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Research innovations improve en route care

  • Published
  • By J.D. Levite
  • Air Force Surgeon General Public Affairs
In combat situations, there is a critical window of time between when a U.S. warfighter sustains a trauma injury and when they receive proper medical attention. This window, known as the golden hour, is where the military’s en route care efforts come into play.

En route care focuses on the patient’s movement to a proper facility while keeping them safe and treating their injury.

The Combat Casualty Care Research Program at Fort Detrick, Maryland, is dedicated to constantly finding new ways to improve en route care through research and development.

“As healthcare advances, technology and techniques and the way we’re actually able to provide care for our patients does too,” said Lt. Col. Antoinette Shinn, CCCRP’s Forward Surgical-En Route Care portfolio manager. “We want to be able to provide care and maintain the same high standard, whether it’s far forward in the field or in the back of an ambulance.”

That’s easier said than done because the entirety of en route care covers a wide variety of situations and problems including where the injury occurred, the type of injury, and how the patient needs to be transported. Shinn said her portfolio’s goals include understanding the impact of transport on both the patient’s well-being and the clinician’s performance, as well as understanding the best time to begin transporting a patient ill enough to suffer from the movement.

She said, “In an environment where we may not be able to have our patients evacuated as quickly as we’d like, how then can we move capabilities to them until they can be evacuated?” For the CCCRP, they’re exploring all types of options from using drones to employing Navy hospital ships to taking advantage of new technological advances like Bluetooth that can help with data recording.

“One of the challenges is also to be able to capture all the documents for that patient’s care. We’ve found throughout previous conflicts that at the point of injury when people are injured, a lot of what happens in the care of that patient is lost.”

Shinn said one of the reasons for this is that most of the time the data about a patient’s injury is recorded on paper, which can be lost during transit or stained with dirt or blood. Some of the options her portfolio is researching to get around this problem are the Army’s Nett Warrior device, which Shinn called “an iPhone for data injury,” other systems built around voice capabilities, and even electronic devices with direct access to the Department of Defense trauma registry.

On top of all that, Shinn said they’re also researching better ways to unite all service branches. As such, en route care will no doubt look a lot different when you add in a Blackhawk helicopter, a V-22 Osprey, a Navy hospital ship, and all the other possible platforms available.

“Now that we have this conversation and share our expertise together, I think it offers a lot more opportunity to improve care across the spectrum and for us to have a better understanding based upon the platform,” Shinn said.

In terms of observations from the battlefield, Shinn added that the Forward Surgical-En Route Care portfolio team has learned a substantial amount from the conflicts in Iraq and Afghanistan, as they want to be prepared for any changes that come up in the future.