Trauma Research Unit, Department of Surgery, Erasmus University Medical Center, Rotterdam, Zuid-Holland 3015 GD, The Netherlands.
Department of Surgery, Alrijne Hospital, Leiderdorp, Zuid-Holland 2353 GA, The Netherlands.
Mil Med. 2024 Feb 27;189(3-4):e645-e651. doi: 10.1093/milmed/usad364.
INTRODUCTION: During tactical combat casualty care, life- and limb-saving procedures might also be performed by combat medics. This study assesses whether it is feasible to use a head-mounted display (HMD) to provide telemedicine (TM) support from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. MATERIALS AND METHODS: Nine combat medics were randomized into groups to perform a two-incision lower leg fasciotomy. One group used the Vuzix M400 and the second group used the RealWear HMT-1Z1. A third, control, group received no guidance. In the Vuzix M400 group and RealWear HMT-1Z1 group, a senior surgeon examined the results after the two-incision lower leg fasciotomy was finished to assess the release of compartments, possible collateral damage, and performance of the combat medics. In the control group, these results were examined by a surgical resident with expertise in two-incision lower leg fasciotomies. The resident's operative performance questionnaire was used to score the performance of the combat medics. The telehealth usability questionnaire was used to evaluate the usability of the HMDs as perceived by the combat medics. RESULTS: Combat medics using an HMD were considered competent in performing a two-incision lower leg fasciotomy (Vuzix: median 3 [range 0], RealWear: median 3 [range 1]). These combat medics had a significantly better score in their ability to adapt to anatomical variances compared to the control group (Vuzix: median 3 [range 0], RealWear: median 3 [range 0], control: median 1 [range 0]; P = .018). Combat medics using an HMD were faster than combat medics in the control group (Vuzix: mean 14:14 [SD 3:41], RealWear: mean 15:42 [SD 1:58], control: mean 17:45 [SD 2:02]; P = .340). The overall satisfaction with both HMDs was 5 out of 7 (Vuzix: median 5 [range 0], RealWear: median 5 [range 1]; P = .317). CONCLUSIONS: This study shows that it is feasible to use an HMD to provide TM support performance from a consulted senior surgeon for combat medics when performing a two-incision lower leg fasciotomy. The results of this study suggest that TM support might be useful for combat medics during tactical combat casualty care when performing life- and limb-saving procedures.
引言：在战术战斗伤员救治中，挽救生命和肢体的程序也可能由战斗医护人员执行。本研究评估了当战斗医护人员进行双切口小腿筋膜切开术时，使用头戴式显示器（HMD）为其提供咨询高级外科医生的远程医疗（TM）支持是否可行。
材料和方法：9 名战斗医护人员被随机分为两组，分别进行双切口小腿筋膜切开术。一组使用 Vuzix M400，另一组使用 RealWear HMT-1Z1。第三组，即对照组，未接受指导。在 Vuzix M400 组和 RealWear HMT-1Z1 组中，一名高级外科医生在完成双切口小腿筋膜切开术之后检查结果，以评估间隔释放情况、可能的附带损伤以及战斗医护人员的操作情况。在对照组中，一位具有双切口小腿筋膜切开术专业知识的外科住院医师检查了这些结果。使用手术操作性能调查问卷对战斗医护人员的操作表现进行评分。使用远程医疗可用性调查问卷评估战斗医护人员对 HMD 的可用性感知。
结果：使用 HMD 的战斗医护人员被认为能够胜任双切口小腿筋膜切开术（Vuzix：中位数 3 [范围 0]，RealWear：中位数 3 [范围 0]）。与对照组相比，这些战斗医护人员在适应解剖变异方面的能力得分显著更高（Vuzix：中位数 3 [范围 0]，RealWear：中位数 3 [范围 0]，对照组：中位数 1 [范围 0]；P = 0.018）。使用 HMD 的战斗医护人员比对照组的战斗医护人员更快（Vuzix：平均 14:14 [SD 3:41]，RealWear：平均 15:42 [SD 1:58]，对照组：平均 17:45 [SD 2:02]；P = 0.340）。对两种 HMD 的总体满意度均为 7 分中的 5 分（Vuzix：中位数 5 [范围 0]，RealWear：中位数 5 [范围 1]；P = 0.317）。
结论：本研究表明，使用 HMD 为战斗医护人员提供咨询高级外科医生的 TM 支持在进行双切口小腿筋膜切开术时是可行的。研究结果表明，在进行挽救生命和肢体的程序时，TM 支持可能对战术战斗伤员救治中的战斗医护人员有用。
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