JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas –
Two physicians at the U.S. Army Institute of Surgical Research at Joint Base San Antonio-Fort Sam Houston are focused on improving tactical combat casualty care through research that finds the best resources and methods for treating and improving the survivability rate of wounded service members on the battlefield.
During the last three years, Maj. (Dr.) Steven Schauer, USAISR physician-scientist, and Maj. (Dr.) Ian Hudson, USAISR Tactical Combat Casualty Care emergency physician, have worked together on several studies on tactical combat casualty care, the field of military medicine focusing on life-saving techniques and strategies that are used to provide the best trauma care on the battlefield.
The USAISR physicians conducted their latest studies on tactical combat casualty care July 8-9 at Hunter Army Airfield in Georgia. Participating in the study were 10 combat medics with the 160th Special Operations Aviation Regiment, who were tested while using the i-view video laryngoscope on a mobile aircraft simulator.
The i-view video laryngoscope is a disposable device with a breathing tube that is inserted into the trachea of a patient to check for a blocked airway. The device includes an LCD screen that allows the user to view the airway of the patient.
Schauer said the combat medics were assessed on how well they were able to use the i-view video laryngoscope during the aircraft simulations. He said nine of the 10 combat medics tested on the simulator were able to use the i-view video laryngoscope in 90 seconds or less.
After completing the simulation, the combat medics were given the chance to provide their feedback on the i-view video laryngoscope.
“Overall, they liked the device,” said Schauer about the feedback provided by the combat medics. “There were a few modifications that they wanted to see done to the device to make it more usable in their particular setting.”
The study with the combat medics is to see how effective the i-view video laryngoscope is compared to a Glidescope, which is the current airway device used in the field. The Glidescope is a video device used for endotracheal intubation, the procedure used to open a patient’s airway if they have an airway blockage, a respiratory illness, or in trauma.
Schauer said the Glidescope has a limited presence on the battlefield because the devices, for the most part, can be used in field hospitals and by forward surgical teams.
Cost-wise, the Glidescope costs the military $11,000 to purchase, while the i-view video laryngoscope is relatively inexpensive at $110 per device.
Schauer said the i-view video laryngoscope is a much better device for combat medics to utilize in a combat setting.
“The i-view video laryngoscope allows them an indirect visualization of the airway, which allows them to get the endotracheal tube in faster and easier, with ideally fewer complications,” Schauer said.
Hudson said one of the modifications the combat medics who were part of the study suggested for improving the i-view video laryngoscope is for the LCD screen to have a swivel capability, so the medics could view the airway of a wounded servicemember no matter what position the patient is lying in, whether the medic is at their head, alongside or straddling them.
Schauer said the objective of each of the studies he and Hudson have conducted is identifying ways to improve guidelines or materiels for tactical combat casualty care. The study done at Hunter Army Airfield with the combat medics followed this standard.
“The second most frequent cause of death in the battlefield is airway obstruction,” Schauer said. “This study was seeking to figure out a better method for intervening on an airway obstruction, helping to minimize the number of people who die on the battlefield and will survive to make it to a hospital.”
Hudson said he and Schauer value the feedback they get from combat medics when conducting their research. He said Schauer, who is the head researcher of the study, likes to see what combat medics can do in different simulated situations using several devices and methods for treating wounded servicemembers.
“This population (of medics) Steve (Schauer) managed to link up with is very valuable,” Hudson said. “These are people who are in a continuous state of readiness; they’re always looking at the potential for deployment, for a mission. A lot of them have been on missions recently and so their feedback is very valuable because it’s fresh and it’s real in the sense there’s immediacy. They might need something next week to care for a potential casualty.”
On July 9, Schauer and Hudson conducted a separate study with the combat medics at Hunter Army Airfield by having them test a variety of supraglottic airways (blind insertion breathing tubes) such as the i-gel airway device on a mannequin. The i-gel is a non-inflatable airway management device used for anesthesia and resuscitation.
Schauer said the study on the i-gel airway device was a qualitative study, in which numerical data was not collected but background data on the participants was. He said the goal of the study was to teach the combat medics about a device they hadn’t used before and to conduct a semi-formal interview after the medics used the device to get their feedback and opinions on whether they could use it effectively in a combat setting.
The physicians are hoping to publish their findings and research on the i-view video laryngoscope in a military medical journal later this year. The study with the combat medics testing their skills on the i-view video laryngoscope was part of a two-year overall study on tactical combat casualty care.
Schauer said he and Hudson share the findings and data from their research by publishing their studies in military medical journals, by attending military medical conferences with their colleagues and with the U.S. Army Medical Research and Development Command, or MRDC.
“We use this data in real-time often as we get it to help inform medical decision-makers such as the combat development integration at MRDC,” Schauer said. “They need this data to help them allocate efforts, resources and funding.”
Hudson said doing research that can improve methods and guidelines for airway management will help to save lives on the battlefield, especially during the “golden hour,” the hour following a traumatic injury in which medical treatment to prevent mortality in a wounded servicemember is the most effective, enhancing the chance the injured servicemember will survive.
“It’s very simple in that the faster an airway can be secured, the more time it frees up combat medics for other things that can harm and kill a Soldier,” Hudson said. “If the airway intervention is easy and efficient, that frees up hands and time to do other very important things to save lives.”