Telemedicine-Guided Two-Incision Lower Leg Fasciotomy Performed by Combat Medics During Tactical Combat Casualty Care: A Feasibility Study.

Autor:	Stark PW; Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands.; Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands., Borger van der Burg BLS; Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands., van Waes OJF; Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands.; Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands., van Dongen TTCF; Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands.; Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands., Wouter; Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands., Casper M; Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands., Hoencamp R; Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands.; Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands.; Defense Healthcare Organization, Ministry of Defense, Den Haag, Zuid-Holland 2511 CB, The Netherlands.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Feb 27; Vol. 189 (3-4), pp. e645-e651.
DOI:	10.1093/milmed/usad364
Abstrakt:	Introduction: During tactical combat casualty care, life- and limb-saving procedures might also be performed by combat medics. This study assesses whether it is feasible to use a head-mounted display (HMD) to provide telemedicine (TM) support from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. Materials and Methods: Nine combat medics were randomized into groups to perform a two-incision lower leg fasciotomy. One group used the Vuzix M400 and the second group used the RealWear HMT-1Z1. A third, control, group received no guidance. In the Vuzix M400 group and RealWear HMT-1Z1 group, a senior surgeon examined the results after the two-incision lower leg fasciotomy was finished to assess the release of compartments, possible collateral damage, and performance of the combat medics. In the control group, these results were examined by a surgical resident with expertise in two-incision lower leg fasciotomies. The resident's operative performance questionnaire was used to score the performance of the combat medics. The telehealth usability questionnaire was used to evaluate the usability of the HMDs as perceived by the combat medics. Results: Combat medics using an HMD were considered competent in performing a two-incision lower leg fasciotomy (Vuzix: median 3 [range 0], RealWear: median 3 [range 1]). These combat medics had a significantly better score in their ability to adapt to anatomical variances compared to the control group (Vuzix: median 3 [range 0], RealWear: median 3 [range 0], control: median 1 [range 0]; P = .018). Combat medics using an HMD were faster than combat medics in the control group (Vuzix: mean 14:14 [SD 3:41], RealWear: mean 15:42 [SD 1:58], control: mean 17:45 [SD 2:02]; P = .340). The overall satisfaction with both HMDs was 5 out of 7 (Vuzix: median 5 [range 0], RealWear: median 5 [range 1]; P = .317). Conclusions: This study shows that it is feasible to use an HMD to provide TM support performance from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. The results of this study suggest that TM support might be useful for combat medics during tactical combat casualty care when performing life- and limb-saving procedures. (© The Association of Military Surgeons of the United States 2023.)
Databáze:	MEDLINE
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