USAISR Explores Mixed Reality Headsets for Burn Casualty Care

Story by Paul Lagasse

Medical Research and Development Command

FORT DETRICK, Md. – In future large-scale combat operations, mass casualty events involving burns could pose challenges for critical care physicians due to a lack of burn beds and insufficient numbers of adequately trained personnel. Researchers at the Institute of Surgical Research Organ Support and Automation Technologies team, known as CRT3, and the ISR Clinical Burn Center are investigating the use of mixed reality tools as a medical force multiplier to reduce morbidity and mortality on the battlefield.

Threat assessment trends suggest an increasing potential for explosions capable of causing burn mass casualty incidents in combat scenarios as well as from attacks on civilian population centers. BMCIs can cause anywhere from tens to thousands of burn trauma casualties. Because burn care is among the most complex form of trauma, interventions require significant amounts of specially trained personnel and significant resources. Therefore, BMCIs would place significant stress on the military medical system both at the point of injury and at increasing echelons of care.

The anticipated austere environments of LSCO have medical planners and providers examining the logistical challenges in transporting resources to the point of injury and the evacuation of injured personnel to advanced care. Communications are also likely to be disrupted, both due to surge usage and damage to in situ infrastructure, hampering the ability to provide remote mentoring support to clinicians responding to the event. In such cases, medics will need every advantage possible to intervene in the critical early hours post-injury.

To help address this, the Virtual Health team within CRT3 led by Sena Mike, data scientist and principal investigator at ISR, is developing a clinical decision support system that uses commercial off-the-shelf augmented reality headsets and custom software, collectively called the Augmented Reality Burn Assist Manager. This CDSS delivers essential medical knowledge to novice clinicians, enabling them to perform the critical tasks involved in burn patient management and surgical guidance, resulting in higher adherence to the latest clinical practice guidelines while also lowering the clinician’s cognitive burden.

“Our task was to develop a tool that a medic could use to perform tasks that were out of the scope of their training and practice,” says Mike. “Basically, we wanted to develop a device that we could hand off to someone who has at least some clinical background and have them perform an assessment or complete a procedure using pictures, videos, texts, and holographic overlays that take them through each step.”

Tests Assess Usability for Assessing and Treating Burn Wounds

Mike’s AR project is part of a new portfolio established by the Defense Health Agency Research and Engineering’s Combat Casualty Care Research Portfolio. CCCRP supports research into the use of intelligent data-driven, semiautonomous, and autonomous technologies to optimize medical care for Service Members. With funding from CCCRP, Mike, retired Army Lt. Col. Maria Serio-Melvin, and a team of researchers conducted a series of studies to determine whether ARBAM enhanced a clinician’s ability to provide effective care to a simulated burn patient compared to current standard-of-care tools such as paper CPGs.

In the study, 11 participants were asked to perform four burn-related tasks, alternately using the Joint Trauma System CPGs with supplemental worksheets and the CRT3’s ARBAM system:

• Determine burn size
• Manage burn fluid resuscitation
• Calculate pain medication dosage
• Perform a simulated escharotomy

Participants were provided with a scripted scenario to ensure consistency, and they were assessed on their completion time and performance accuracy. Mike and her team found that the average completion times for three of the four tasks were generally the same, with fluid resuscitation being faster with ARBAM than with paper guides (4.7 minutes compared to 6.9 minutes). The overall performance scores with ARBAM were higher for three of the four tasks (fluid resuscitation, medicine dosage calculation, and escharotomy), meeting the threshold of statistical significance.

Following the completion of the study, the Virtual Health researchers undertook two usability assessments to gauge user interaction and experience with the system – for the assessments, renamed the Augmented Reality Surgical Assist Manager – while assisting surgeons with the performance of simulated cricothyrotomies and chest tube insertions. The overall positive feedback they received from the clinicians who tested the system was invaluable for identifying areas for improvement.

“The usability studies were important because no matter what device or application you give a clinician, if they do not accept it and don’t want to use it, they will abandon that technology,” says Mike. “Based off of the usability assessments, we were able to identify and prioritize gaps that the software needed to address prior to the final clinical performance study.”

The clinical performance studies compared the accuracy and efficiency of the AR system in the completion of those key tasks compared to existing guidance methods and determined whether the system can be developed and translated into a full-fledged clinical decision support system for providing remote patient care.

“When this technology first came out, we really didn’t know if people would find it too foreign or cumbersome, but people found it fascinating,” says Mike. “It has a coolness factor, like Iron Man – you can still see your environment, but yet you can manipulate all of these digital assets in front of you. I can see myself using this in the future.”

ARBAM Has Training Potential

In addition to providing burn patient management and surgical guidance, ARBAM also offers the potential to offer fully immersive burn education and training scenarios. Mike says that several of the clinicians who participated in the research study and the usability assessments commented that they learned a lot while operating the device. Although the ARBAM/ARSAM device currently does not incorporate the “why” of a task, she says it could feasibly be incorporated.

“The level of fidelity of the software for providing decision support, and the way we’ve been able to take multiple CPGs and turn them into easily usable, digestible chunks with language that is accessible to non-expert users, means that the device could be used to augment a didactic training program right now with very little to no change to the software,” says Maj. Angela Samosorn, Ph.D., ISR’s chief of clinical research support. “The system already incorporates many learning principles by design, as well as by virtue of how the team set up the research questions and the software and the studies.”

Samosorn says that limitations of currently available hardware make the prototype system difficult to operate in a battlefield setting, but that will change as future iterations of AR devices come on the market. In the meantime, the prototype can be used to familiarize medics and surgeons with the principles and methodology so that they will be comfortable with them when the hardware catches up.

Device Will be Tested at Project Convergence Capstone 5

The U.S. Army Futures Command has invited ISR to test the prototype ARBAM/ARSAM system at the Project Convergence Capstone 5 exercise to be held in the spring of 2025. The U.S. Army Futures and Concepts Center, a subordinate organization under AFC, conducts annual Project Convergence exercises as a way to provide front-line Warfighters from the Army, Navy, Air Force, Marine Corps, Space Force, and militaries from partner and allied countries with opportunities to experiment with emerging capabilities, formations and doctrines in real-world conditions. The system will be one of four technologies from MRDC that will be tested during the event.

ISR has three learning objectives that it hopes to meet from the testing at PC-C5. One is to determine which point in the survival chain of the Department of Defense Joint Trauma System that mixed-reality technology can be integrated most effectively for patient care. Another objective is to determine whether the operator’s performance and cognitive workload decreases when using the applications compared to standard tools when used in a high-fidelity simulation. Finally, the team seeks to identify software usability and issues that can be addressed in future software upgrades.

“We originally envisioned this project as a research effort, not necessarily to develop an advanced product,” says Mike. “However, through the process and validation of our research studies, we have a much higher technology readiness level than a lot of other research products. So, we feel confident that we are ready to showcase this at PC-C5 and at other demos and experimentation events.”

Mike also noted that, although the ARBAM/ARSAM project is still in the research phase, the Virtual Health team has its eye on eventual commercialization for fielding with military medical professionals.

“Virtual reality and AR are being used more and more widely in health care, and the FDA has already cleared several devices,” says Mike. “How soon we can get this into the hands of Warfighters to start saving people’s lives is yet to be determined, but in the meantime, even lower hanging fruit like transitioning this into a training application and getting it into other training labs would be a success in our eyes, for sure.”

NOTE: A version of this story was originally published in the Winter 2024/2025 issue of Combat & Casualty Care.