Hemorrhage is the most preventable cause of posttraumatic 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 trained 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, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.

译文

:出血是创伤后死亡的最可预防原因。许多病例在解剖学上可能是可挽救的,但如果没有后勤人员或训练有素的人员在严酷的环境中进行诊断或复苏手术,则仍然致命。超声和手术的远程指导技术的革命可能会增强利用非医师技能的能力。因此,我们的研究合作探索了远程指导,以使非医师能够在严峻的环境中解决交界处和躯干出血的控制问题。重大研究涉及使用远程元素超声(RTMUS)识别躯干和关节血流失血,远程指导复苏手术以控制躯干出血,了解和缓解此类任务期间的生理压力以及在严格的条件下进行损伤控制手术(DCS)的技术实用性环境。迭代项目涉及使用RTMUS随机指导消防员以识别躯干(RCT)和交界处(飞行员)出血,在解剖学上现实的外科培训师(Cut Suit)中进行进行复苏性躯干放血手术的MedTechs的随机远程指导,包括生理监测,以及训练有素的外科医生,对正常(1g)和失重(0g)的躯体出血控制进行比较随机研究。这项工作表明,可以远程指导消防员在模拟器上执行即时躯干RTMUS。消防员和指导者都对自己的能力充满信心,超声波准确率达97%。孟菲斯市的一名初次使用超声的消防员也可以从夏威夷进行远程指导,以在活组织模型中使用RTMUS识别并随后压塞动脉结膜出血。此后,受指导和未受指导的MedTechs以及受过训练的外科医生都完成了复苏手术,以控制Cut-Suit上的出血,证明了所有参与者的实用性。尽管远程指导并没有减少MedTechs的失血量,但它增加了程序的置信度并降低了生理压力。因此,远程指导可能会增加非医师执行心理艰巨任务的可行性。最终,失重的DCS是可行的,与1g的差异不大。总体而言,集体证据表明,远程指导支持诊断,无创治疗以及最终的复苏手术,以挽救那些在严酷环境中放血的人,因此应进行更严格的研究。

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