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

出血是创伤后死亡最可预防的原因。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峻的环境中进行诊断或复苏手术,则仍然致命。超声波和外科手术远程指导技术的革命可能会增强利用非医生技能的能力。因此,我们的研究合作探索了远程指导,以使非医生能够在严峻的环境中解决交界处和躯干出血控制问题。主要研究包括使用远程远程超声 (RTMUS) 识别躯干和交界性放血,远程指导复苏手术以控制躯干出血,理解和减轻此类任务期间的生理压力,以及在严峻环境中进行损伤控制手术 (DCS) 的技术实用性。迭代项目包括随机指导消防员使用RTMUS识别躯干 (RCT) 和交界 (pilot) 出血,随机远程指导MedTechs在解剖学上逼真的外科训练器 (“切割服”) 中进行躯干放血的复苏手术,包括生理监测,和训练有素的外科医生进行了一项比较随机研究,以正常 (1g) 与失重 (0g) 的躯干出血控制。这项工作表明,可以远程指导消防员在模拟器上执行及时的躯干RTMUS。消防员和导师都对自己的能力充满信心,超声波97% 准确。孟菲斯的一名未经超声检查的消防员也可以从夏威夷进行远程指导,以识别并随后在活组织模型中使用RTMUS填塞动脉交界性出血。此后,经过指导和未经指导的MedTechs和训练有素的外科医生都完成了复苏手术,以控制剪裁服上的出血,这证明了所有参与者的实用性。虽然远程指导并没有减少MedTechs的失血,但它增加了程序信心并减少了生理压力。因此,远程指导可能会增加非医生执行心理艰巨任务的可行性。最后,失重的dc是可行的,与1g没有根本差异。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,以潜在地挽救那些在严峻环境中放血的人,因此应进行更严格的研究。

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