The Damage Control Surgery in Austere Environments Research Group (DCSAERG): A dynamic program to facilitate real-time tele-mentoring/tele-diagnosis to address exsanguination in extreme and austere environments.

Hemorrhage is the most preventable cause of post-traumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or Resuscitative-surgery in austere-environments. Revolutions in technology for remote-mentoring of ultrasound and surgery may enhance capabilities to utilize the skill-sets of non-physicians. Thus, our Research-Collaborative explored remote-mentoring to empower non-physicians to address junctional and torso hemorrhage-control in Austere-environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative-surgery for torso hemorrhage-control, understanding and mitigating physiological stress during such tasks; and the technical practicalities of conducting Damage Control Surgery (DCS) in Austere Environments. Iterative projects involved: randomized guiding of Firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS; Randomized remote-mentoring of MedTechs conducting Resuscitative-surgery for torso exsanguination in an anatomically-realistic surgical trainer ("Cut-Suit") including physiological monitoring; and trained surgeons conducting a comparative randomized study for torso hemorrhage-control in normal (1g) versus weightlessness (0g). This work demonstrated that Firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both Firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive Firefighter in Memphis could also be remotely-mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, (both mentored and unmentored MedTechs) and train-surgeons completed Resuscitative-surgery for Hemorrhage-control on the Cut-Suit, demonstrating practicality for all involved. While Remote-mentoring did not decrease blood loss among MedTechs it increased procedural confidence, and decreased physiologic stress. Therefore, remote-mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that Remote-mentoring supports diagnosis, non-invasive therapy, and ultimately Resuscitative-surgery to potentially rescue those exsanguinating in Austere-environments and should be more rigorously studied. (C) 2017 Lippincott Williams & Wilkins, Inc.

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