May 27, 2022

4TDS: Trauma Triage, Treatment, and Training Decision Support

Congratulations to Applied Research Associates (ARA) for receiving the 2022 MTEC Impact Award, which recognizes an MTEC member’s outstanding support of a high impact military need.

ML-supported decision support for austere battlefield settings: Saving lives on the battlefield through Tactical Combat Casualty Care (TCCC) and Prolonged Field Care (PFC) relies on accurate, rapid diagnosis and treatment to prevent the effects of trauma that can lead to morbidity and mortality if not detected. To meet that need, Applied Research Associates, the Mayo Clinic, and Ambient Clinical Analytics developed the Trauma Triage Treatment and Training Decision Support (4TDS) system. The 4TDS app displays six vital signs (heart rate, respiration rate, peripheral oxygen saturation (SpO2), and diastolic and systolic blood pressure) streamed from a vital signs monitor (VitalTag, Pacific Northwest National Laboratory, Richland, WA) that is placed on a casualty at point of injury (PoI) and connected to the phone. Two artificial intelligence (AI) models analyze the signs. One indicates the current risk of internal hemorrhage and probability of the need for a massive transfusion (more than one unit of red blood cells), while the other indicates the probability of shock.

Participatory design ensures solutions align with TCCC/PFC: Early engagement with experienced military medics and clinicians from all 3 services ensured 4TDS reflects their mental models and work processes. It also built support among potential users should the system transition to operational use. Two series of usability assessments with nearly 100 Army, Navy and Air Force medics, nurses, doctors, and physician’s assistants at Joint Base San Antonio discovered opportunities for improvement and confirmed alignment with TCCC/PFC needs. Scripted scenarios led participants through casualty care decisions to verify whether 4TDS improved their performance, and reviewed refresher training on life-critical skills such as restoring a compromised airway. ARA is working closely with the military medical community to complete FDA approvals and get 4TDS and VitalTag fielded to military medics of all services.

These projects were funded through MTEC’s 17-08-Multi-Topic Request for Project Proposals (RPP) sponsored by the USAMRDC and the 20-01-Hemorrhage Detection RPP sponsored by USAMMDA.