Injuries on the battlefield often result in life-threatening airway or breathing problems, which can manifest immediately at the point of injury or in a delayed fashion. The life-saving treatment of ventilation can be administered either manually by providing an unconscious patient with assisted breaths using an Ambu bag or mechanically with a ventilator. This treatment will continue to be administered across the continuum of care, from point of injury, to early role III facilities, aeromedical evacuation, intensive care units, and to the operating room. Even in ideal conditions, when an experienced provider can devote complete attention to a single patient, delivering the appropriate amount of air for each breath and at the proper rate is a challenge- even with our most sophisticated technology. Providing inappropriate ventilation support occurs often and is seldom recognized. A shortage of critical care-trained providers on the battlefield and in early clinical environments means that critical care must be delivered by non-specialist providers. During Operation Enduring Freedom and Operation Iraqi Freedom, over 60% of patients required mechanical ventilation during critical care transport out of theater, with more than 60% of these patients receiving inappropriate ventilation. The result was longer average duration on the ventilator and higher morbidity and mortality (SOCOM proposal #15 reference.)
In support of AFMS, the MHRF is collaborating with researchers from the University of California Davis Medical Center, Wake Forest Baptist Medical Center, and the 60th Clinical Investigation Facility at Travis AFB to develop a novel ventilation monitoring and management technology to extend the capability of providers in far-forward environments. The premise behind this technology is to condense the immense knowledge and clinical decision-making capability of the most skilled pulmonary and critical care physicians into a compact, portable, low-cost device that can intelligently guide ventilation across the full spectrum of care. At the point of injury, this device can be connected to a simple bag-mask to determine optimal size and timing of the delivered breaths, but it can also be used with a mechanical ventilator to determine if the machine settings are appropriate and recommend specific changes when they are not. The overarching goal is to develop a completely automated system that Provides continuous ventilation monitoring, detrimental event identification, pulmonary injury detection, and clinical decision support until ventilator support is no longer required.
The purpose for developing this technology is best summed up by Maj Gen Najia West, “Due to tactical or operational circumstances, any member of the ground force healthcare team (combat medic, nurse, or physician) may be faced with providing prolonged casualty care in an environment lacking robust medical infrastructure.” This device will serve as a force multiplier, greatly expanding the capability of Special Operations Force medics, particularly in mass casualty scenarios. Yet its capabilities extend well beyond military application, encompassing nearly all situations where ventilation support is needed, representing millions of patients annually in the United States alone. This innovative and disruptive technology will enable the delivery of highly advanced, individualized, evidence-based ventilation management, leading to reduced duration of mechanical ventilation and ICU length of stay, and reduced morbidity, mortality, and cost wherever ventilation support is needed.