Military medicine
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Training for mass casualty incident (MCI) response is critical to ensure that resource allocation and treatment priorities limit preventable mortality. Previous research has investigated the use of immersive virtual environments as an alternative to high fidelity MCI training, which is expensive and logistically challenging to implement. While these have demonstrated positive early results, they still require complex technology deployment, dedicated training facilities, and significant time from instructors and facilitators. This study explores the feasibility of a smartphone-based application for trauma care training and MCI triage to fill the gap between classroom learning and high-fidelity simulation. The goals of this investigation were to evaluate clinician perceptions of a virtual MCI training simulator's usability, acceptability, fidelity, functionality, and pacing. ⋯ This study provides encouraging evidence that easy to deploy smartphone-based simulations may be an effective way to supplement MCI and care under fire training. Although the study is limited by a small sample size, there was strong agreement among participants from a wide variety of emergency medicine roles that such a simulation could train core topics associated with MCI triage. Because app-based simulations are easily deployable and can be executed quickly and frequently, they could be used as a more flexible training model compared to large scale live or virtual reality-based simulations. The results of this investigation also indicate that a sufficient level of medical realism can be achieved without live simulation.
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Respiratory rate (RR) is a crucial vital sign in patient monitoring and is often the best marker of the deterioration of a sick patient. It can be used to help diagnose numerous medical conditions and has been demonstrated to be an independent predictor of patient outcomes in various critical care settings and is incorporated in many clinical early warning scores. Here, we report on the performance of depth-camera-based system for the noncontact monitoring of RR during a ramped RR protocol. The ramped breathing protocol was developed specifically to test the relatively rapid changes in rates, which include clinically important low and high ranges of RRs. ⋯ The technology performed well, exhibiting an RMSD accuracy well within our target of 3 breaths/min, both across the whole range and across each individual subrange. In summary, our results indicate the potential viability of continuous noncontact monitoring for the determination of RR over a clinically relevant range.
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It is critical to develop and implement lab-based computer experiments that simulate real-world tasks in order to characterize operational requirements and challenges or identify potential solutions. Achieving a high degree of laboratory control, operational generalizability, and ease-of-use for a task is challenging, often leading to the development of tasks that can satisfy some facets but not all. This can result in insufficient solutions that leave real-world stakeholders with unsolved problems. ⋯ The lab-based sonar application provides new possibilities for research, not limited to signal intensity and signal density but also through the manipulation of parameters such as the number of unique targets, target appearance, and task duration. This application may illuminate the operational demands that each of these factors may have on operator behavior within the dynamic tasks.
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Inhaled nitric oxide (INO) is a selective pulmonary vasodilator delivered from compressed gas cylinders filled to 2,200 psig (137.8 bar) with 800 ppm of NO in a balance of nitrogen. NO is currently FDA-approved for use in term or near-term infants with hypoxemia and signs of pulmonary hypertension in the absence of cardiac disease. INO has also been shown to improve oxygenation in adults with refractory hypoxemia. Current doctrine precludes the use of NO during military aeromedical transport owing to the requirement for large compressed gas cylinders. We performed a bench evaluation of 2 delivery systems that create NO from room air without the need for pressurized cylinders. ⋯ Both devices delivered a reliable INO dose at ground level. Altitude significantly affected INO delivery accuracy at 14,000 ft (4,267 meter) (P < 0.01) with both devices and at 8,000 ft (2,437 meter) (P < 0.01) with LungFit. Differences in INO dosage were not statistically significant with the Odic device at 8,000 ft (2,437 meter)(P > 0.05) although there were large variations with selected ventilator settings. With careful monitoring, devices creating INO from room air without cylinders could be used during aeromedical transport without the need for pressurized cylinders.
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Mental health diagnosis requiring further treatment is one of the top reasons for medical evacuation in the U.S. Central Command (USCENTCOM) area of responsibility (AOR) as of 2022. This study establishes a baseline in which the effectiveness of medical interventions can be measured to determine if they have an impact on the rate of evacuation out of USCENTCOM. ⋯ The study establishes a benchmark mental health evacuation rate. This rate will be useful for assessing mental health evacuation reduction initiatives in the USCENTCOM AOR.