMID: 33289672 PMCID: PMC7755537 DOI: 10.2196/18959] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/16/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background Telemedicine offers a unique opportunity to improve coordination and administration for urgent patient care remotely. In an emergency setting, it has been used to support first responders by providing telephone or video consultation with specialists at hospitals and through the exchange of prehospital patient information. This technological solution is evolving rapidly, yet there is a concern that it is being implemented without a demonstrated clinical need and effectiveness as well as without a thorough economic evaluation. Objective Our objective is to systematically review whether the clinical outcomes achieved, as reported in the literature, favor telemedicine decision support for medical interventions during prehospital care. Methods This systematic review included peer-reviewed journal articles. Searches of 7 databases and relevant reviews were conducted. Eligibility criteria consisted of studies that covered telemedicine as data- and information-sharing and two-way teleconsultation platforms, with the objective of supporting medical decisions (eg, diagnosis, treatment, and receiving hospital decision) in a prehospital emergency setting. Simulation studies and studies that included pediatric populations were excluded. The procedures in this review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The Risk Of Bias In Non-randomised Studies–of Interventions (ROBINS-I) tool was used for the assessment of risk of bias. The results were synthesized based on predefined aspects of medical decisions that are made in a prehospital setting, which include diagnostic decision support, receiving facility decisions, and medical directions for treatment. All data extractions were done by at least two reviewers independently. Results Out of 42 full-text reviews, 7 were found eligible. Diagnostic support and medical direction and decision for treatments were often reported. A key finding of this review was the high agreement between prehospital diagnoses via telemedicine and final in-hospital diagnoses, as supported by quantitative evidence. However, a majority of the articles described the clinical value of having access to remote experts without robust quantitative data. Most telemedicine solutions were evaluated within a feasibility or short-term preliminary study. In general, the results were positive for telemedicine use; however, biases, due to preintervention confounding factors and a lack of documentation on quality assurance and protocol for telemedicine activation, make it difficult to determine the direct effect on patient outcomes. Conclusions The information-sharing capacity of telemedicine enables access to remote experts to support medical decision making on scene or in prolonged field care. The influence of human and technology factors on patient care is poorly understood and documented.
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Affiliation(s)
- Yesul Kim
- National Trauma Research Institute, Melbourne, Australia.,Monash University, Melbourne, Australia.,Trauma Services, Alfred Health, Melbourne, Australia
| | - Christopher Groombridge
- National Trauma Research Institute, Melbourne, Australia.,Monash University, Melbourne, Australia.,Trauma Services, Alfred Health, Melbourne, Australia
| | - Lorena Romero
- The Ian Potter Library, Alfred Health, Melbourne, Australia
| | - Steven Clare
- National Trauma Research Institute, Melbourne, Australia.,Trauma Services, Alfred Health, Melbourne, Australia
| | - Mark Christopher Fitzgerald
- National Trauma Research Institute, Melbourne, Australia.,Monash University, Melbourne, Australia.,Trauma Services, Alfred Health, Melbourne, Australia
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Heaton HA, Russi CS, Monroe RJ, Thompson KM, Koch KA. Telehealth dashboard: leverage reporting functionality to increase awareness of high-acuity emergency department patients across an enterprise practice. BMJ Health Care Inform 2020; 26:bmjhci-2019-100093. [PMID: 31843765 PMCID: PMC7252997 DOI: 10.1136/bmjhci-2019-100093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/08/2019] [Accepted: 12/03/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Emergency Medicine Telehealth (TeleEM) represents an opportunity to work directly with referral centres, rural facilities and underserved areas to mitigate unnecessary testing, optimise resource utilisation and facilitate patient transfers across health systems. To optimise the impact of a TeleEM programme, a tool is needed to remotely monitor patient activity in multiple emergency department facilities, concurrently. METHODS After identifying data sources for activation criteria put forth by the TeleEM operations group, rules were constructed within the electronic health record to facilitate data checks and ultimately produce a yes/no response if the category's conditions were met. Responses were organised into a table, with functionality allowing end users to drill into the different sites to see patient-specific information for patients meeting activation criteria. CONCLUSIONS The TeleEM dashboard allows for proactive engagement by the TeleEM physician and strengthens the team-based approach of critically ill.
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Affiliation(s)
- Heather A Heaton
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Karen A Koch
- Department of Nursing Informatics, Mayo Clinic, Rochester, Minnesota, USA
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