Tomorrow’s Tech: The Automated Critical Care System (Web Exclusive)


There might not always be someone around to provide care for every patient in the midst of a crisis situation. New technology is providing a way to automate care for some patients. (Photo by MC3 Kelly M. Agee)

By Chris Santee

Care of combat casualties is complex and difficult in the haze and chaos of the battlefield. As the battlefield of the future evolves—where expeditionary forces may penetrate deeper into remote areas where casualties can take hours or days to evacuate—the capabilities needed for patient care must be compact, lightweight, energy-efficient, multipurposed, and scalable to meet mission requirements.

What is needed is a way to make the clinical expertise and capabilities of a critical-care center available to patients while they’re being cared for and evacuated. The Office of Naval Research (ONR) is developing one such patient care platform—the Automated Critical Care System (ACCS)—which can be described as an intensive care unit in a suitcase.

The ONR Force Health Protection program has been researching the use of autonomous (closed-loop-control) systems for fluid resuscitation and mechanical ventilation since 2005. That effort led to demonstrated improvements in medical situational awareness and safety as well as reductions in the logistical requirements for fluids and oxygen. As a continuation of these studies, ONR approved a research program to develop a prototype ACCS.

The ACCS development represents the integration of seven medical technologies—mechanical ventilation; supplemental oxygen therapy; sedation; casualty and fluid warming; physiologic monitoring; fluid and drug therapy; and patient data accumulation, storage, and transmission—into one modular hardware system.

The integration of these technologies into a single life-sustaining medical device is a complex undertaking, requiring the contributions of numerous experts, both in the field and in tertiary care environments.

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The current ONR effort, which involves partners from other services, industry, and academia, is developing a suite of highly complex but proven medical technologies into a system of systems that will integrate patient physiological monitoring systems with a battery of interventional therapeutic systems controlled by software algorithms.

The ACCS will provide autonomous medical care to critically injured or ill warfighters. The system will assist caregivers by providing casualty-management guidance based on continuously updated measures of patient medical status, physiological monitoring, and treatment in either a “decision assist” or autonomous mode.

The current expeditionary combat environment does not provide or allow for constant monitoring by a dedicated care provider. This is where the ACCS comes in, providing autonomous capability and timely recognition of unstable conditions, allowing for earlier intervention. The goal is that the system will save lives and improve patient outcomes through fewer hospital days, reduced treatment costs, and a faster return to duty for personnel.

The ACCS will provide expeditionary combat medicine with an autonomous device that consistently monitors and adjusts care to a patient’s condition. Weighing roughly 20 pounds, the system is ideal for use ashore or during transport; aboard a ship or submarine; or, in the future, on autonomous vehicles such as the Autonomous Aerial Cargo Utility System configured for casualty evacuation missions. ACCS’s portability allows medical personnel to extend the “golden hour”—the critical 60 minutes after a major traumatic injury during which prompt treatment can prevent shock and a multitude of other complications, including death.

The prototype design is a simple, lightweight, under-litter-based system, capable of both decision assistance or full autonomy (or mixed), depending on the mode selected by the caregiver.

Decision-assistance algorithms provide treatment recommendations based on the real-time assessment of the patient’s physiology, which either can be accepted or rejected by the caregiver. Closed-loop-control algorithms manage the patient without caregiver input. The idea is that the system will give healthcare providers of various skill levels the ability to maintain a critically injured or ill patient for a minimum of two to six hours without any degradation in clinical status in areas of ventilation, fluids/medications delivery, physiological monitoring, and maintaining and transmitting patient data records to a higher echelon of care.

Before its full fielding, the ACCS must undergo further research and development milestones, along with final Federal Drug Administration testing, review, and approval. The last hurdle prior to approval for deployment must be substantial education for both medical personnel and the general public to ease concerns about “computerized care” and the idea that ACCS will remove the physician from the loop.

In practice, the concept is for the ACCS to serve as a force multiplier or physician extender, allowing a health care provider better control and more oversight in the treatment of several injured personnel simultaneously, freeing additional medical personnel and resources to focus on the more critical patients.

About the Author:

Chris Santee is a support contractor with the Office of Naval Research’s Warfighter Performance Department.

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