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Team Surgency
Supporting time-critical combat care during mass casualty response
Week 0:
Problem: Developing the capability
for forward deployment of robotic
telesurgery in order to reduce the
‘Golden Hour’ critical time window
with early surgical intervention
Solution: Solve signal latency for
robotic telesurgery
Week 10:
Problem: Addressing triage and
treatment bottlenecks during mass
casualty situations at a Role 1
Battalion Aid Station
Solution: improve situational
awareness and intra-BAS
communication
90+
Interviews
Chris Sebastian
Software Engineering &
Product
Andrew DeClerck
Machine Learning &
Software Engineering
Negin Behzadian
Analog Circuit Design &
Signals
Abbey Cutchin
Tissue Engineering &
Orthopedic Surgery
Mentors and Sponsors
Rafi Holtzman
Dr. Steve Hong
Amanda Love, USAMMA
The Team
Who We Interviewed
58+
Experts
20
Users
12
Buyers
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
Develop capability for robotic
telesurgery that would allow
physicians to provide time-critical
treatments for injured patients from
remote geographic distances.
The Original Challenge
“People are scared to move a
daVinci down a hallway, let alone
use it on the battlefield”
- Anonymous Stanford Hospital Trauma Surgeon
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
Where can we add value?
Evacuation
Forward CarePOINT OF INJURY
Role 2
Role 3
Visit to 129th Rescue
Wing at Moffett Airfield
90%
before arrival to medical treatment facility
25%
of those fatalities were deemed survivable
Where can we add value?
Evacuation
Forward CarePOINT OF INJURY
Role 2
Role 3
“[Mass casualty triage] is not a
patient care problem, it’s a
management problem.”
- 129th Rescue Wing Pararescuer
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
Civilian Mass Casualty Training Simulation
“It’s a waste of time to try and
diagnose — it’s all about
prioritization.”
- Timothy Browder, MD; Stanford Trauma Surgery
Justin
Roberto
Davis
Clute
Nicolas
Lozano
MVP 1.0
A Potential Solution for Automating Pre-Evacuation Mass
Casualty Prioritization
UWB
Network
Zephyr Vitals Sensors
Leveraging FDA-approved physiological monitoring system, already deployed in several high-stress
operational environments
“The first time extensive triage
takes place is at the Battalion Aid
Station.”
- LtCol Hasseltine, former Commanding Officer, 2d
Battalion, 7th Marines,1st Marine Divison
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
Battalion Aid Station?
EXPECTANT
STAGING
AREA
BLACK
MEDEVAC:
Medical Officer
TRIAGE TREATMENT
INCOMING
CASUALTIES
MEDEVAC
To Role II/III
Current Prioritization at Battalion Aid Stations
White Board
TrackingTriage Card
“There is a continuous stream of
communication at a BAS supporting triage,
treatment, and EVAC of casualties across
medical and tactical personnel. This chain
could easily break down in the chaos of a
mass cal.”
- MAJ Michael Holloway, former BAS Physician Assistant
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
MVP 2.1: Triage Manager Interface
MVP 2.2: Physician Assistant Interface
Final MVP: Evaluating Product-Mission Fit at the BAS
TRIAGE TREATMENT
CAS. INFO
INPUT:
Secondary Triage
Officer
OUTPUT:
Physician
Assistant
EXPECTANT
STAGING AREA
BLACK
SENSOR
INPUT:
Field Medics
MEDEVAC:
Medical Officer
Surgency: Mission Model Canvas
- UI/UX Design MVP
- Software Engineering
- Interface/integrate w/
Zephyr sensors
- Purchase/support
Zephyr supply
- Gain buy-in from JTS
and incorporate in
standard practice
- Continued sponsorship
by military beneficiary
- Industry (wearable
sensors, H2Care, Zephyr
Technologies)
- Course faculty and staff,
military liaisons, DIUx,
SOFWERX, In-Q-Tel
- Problem Sponsors:
USAMMA
- DoD organization with
interest in medical device
research (USAMRMC,
TATRC, DARPA)
- Joint Trauma Registry
-Primary: Physician
Assistants at Role 1 BAS
- Secondary: other BAS
medical officers (i.e., triage
medics), and potentially
tactical officers
- Tertiary:
Care providers at higher
echelons of care
- Increase situational
awareness: Constant vital
monitoring provides PA with
greater awareness of patient
status.
- Improve efficiency of
communication among BAS
roles: Augmenting PA access
to communication flow from
medical officer -> PA ->
Platoon Sgt for quicker, more
informed decisions
- Improve efficiency of
MEDEVACs from BAS: More
accurate prioritization during
MEDEVAC requests prevents
unnecessary allocation of
MEDEVACs and crew
-Medical force multiplier: With
more efficient allocation of
MEDEVACs, allow for increased
access to shared resources
between different teams.
- Improved medic-supported triage of combat injuries at POI in
mass casualty situations
- Widespread adoption & trust from DoD medical team and DoD
command
- Lives saved / Improved Quality of Care / Time to MEDEVAC /
MEDEVACS sent vs patients transported
- Test case in mass
casualty situation with
advanced medical first
responders (18D trained)
- Test case in mass
casualty situation with
standard combat medics
Fixed:
- Software design & engineering
- Robotics/Surgery Suite Costs
Variable:
- Customer acquisition/sales
- USAMMA procurement
/sustainment resources
- Medical Advisors
- Testing facilities
- AI/ML advisors
- Need demand signal
from BAS medical officers
responsible for triage,
treatment, and EVAC
decisions
- Need execution and
active use by medics and
first responders at BAS
-Need implementation
direction from DoD
leadership
Beneficiaries
Mission AchievementMission Budget/Costs
Buy-In/Support
Deployment
Value PropositionKey Activities
Key Resources
Key Partners
Value Propositions and Beneficiaries
Automated Continuous
Monitoring
Improved Intra-BAS
Communication
Increased Situational
Awareness @BAS
Medical personnel at
a BAS
Care providers at higher
echelons of care
Increased Situational
Awareness/Preparation at
higher Roles of Care
Tactical personnel at
a BAS
“I have dozens of anecdotes of
patients that have died or had poor
outcomes, because the number of
casualties overwhelmed capability
to monitor or treat...”
- LtCol DeLellis, Deputy Surgeon at the United States Army
Special Operations Command
“...active monitoring would likely
have changed the outcome, for
the better, for many of those
patients.”
- LtCol DeLellis, Deputy Surgeon at the United States Army
Special Operations Command
Mission Achievement:
Save lives deemed survivable, where they
are often lost
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
Development - Data Entry Application
Development - PA Interface
Development - PA Interface
Testing our Final MVP: 23rd Marine Regiment
“[The MVP] would effectively eliminate
the standard 15 minute interval
between vital re-measurements by
enabling continuous vitals monitoring.”
- 23rd Marine Regiment Corpsman
0 1 2 3 4 5 6 7 8 9
EmotionalState
10
Robotic
Telesurgery
?
What is the
Problem?
It’s a
Management
Problem!
Who is this
for?
Beneficiary Buy-In
Development
Next Steps
Our Journey
Internal Readiness Level
Prototype of low-
fidelity Minimum
Viable Product
Immediate Next Steps
Hacking for Defense
Spring 2017
Open Source GitHub
Where do we go from here?
- Secure funding sources for further development i.e. the
AAMTI Award
- Interface with Zephyr biopatch sensors
- Work with USAMMA to develop formal requirement upon
MVP screening
- Explore field testing with a unit in a frequent deployment
cycle i.e. the 101st Airborne
Acknowledgements:
- USAMMA: Amanda Love, Jay Wang, Nita Grimsley
- TATRC: Daniel Kral, James Beach, Nathan Fisher
- Mentors: Steven Hong, David Zinn, George Hasseltine, Seth
Krummrich, Rafi Holtzman, Tammer Barkouki
- MVP Feedback: Stephen DeLellis, Jeffrey Oliver, Michael Holloway,
Erwin Villeros

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Surgency Hacking for Defense 2017

  • 1. Team Surgency Supporting time-critical combat care during mass casualty response Week 0: Problem: Developing the capability for forward deployment of robotic telesurgery in order to reduce the ‘Golden Hour’ critical time window with early surgical intervention Solution: Solve signal latency for robotic telesurgery Week 10: Problem: Addressing triage and treatment bottlenecks during mass casualty situations at a Role 1 Battalion Aid Station Solution: improve situational awareness and intra-BAS communication 90+ Interviews
  • 2. Chris Sebastian Software Engineering & Product Andrew DeClerck Machine Learning & Software Engineering Negin Behzadian Analog Circuit Design & Signals Abbey Cutchin Tissue Engineering & Orthopedic Surgery Mentors and Sponsors Rafi Holtzman Dr. Steve Hong Amanda Love, USAMMA The Team
  • 4. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 5. Develop capability for robotic telesurgery that would allow physicians to provide time-critical treatments for injured patients from remote geographic distances. The Original Challenge
  • 6. “People are scared to move a daVinci down a hallway, let alone use it on the battlefield” - Anonymous Stanford Hospital Trauma Surgeon
  • 7. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 8. Where can we add value? Evacuation Forward CarePOINT OF INJURY Role 2 Role 3
  • 9. Visit to 129th Rescue Wing at Moffett Airfield
  • 10. 90% before arrival to medical treatment facility
  • 11. 25% of those fatalities were deemed survivable
  • 12. Where can we add value? Evacuation Forward CarePOINT OF INJURY Role 2 Role 3
  • 13. “[Mass casualty triage] is not a patient care problem, it’s a management problem.” - 129th Rescue Wing Pararescuer
  • 14. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 15. Civilian Mass Casualty Training Simulation
  • 16. “It’s a waste of time to try and diagnose — it’s all about prioritization.” - Timothy Browder, MD; Stanford Trauma Surgery
  • 17. Justin Roberto Davis Clute Nicolas Lozano MVP 1.0 A Potential Solution for Automating Pre-Evacuation Mass Casualty Prioritization
  • 18. UWB Network Zephyr Vitals Sensors Leveraging FDA-approved physiological monitoring system, already deployed in several high-stress operational environments
  • 19. “The first time extensive triage takes place is at the Battalion Aid Station.” - LtCol Hasseltine, former Commanding Officer, 2d Battalion, 7th Marines,1st Marine Divison
  • 20. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 21. Battalion Aid Station? EXPECTANT STAGING AREA BLACK MEDEVAC: Medical Officer TRIAGE TREATMENT INCOMING CASUALTIES MEDEVAC To Role II/III
  • 22. Current Prioritization at Battalion Aid Stations White Board TrackingTriage Card
  • 23. “There is a continuous stream of communication at a BAS supporting triage, treatment, and EVAC of casualties across medical and tactical personnel. This chain could easily break down in the chaos of a mass cal.” - MAJ Michael Holloway, former BAS Physician Assistant
  • 24. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 25. MVP 2.1: Triage Manager Interface
  • 26. MVP 2.2: Physician Assistant Interface
  • 27. Final MVP: Evaluating Product-Mission Fit at the BAS TRIAGE TREATMENT CAS. INFO INPUT: Secondary Triage Officer OUTPUT: Physician Assistant EXPECTANT STAGING AREA BLACK SENSOR INPUT: Field Medics MEDEVAC: Medical Officer
  • 28. Surgency: Mission Model Canvas - UI/UX Design MVP - Software Engineering - Interface/integrate w/ Zephyr sensors - Purchase/support Zephyr supply - Gain buy-in from JTS and incorporate in standard practice - Continued sponsorship by military beneficiary - Industry (wearable sensors, H2Care, Zephyr Technologies) - Course faculty and staff, military liaisons, DIUx, SOFWERX, In-Q-Tel - Problem Sponsors: USAMMA - DoD organization with interest in medical device research (USAMRMC, TATRC, DARPA) - Joint Trauma Registry -Primary: Physician Assistants at Role 1 BAS - Secondary: other BAS medical officers (i.e., triage medics), and potentially tactical officers - Tertiary: Care providers at higher echelons of care - Increase situational awareness: Constant vital monitoring provides PA with greater awareness of patient status. - Improve efficiency of communication among BAS roles: Augmenting PA access to communication flow from medical officer -> PA -> Platoon Sgt for quicker, more informed decisions - Improve efficiency of MEDEVACs from BAS: More accurate prioritization during MEDEVAC requests prevents unnecessary allocation of MEDEVACs and crew -Medical force multiplier: With more efficient allocation of MEDEVACs, allow for increased access to shared resources between different teams. - Improved medic-supported triage of combat injuries at POI in mass casualty situations - Widespread adoption & trust from DoD medical team and DoD command - Lives saved / Improved Quality of Care / Time to MEDEVAC / MEDEVACS sent vs patients transported - Test case in mass casualty situation with advanced medical first responders (18D trained) - Test case in mass casualty situation with standard combat medics Fixed: - Software design & engineering - Robotics/Surgery Suite Costs Variable: - Customer acquisition/sales - USAMMA procurement /sustainment resources - Medical Advisors - Testing facilities - AI/ML advisors - Need demand signal from BAS medical officers responsible for triage, treatment, and EVAC decisions - Need execution and active use by medics and first responders at BAS -Need implementation direction from DoD leadership Beneficiaries Mission AchievementMission Budget/Costs Buy-In/Support Deployment Value PropositionKey Activities Key Resources Key Partners
  • 29. Value Propositions and Beneficiaries Automated Continuous Monitoring Improved Intra-BAS Communication Increased Situational Awareness @BAS Medical personnel at a BAS Care providers at higher echelons of care Increased Situational Awareness/Preparation at higher Roles of Care Tactical personnel at a BAS
  • 30. “I have dozens of anecdotes of patients that have died or had poor outcomes, because the number of casualties overwhelmed capability to monitor or treat...” - LtCol DeLellis, Deputy Surgeon at the United States Army Special Operations Command
  • 31. “...active monitoring would likely have changed the outcome, for the better, for many of those patients.” - LtCol DeLellis, Deputy Surgeon at the United States Army Special Operations Command
  • 32. Mission Achievement: Save lives deemed survivable, where they are often lost
  • 33. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 34. Development - Data Entry Application
  • 35. Development - PA Interface
  • 36. Development - PA Interface
  • 37. Testing our Final MVP: 23rd Marine Regiment
  • 38. “[The MVP] would effectively eliminate the standard 15 minute interval between vital re-measurements by enabling continuous vitals monitoring.” - 23rd Marine Regiment Corpsman
  • 39. 0 1 2 3 4 5 6 7 8 9 EmotionalState 10 Robotic Telesurgery ? What is the Problem? It’s a Management Problem! Who is this for? Beneficiary Buy-In Development Next Steps Our Journey
  • 40. Internal Readiness Level Prototype of low- fidelity Minimum Viable Product
  • 41. Immediate Next Steps Hacking for Defense Spring 2017 Open Source GitHub
  • 42. Where do we go from here? - Secure funding sources for further development i.e. the AAMTI Award - Interface with Zephyr biopatch sensors - Work with USAMMA to develop formal requirement upon MVP screening - Explore field testing with a unit in a frequent deployment cycle i.e. the 101st Airborne
  • 43. Acknowledgements: - USAMMA: Amanda Love, Jay Wang, Nita Grimsley - TATRC: Daniel Kral, James Beach, Nathan Fisher - Mentors: Steven Hong, David Zinn, George Hasseltine, Seth Krummrich, Rafi Holtzman, Tammer Barkouki - MVP Feedback: Stephen DeLellis, Jeffrey Oliver, Michael Holloway, Erwin Villeros