Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control

TeleMedical Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Departments of Surgery (Kirkpatrick, J.L. McKee) and Critical Care Medicine (Kirkpatrick), and the Trauma Service (Kirkpatrick, J.L. McKee), Foothills Medical Centre (Kirkpatrick, J.L. McKee), Calgary, Alta.; Canadian Forces Medical Services (Kirkpatrick); Edmonton Fire Department (I. McKee), Edmonton, Alta.; Arapahoe County Sheriff's Office (Knudsen), Centennial, Colo.; South Metro Fire Rescue (Shelton), Denver, Colo.; Rocky Vista School of Medicine (LaPorta), Parker, Colo.; Purdue University (Wachs), West Lafayette, Ind. andrew.kirkpatrick@ahs.ca. TeleMedical Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Departments of Surgery (Kirkpatrick, J.L. McKee) and Critical Care Medicine (Kirkpatrick), and the Trauma Service (Kirkpatrick, J.L. McKee), Foothills Medical Centre (Kirkpatrick, J.L. McKee), Calgary, Alta.; Canadian Forces Medical Services (Kirkpatrick); Edmonton Fire Department (I. McKee), Edmonton, Alta.; Arapahoe County Sheriff's Office (Knudsen), Centennial, Colo.; South Metro Fire Rescue (Shelton), Denver, Colo.; Rocky Vista School of Medicine (LaPorta), Parker, Colo.; Purdue University (Wachs), West Lafayette, Ind.

Canadian journal of surgery. Journal canadien de chirurgie. 2022;65(2):E242-e249

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PICO Summary

Population

Public safety bomb technicians (n= 4).

Intervention

Application of wound clamps with the heavy-duty bomb disposal Wolverine robot (n= 2).

Comparison

Application of wound clamps with the lightweight bomb disposal Dragon Runner robot (n= 2).

Outcome

There was complete cessation of simulated bleeding in 60% of applications consistently across all technicians and both robots. There was no difference in success rates with the two robots. However, there were differences in fluid loss and application time, with the Wolverine robot being faster and losing less fluid.
Abstract
BACKGROUND Early hemorrhage control after interpersonal violence is the most urgent requirement to preserve life and is now recognized as a responsibility of law enforcement. Although earlier entry of first responders is advocated, many shooting scenes remain unsafe for humans, necessitating first responses conducted by robots. Thus, robotic hemorrhage control warrants study as a care-under-fire treatment option. METHODS Two bomb disposal robots (Wolverine and Dragon Runner) were retrofitted with hemostatic wound clamps. The robots' ability to apply a wound clamp to a simulated extremity exsanguination while controlled by 4 experienced operators was tested. The operators were randomly assigned to perform 10 trials using 1 robot each. A third surveillance robot (Stair Climber) provided further visualization for the operators. We assessed the success rate of the application of the wound clamp to the simulated wound, the time to application of the wound clamp and the amount of fluid loss. We also assessed the operators' efforts to apply the wound clamp after an initial attempt was unsuccessful or after the wound clamp was dropped. RESULTS Remote robotic application of a wound clamp was demonstrated to be feasible, with complete cessation of simulated bleeding in 60% of applications. This finding was consistent across all operators and both robots. There was no difference in the success rates with the 2 robots (p = 1.00). However, there were differences in fluid loss (p = 0.004) and application time (p < 0.001), with the larger (Wolverine) robot being faster and losing less fluid. CONCLUSION Law enforcement tactical robots were consistently able to provide partial to complete hemorrhage control in a simulated extremity exsanguination. Consideration should be given to using this approach in care-under-fire and care-behind-the-barricade scenarios as well as further developing the technology and doctrine for robotic hemorrhage control.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine