Augmented reality and telestrated surgical support for point of injury combat casualty care: A feasibility study

Providing surgical care in remote environments presents a significant challenge. Telepresence and telesurgery have the potential to bridge the gap between definitive care and nonsurgical critical care for prolonged field care scenarios. This feasibility study investigated several key questions regarding the suitability of these technologies for this application. First, what are the technology requirements and minimum specifications for telestration capabilities between a surgical specialist at a Medical Treatment Facility and a remote non-surgeon in a far-forward environment using existing telecommunication systems within the US Army? Second, what training requirements are needed to prepare surgeons and non-surgeons to control lower extremity junctional hemorrhage, and to use associated telestration hardware, software and communications systems? Third, what is the transferability of this training paradigm and technology suite to a wider range of medical care and clinical procedural skills to anticipated future military medical care needs and environments? Our initial feasibility study indicates that telementoring and telestration using augmented reality (AR) systems appears well suited to providing surgical support and training across dispersed groups of medical providers. Forward surgical support using AR and telestration technologies are viable for point of injury surgical support and may be essential to filling this “missing middle” in the Combat Casualty Care continuum. We anticipate that the life and limb saving capabilities supported by this approach will be necessary in future Multi-Domain Battlefield Concept and in cases of remote and dispersed operations.