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

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...

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Autores principales: Kirkpatrick, Andrew W., McKee, Ian A., Knudsen, Brian, Shelton, Ryan, LaPorta, Anthony J., Wachs, Juan, McKee, Jessica L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: CMA Impact Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8979653/
https://www.ncbi.nlm.nih.gov/pubmed/35365497
http://dx.doi.org/10.1503/cjs.009920
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author Kirkpatrick, Andrew W.
McKee, Ian A.
Knudsen, Brian
Shelton, Ryan
LaPorta, Anthony J.
Wachs, Juan
McKee, Jessica L.
author_facet Kirkpatrick, Andrew W.
McKee, Ian A.
Knudsen, Brian
Shelton, Ryan
LaPorta, Anthony J.
Wachs, Juan
McKee, Jessica L.
author_sort Kirkpatrick, Andrew W.
collection PubMed
description 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.
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spelling pubmed-89796532022-04-08 Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control Kirkpatrick, Andrew W. McKee, Ian A. Knudsen, Brian Shelton, Ryan LaPorta, Anthony J. Wachs, Juan McKee, Jessica L. Can J Surg Research 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. CMA Impact Inc. 2022-04-01 /pmc/articles/PMC8979653/ /pubmed/35365497 http://dx.doi.org/10.1503/cjs.009920 Text en © 2022 CMA Impact Inc. or its licensors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Research
Kirkpatrick, Andrew W.
McKee, Ian A.
Knudsen, Brian
Shelton, Ryan
LaPorta, Anthony J.
Wachs, Juan
McKee, Jessica L.
Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
title Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
title_full Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
title_fullStr Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
title_full_unstemmed Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
title_short Robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
title_sort robotically applied hemostatic clamping for care-under-fire: harnessing bomb robots for hemorrhage control
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8979653/
https://www.ncbi.nlm.nih.gov/pubmed/35365497
http://dx.doi.org/10.1503/cjs.009920
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