APRIL 19, 2022 – Imagine a kitchen without a countertop or a garage without a space for its tools and nothing but the floor as a workspace. This is how Ground Surgical Teams have worked for years, but engineers from the 711th Human Performance Wing, part of the Air Force Research Laboratory, are addressing this issue. Two 711th HPW teams created a prototype of a more efficient workstation for clinicians to use in austere environments to significantly improve patient care.
“A GST is an expeditionary force that typically is deployed to a very austere environment to treat critical casualty patients and stabilize them for further definitive care,” said Dr. Gregory Burnett, lead engineer, product development branch, 711th HPW Airman Biosciences Division.
Accordingly, anything the GST needs for stabilizing patients must be brought with them, meaning these teams sometimes work with little to no resources, such as tables, hooks and other common equipment in austere environments.
Competition commences
While deployed to such an environment, Maj. Thomas Heering, 711th HPW austere anesthesia cadre for the GST, had an idea that later became a tangible product: a Tactical Anesthesia Workstation.
“This idea originated around when I was deployed in 2019-2020 to an austere surgical environment and we were taking care of trauma victims,” Heering said. “There was no way of organizing all of our equipment like the ventilator, suction and IVs in an efficient and safe manner. We were tripping over a lot of the things that we were trying to manipulate in order to care for the patient.”
Heering returned from his deployment and was stationed at the U.S. Air Force School of Aerospace Medicine, one of two mission units in the 711th HPW, where he began training anesthesia providers. When he noticed the same issues in the training environment, he realized the need to improve patient care.
“So I entered an idea to the Air Force Materiel Command’s Spark Tank competition,” he said.
The idea was recognized in the top five, and the semifinalists presented their ideas to a panel of leaders during the AFMC Senior Leader Conference in October 2021. While TAW was not chosen, senior leadership directed it through AFRL for engineering support where it flowed down to the Rapid Prototyping Cell, which is part of the product development branch within the 711th HPW’s Airman Biosciences Division.
Engineers’ creation
Heering’s initial idea was simple. He wanted an elevated area to easily access items.
“It made me really think, as a clinician, what sort of movements do I make, what sort of things do I need to achieve before inducing a patient with anesthesia before a procedure?” he said.
Working with the RPC team, Heering found improvement areas by asking himself various questions.
“What am I doing to hurt myself or potentially hurt the patient by taking my eyes off the table by bending down to adjust settings or look at medications?” Heering said. “Now I have a whole workspace. What does that do to improve my efficiency in drawing up the proper medications and having them readily available for the patient? These guys helped me realize by offering their engineering brain to my clinician brain.”
The team of engineers included three RPC engineers from the 711th HPW: 2nd Lt. Stevan Gallegos, special warfare mechanical engineer; 1st Lt. Hannah Lyness, special warfare mechanical engineer; and Peter Voland, a Ball Aerospace contractor; and Nathan Stover, the RPC tech lead. This collaboration between the GST cadre at USAFSAM and the RPC team rapidly produced three prototypes in one month and inserted them into the GST’s phase one training course at USAFSAM.
Heering’s work with the RPC team resulted in a prototype that exceeded the original request and met the goal of lifting everything off the ground to provide an efficient workstation.
The team incorporated unique ideas and techniques to make this rapid prototype.
“We used a lot of commercial off-the-shelf equipment (such as) tripods or other quick deploy mechanisms as the backbone for this structure,” Voland said, noting his team employed “laser cutting, as well as 3D printing, band saws and other common shop fabrication.”
While brainstorming, the team developed ideas for collapsible equipment and quick deployment, among other considerations.
“Some of the big capabilities of the TAW is all the medical equipment, either in the emergency room or operating room, is to elevate it to a viewable level instead of on the ground where they have to bend over and view the screens,” Gallegos said.
All three prototypes break down for travel and have extra table space, including areas to insert hooks, blood and IV bags, and places for all monitors. The TAW was created as a prepopulated unit allowing the providers to travel with the screens attached for easier set up.
While all three designs incorporate many unique features, one was the clear winner and was recommended to the GST pilot group for further consideration, Burnett said, noting that it “encapsulates the ease of use, the set up and the view-ability and utility of the equipment necessary during the ‘off the ground’ presentation of the equipment.”
Each prototype continues to undergo testing from stand-up to breakdown, and information is gathered throughout the GST training courses, which began in January.
Testing phase
After introducing the prototype to the GST training course, the students quickly learned its value in mimicking a hospital room and mitigating safety factors that arise when working on the floor with equipment in field-type spaces.
“If providers were to break something because someone trips over it, you are essentially putting the survivability of that casualty at risk,” Burnett said. “So, getting the (equipment) off the ground … is key.”
The TAW goes along with the existing process but includes the additional feature of lifting many of the necessary pieces of equipment off the ground.
In the GST training course, the cadre viewed the effects of adding one and two TAWs to the simulation.
“We saw the efficiency improve both on the operating room side as well as the triage side,” Heering said.
The prototype mimics the look of a U.S. operating room.
“When I bring a patient into a modern operating suite, I have everything I need in one space called the workstation, or the anesthesia workstation, so all of my monitors, anesthesia machine, volatile agents and medications … everything is there,” Heering said.
Overwhelmingly positive feedback
Heering said he was impressed by and proud of the RPC team’s ability to create such quality work in such a short time, allowing the prototype to be tested for the last few months.
“The feedback has been overwhelmingly positive immediately,” Heering said. “Some comments included, ‘I wouldn’t want to deploy without this’ and ‘this really enhanced my care for the patient.’”
During a GST training course, Maj. Adam Faltersack, an anesthesia element chief, 81st Surgical Operations Squadron, Keesler Air Force Base, Mississippi, echoed the same sentiments of the TAW.
“It takes away the need for two people to actually do my job so, if I am looking for someone to hand me things, I don’t need that extra person if I have a table to set things on,” Faltersack said. “I can quickly glance over at the monitor that’s right there and the IV pump that’s right there, I don’t have to worry about things falling over, so it’s a huge step up.”
The RPC team collectively agreed that creating this prototype and receiving the feedback has been gratifying.
“It’s definitely rewarding to be able to have an impact in something as important as casualty or patient care … I love that we could make an impact by helping advance an idea,” Voland said.
While the prototype is not yet a fully-manufactured device, the team appreciated being part of the creation.
“We are just helping bring this concept one step closer to that stage,” Voland added.
By Aleah M. Castrejon
Air Force Research Laboratory Public Affairs