A tool that uses artificial intelligence to pinpoint the delivery of pain management drugs to an injury site is being developed by Army researchers. The aim is to allow personnel who may have limited experience administering anesthetics to get those drugs to patients on the battlefield when they need it most.
“If you look at what’s happening in Ukraine, medical teams have to be constantly on the move. If you stop, you die only because Russia has swarmed Ukraine with all sorts of drones that are constantly looking for targets,” said Dr. Jose Salinas, the lead scientist developing the tool. “Providing that type of environment with solutions that will increase mobility, that will reduce the manpower required to monitor and manage those patients.”
Salinas and Lt. Col. Brian Kirkwood, the team’s chief AI officer, are working on the device for the Army Institute of Surgical Research. The tool is based on the AI-GUIDE, developed by researchers at Massachusetts Institute of Technology’s Lincoln Laboratory, which uses AI to help first responders with limited experience accurately place needles and medical tubes into patients’ upper thigh arteries and veins to manage life-threatening blood loss. The Army’s modified version includes a screen that indicates whether the user should move left, right, up or down, and once it’s in position, it turns green and directs the needle insertion for regional pain management drugs.
The AI system can “basically interpret where the needle should go” and the medical professional, even with limited experience, just has to know how much of the drug to use, Salinas said.
Kirkwood and Salinas gave the example of a soldier in a potential future conflict stepping on a landmine and getting their foot blown off. In this scenario, the U.S. military’s medical teams will have to provide on-the-spot care for the service member’s injury while also remaining situationally aware of overhead drones or other sensing technologies revealing their location.
But with the device delivering local anesthetics, the casualty can get “numbed up and out of pain,” Kirkwood said, adding that “even if the two had to hobble to the next area, that person could still hobble on the other leg and help with their balancing their self so the medic doesn’t have to drag him.”
The military’s current protocol for pain management on the battlefield includes anesthetic drugs, like ketamine and morphine. However, these drugs are systemic and affect a patient’s cognition or physiological functioning. They are also usually administered in a hospital setting rather than on the battlefield, Salinas said.
“If you’re going to use these types of drugs, you’re going to have to have somebody monitor that patient continuously. In the future battlefield, we may not be able to do that,” Salinas said. “We’re going to be in a very kinetic battlefield where we’re going to have to be constantly moving, so there’s really a need to pursue pain control alternatives that do not affect you physiologically, that allow you to potentially still operate weapon systems and and those pain control solutions are basically targeted to the area in which you’re injured.”
Since the standardization of pain management techniques in the Tactical Combat Casualty Care handbook by Dr. Frank Butler in the late 90s, the military has continued to look for other novel methods for managing pain in combat like a “fentanyl lollipop,” an under the tongue dissolvable drug, and an inhaler-dispensed anesthetic but a group of researchers pointed out FDA and investment obstacles to get them approved.
Kirkwood and Salinas said their device will help overcome the current battlefield anaesthetic shortfalls and allow for casualties to remain somewhat alert in an active combat zone.
“The moment we start giving systemic medications that alter the perception or the individual soldier’s mind, we have to take the weapon away,” Kirkwood said. But if the service member “has a clear mind,” — because the anesthetic is local and only numbs the specific area — then they can still be armed and help with suppressive fire until recovery forces can extract them or get them to a safer area.
With the device, researchers envision that dentists, optometrists, physicians, assistants or medics who don’t have expertise giving regional anesthesia can help with patient care in a combat scenario where planners are preparing for a mass casualty situation with limited resources.
“I can stick people on needles, I can manage pain, I know how to suture, I know how to stop bleeding, but I don’t know how to give regional nerve blocks in other portions of the body,” said Kirkwood who is trained as an Army dentist.
“We’re not necessarily saying that they’re going to completely manage the drug delivery. They could get the needle in place, and the emergency medical teams could come and support that,” Kirdwood said. “We don’t know where a mass casualty is going to occur or a prolonged field care scenario is going to happen so these devices will enable us to augment the emergency medical teams to help provide care.”
The current version of the device is still attached to an ultrasound, but the research team is working on reducing the size and weight, while also ruggedizing it for the battlefield. In order to do so, they are also looking for commercial partners to license the intellectual property of the device, help with the design, and scale it. Then they can move on to getting it authorized by the U.S. Food and Drug Administration, which approves medical devices for use as well as formal clinical trials.
“When we tested on our animal models, it’s very clear that this device performs significantly better in terms of being able to get access to the region where you have to deliver the anesthetic much faster, more accurately than doing it manually,” Salinas said, adding that with FDA human trials, they hope to “show that this device is a remarkable improvement of what can be done out there manually.”
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